I am providing general information related to the topic. In case of any particular information, your employer should be your first point of contact. You may contact your ESI Dispensary for assistance and further procedure. You can also call a toll-free/help desk number 1800112526 referring to your ESIC card number, or check out the link below for any related assistance: [https://www.esic.nic.in/reimbursement](https://www.esic.nic.in/reimbursement).
In case you have visited any super specialty hospital or any other hospital in case of a medical emergency, a list of types of cases for which reimbursement is permitted is given below:
- Reimbursement is permissible in case of failure of the mobile dispensary van due to technical defects or otherwise to adhere to its schedule timings, or where IP attached to such a dispensary sustained serious injuries or suffered from serious illness during off hours of the dispensary.
- IPs and their family members had to resort to private treatment during the off hours of ESI dispensary/Emergency Centre due to unavoidable circumstances.
- Medicines prescribed by IMO/Specialist were out of stock in the ESI Dispensary/Approved Chemist, thereby compelling the IPs to make purchases from the market.
- Medicines prescribed by Specialist and not provided by the IMO/IMP, and where the specialist considered such special medicines absolutely necessary for the treatment of the beneficiaries as no substitute medicine was considered equally efficacious, whether as an outpatient or inpatient.
- Special appliances prescribed by Specialist such as Spinal supports, Cervical Collars, Walking Callipers, and Crutches, etc., if considered necessary as part of the treatment.
- Where an IMO/IMP failed to make a domiciliary visit requested by an IP, thereby compelling the IP to make private arrangements for treatment. Under the panel system, such cost is recoverable from the IMP if recommended after investigation by the Medical Service Committee.
Serious cases of accident or illness admitted directly into recognized hospitals where owing to the clinical condition of the patient, being unconscious or otherwise, it was not possible to reveal his identity as an ESI patient and the hospital authorities recovered hospital expenses directly from the patient or the employer.
Serious cases of accident/illness where a beneficiary was admitted directly to a private hospital or in a non-recognized hospital where admission in a hospital recognized under the scheme would have seriously jeopardized his health like sudden heart attacks, fracture of the spine, cerebral hemorrhage, etc.
Expenditure incurred on investigation for blood transfusion. Mental cases that may have incurred expenditure either as an outpatient on specialized therapy such as ECT, etc. Serious cases of accident and illness admitted to recognized hospitals where all the reserved ESI beds were occupied.
Reimbursement of conveyance charges incurred by IP where an ambulance or any other transport under the scheme is not available owing to some reason or the other, and where in the opinion of the IMO/IMP such a patient was non-ambulatory. In respect of specialized examination, laboratory tests, X-ray, other imaging services, etc., recommended by a specialist, but where the IP either due to the breakdown in the machinery or where the nature of the examination of the Laboratory Tests was such that it was beyond the scope of the facilities available in the recognized laboratory/hospital.
In addition to the above types of cases, reimbursement may also be allowed in other cases depending upon the merits of each case and the circumstances under which expenditure was incurred.
Reimbursement of Conveyance Charges: In the absence of availability of an ambulance and where needed in an emergency, any other quick form of transport may be used and the amount spent, subject to the maximum rate prescribed by the Government/Transport authority (both ways), is reimbursed to IPs. To avoid hardship to IP and his family who have to go to any hospital or medical institution for admission, specialist consultation, or investigation, but whose condition is not such as to need an ambulance, provision has been made for the payment of conveyance charges if the hospital/medical institution to which the case is referred is at an out-station or is at a distance of more than 8 kms from the ESI Dispensary or the clinic of the panel doctor. The charges are restricted to actual IInd class railway fare or cost of a single seat in public conveyance both ways, whichever is feasible. If the beneficiary is not in a fit condition to travel without an escort, for reasons to be recorded and so certified by IMO/IMP, the conveyance charges are also allowed for an escort.
The IMO/IMP should keep a separate account of such payments in the prescribed Register and send a quarterly statement of this expenditure to the Director/AMO by the 15th of the month following the quarter ending in March, June, Sept. and December. The returns received from different areas in the State may be consolidated area-wise by the Director/AMO and a quarterly statement sent to the Corporation.
The expenditure on conveyance charges forms part of the Medical Care under the E.S.I. Scheme and hence sharable between the Corporation and the State Government in the usual ratio within the ceiling prescribed.
I hope this information will be helpful for those who are trying to find some financial aid under the ESI scheme after a critical medical situation. Good luck.
From India, Mumbai
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3In case you have visited any super specialty hospital or any other hospital in case of a medical emergency, a list of types of cases for which reimbursement is permitted is given below:
- Reimbursement is permissible in case of failure of the mobile dispensary van due to technical defects or otherwise to adhere to its schedule timings, or where IP attached to such a dispensary sustained serious injuries or suffered from serious illness during off hours of the dispensary.
- IPs and their family members had to resort to private treatment during the off hours of ESI dispensary/Emergency Centre due to unavoidable circumstances.
- Medicines prescribed by IMO/Specialist were out of stock in the ESI Dispensary/Approved Chemist, thereby compelling the IPs to make purchases from the market.
- Medicines prescribed by Specialist and not provided by the IMO/IMP, and where the specialist considered such special medicines absolutely necessary for the treatment of the beneficiaries as no substitute medicine was considered equally efficacious, whether as an outpatient or inpatient.
- Special appliances prescribed by Specialist such as Spinal supports, Cervical Collars, Walking Callipers, and Crutches, etc., if considered necessary as part of the treatment.
- Where an IMO/IMP failed to make a domiciliary visit requested by an IP, thereby compelling the IP to make private arrangements for treatment. Under the panel system, such cost is recoverable from the IMP if recommended after investigation by the Medical Service Committee.
Serious cases of accident or illness admitted directly into recognized hospitals where owing to the clinical condition of the patient, being unconscious or otherwise, it was not possible to reveal his identity as an ESI patient and the hospital authorities recovered hospital expenses directly from the patient or the employer.
Serious cases of accident/illness where a beneficiary was admitted directly to a private hospital or in a non-recognized hospital where admission in a hospital recognized under the scheme would have seriously jeopardized his health like sudden heart attacks, fracture of the spine, cerebral hemorrhage, etc.
Expenditure incurred on investigation for blood transfusion. Mental cases that may have incurred expenditure either as an outpatient on specialized therapy such as ECT, etc. Serious cases of accident and illness admitted to recognized hospitals where all the reserved ESI beds were occupied.
Reimbursement of conveyance charges incurred by IP where an ambulance or any other transport under the scheme is not available owing to some reason or the other, and where in the opinion of the IMO/IMP such a patient was non-ambulatory. In respect of specialized examination, laboratory tests, X-ray, other imaging services, etc., recommended by a specialist, but where the IP either due to the breakdown in the machinery or where the nature of the examination of the Laboratory Tests was such that it was beyond the scope of the facilities available in the recognized laboratory/hospital.
In addition to the above types of cases, reimbursement may also be allowed in other cases depending upon the merits of each case and the circumstances under which expenditure was incurred.
Reimbursement of Conveyance Charges: In the absence of availability of an ambulance and where needed in an emergency, any other quick form of transport may be used and the amount spent, subject to the maximum rate prescribed by the Government/Transport authority (both ways), is reimbursed to IPs. To avoid hardship to IP and his family who have to go to any hospital or medical institution for admission, specialist consultation, or investigation, but whose condition is not such as to need an ambulance, provision has been made for the payment of conveyance charges if the hospital/medical institution to which the case is referred is at an out-station or is at a distance of more than 8 kms from the ESI Dispensary or the clinic of the panel doctor. The charges are restricted to actual IInd class railway fare or cost of a single seat in public conveyance both ways, whichever is feasible. If the beneficiary is not in a fit condition to travel without an escort, for reasons to be recorded and so certified by IMO/IMP, the conveyance charges are also allowed for an escort.
The IMO/IMP should keep a separate account of such payments in the prescribed Register and send a quarterly statement of this expenditure to the Director/AMO by the 15th of the month following the quarter ending in March, June, Sept. and December. The returns received from different areas in the State may be consolidated area-wise by the Director/AMO and a quarterly statement sent to the Corporation.
The expenditure on conveyance charges forms part of the Medical Care under the E.S.I. Scheme and hence sharable between the Corporation and the State Government in the usual ratio within the ceiling prescribed.
I hope this information will be helpful for those who are trying to find some financial aid under the ESI scheme after a critical medical situation. Good luck.
From India, Mumbai
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Dear User,
Sure, I understand your query and here's a detailed and practical answer to it:
If you are an Insured Person (IP) under the ESIC scheme, you are eligible for reimbursement in certain cases. Here are some of them:
🚵If the mobile dispensary van fails to adhere to its scheduled timings, reimbursement is permissible.
🚵If you or your family members had to resort to private treatment during the off hours of the ESI dispensary or emergency centre due to unavoidable circumstances.
🚵If medicines prescribed by IMO/Specialist were out of stock in the ESI Dispensary and you had to purchase them from the market.
🚵If special appliances prescribed by a Specialist such as spinal supports, cervical collars, walking callipers, etc., are considered necessary as part of the treatment.
🚵If an IMO fails to make a domiciliary visit, you can claim the cost of private arrangements for treatment.
In cases of emergencies, there are specific scenarios where you can claim reimbursements:
🚵If you are admitted directly into recognized hospitals where it was not possible to reveal your identity as an ESI patient and hospital expenses were recovered directly from you.
🚵In case of serious accidents or illness where you are admitted directly to a private hospital or a non-recognized hospital.
There are also provisions for reimbursement of conveyance charges:
🚵If an ambulance was not available and you had to resort to a quick form of transport.
🚵If you had to travel to any hospital or medical institution for admission, specialist consultation, or investigation and it was at a distance of more than 8 km from the ESI Dispensary.
Each case is reviewed independently, and depending on the merits of each case, reimbursement may be allowed.
Here is a step-by-step guide to apply for reimbursement:
1️⃣ Visit the official ESIC website at: https://www.esic.nic.in/reimbursement
2️⃣ Navigate to the 'Reimbursement' section.
3️⃣ Fill out the necessary details and follow the instructions on the webpage.
For further assistance, you can contact your ESI Dispensary or call the toll-free help desk number 1800112526 with your ESIC card number.
Hope this information helps. Stay safe!
Best, [Your Name]
From India, Gurugram
Acknowledge(0)Amend(0)
Sure, I understand your query and here's a detailed and practical answer to it:
If you are an Insured Person (IP) under the ESIC scheme, you are eligible for reimbursement in certain cases. Here are some of them:
🚵If the mobile dispensary van fails to adhere to its scheduled timings, reimbursement is permissible.
🚵If you or your family members had to resort to private treatment during the off hours of the ESI dispensary or emergency centre due to unavoidable circumstances.
🚵If medicines prescribed by IMO/Specialist were out of stock in the ESI Dispensary and you had to purchase them from the market.
🚵If special appliances prescribed by a Specialist such as spinal supports, cervical collars, walking callipers, etc., are considered necessary as part of the treatment.
🚵If an IMO fails to make a domiciliary visit, you can claim the cost of private arrangements for treatment.
In cases of emergencies, there are specific scenarios where you can claim reimbursements:
🚵If you are admitted directly into recognized hospitals where it was not possible to reveal your identity as an ESI patient and hospital expenses were recovered directly from you.
🚵In case of serious accidents or illness where you are admitted directly to a private hospital or a non-recognized hospital.
There are also provisions for reimbursement of conveyance charges:
🚵If an ambulance was not available and you had to resort to a quick form of transport.
🚵If you had to travel to any hospital or medical institution for admission, specialist consultation, or investigation and it was at a distance of more than 8 km from the ESI Dispensary.
Each case is reviewed independently, and depending on the merits of each case, reimbursement may be allowed.
Here is a step-by-step guide to apply for reimbursement:
1️⃣ Visit the official ESIC website at: https://www.esic.nic.in/reimbursement
2️⃣ Navigate to the 'Reimbursement' section.
3️⃣ Fill out the necessary details and follow the instructions on the webpage.
For further assistance, you can contact your ESI Dispensary or call the toll-free help desk number 1800112526 with your ESIC card number.
Hope this information helps. Stay safe!
Best, [Your Name]
From India, Gurugram
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