ESI Beneficiaries to get Medical Services from the nearby empaneled hospital directly

Employees State Insurance Corporation has released a circular dated 17th February 2021 regarding ESI Beneficiaries to get Medical Services from the nearby impaneled private hospital directly without a referral.

Here are the details of the ESI circular regarding this circular :

In case of non-availability of Employees State Insurance Corporation Hospital or dispensary within a radius of 10 km of housing, the beneficiaries will be provided medical care facility from empaneled hospitals nearest to the Employees State Insurance Corporation.

Considering the increase in the number of Employees State Insurance Beneficiaries after the expansion of the Employees State Insurance Scheme in the new geographical areas, strengthening the medical care infrastructure by the Employees State Insurance Corporation to provide better medical services around the residence of the beneficiaries. Constant efforts are being made for

With a view to overcome the difficulties faced by the beneficiaries due to the non-availability of medical care infrastructure of the Employees State Insurance Corporation ie hospital or dispensary or insurance medical practitioner etc., within the radius of 10 kilometers of housing, the Employees State Insurance Beneficiaries are now Employees State Insurance Employees without a referral from a dispensary or hospital can avail cashless medical care services from empaneled hospitals nearest to the State Insurance Corporation.

In order to avail medical services in such areas, the Employees State Insurance Beneficiary Aadhaar along with the Government-issued ID Card / Employee State Insurance e-Identity Card / Health Passbook can go to the Employees State Insurance Empaneled Hospital and cashless Medicare for OPD services. Can be consulted. OPD consultation through the Regional Office nearest dispensary cum branch office (DCBO) or where dispensary cum branch office (DCBO) of such beneficiary employees State Insurance Corporation is not available You can also get reimbursement for the purchase of medicines written during.

In case of examination or admission for admitted patient treatment, the designated hospital will obtain permission from the Employees State Insurance Approval Authority through the online system within 24 hours and provide cashless treatment to the beneficiary. A copy of the guidelines issued by Headquarters, Employees State Insurance Corporation is available on the website www.esic.nic.in.

Read the official Circular of ESI Beneficiaries to get Medical Services from the nearby empaneled hospital directly without a referral

Source : https://www.esic.nic.in
Source : https://www.esic.nic.in

Process Flow Chart To Get Benefit on ESI Beneficiaries Seeking Medical Services From Nearby ESIC Empaneled Hospital

  1. Such beneficiary reports at nearest ESIC impaneled hospital for availing medical service without a referral from ESI dispensary/IMP etc.
  2. Cross-verification regarding the genuineness of identity by an authorized person of impaneled Hospital with ESL card /ePehchaan Letter/Health Passbook along with Aadhaar or any other Government-issued photo Identity card.
  3. Eligibility checked through the appropriate field of UTI module linked to ‘Panchdeep’ module of ESIC.
  4. Beneficiary provided with OPD Consultation by the impaneled hospital.
  5. Photo and Aadhaar uploaded on UTI portal along with consultation bill following all UTI portal/ESIC process validation.
  6. Reimbursement of prescribed medicines from nearest DCBO or Regional office if DCBO is not available on bill submission by IP
  7. In case the patient requires investigations, hospitalization, online permission to be obtained by the impaneled hospital within 24 hours from the nearest ESIC approving authority as per existing ESIC guidelines for direct admission in Emergency.
Source : https://www.esic.nic.in

Read the official Circular in Hindi of ESI Beneficiaries to get Medical Services from the nearby empaneled hospital directly without a referral

In The Last

This ESI circular will give benefit to those IP who are living in such places were in the radius of 10 Km or more no ESI dispensary or Hospitals available. Now they will get benefited from it.

Also Read Article : Know All about ESI Benefits

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