From April 1, the Employees State Insurance Corporation (ESIC) plans to provide super speciality treatment to retired insured persons (IPs), with a ceiling of ₹10 lakh a year.
“The retired IPs and their spouses are getting in-house medical facility benefit on payment of ₹120 per anum. Now, the Corporation has approved in principle, extending the facility of super speciality treatment (SST) to retired IPs”, subject to some eligibility conditions, ESIC said in a release. This was decided at a ESIC recent meeting in Kochi.
The ESIC said the “option to join shall be one time on retirement (under Rule 61). No enrolment shall be allowed thereafter.” The“ceiling of expenditure on SST/all referrals to tie-up hospitals in a financial year may be restricted to ₹10,00,000.”
On the hike in premium, it said: “The actuary has made a rough assessment of ₹1,700/month for ₹10 lakh cover to retired member and spouse for SST. However, monthly contribution to be paid to avail SST along with medical benefits by retired IPs will be decided later by the Ministry of Labour & Employment. This facility is likely to be made available w.e.f. 01.04.2017.”
Under the norms, only the IP and his/her spouse shall be eligible for treatment; a retired IP who has opted out at any time after retirement shall not be eligible to rejoin on any subsequent date; IPs already retired but not enrolled so far may be given a one time opportunity to join the scheme within three months.
However, they shall be eligible for SST only after six months.