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Medical Benefits
Eligibility: An Insured Person and his family members become entitled to medical care from the date he enters the insurable employment and the entitlement continues so long as the insured person is in insurable employment or is qualified to claim sickness, maternity or disablement benefit.
The entitlement to medical care is extended upto two years to persons suffering from 34 specified chronic or long term diseases. Medical treatment to persons, who go out of coverage during the period of treatment, is not discontinued till the spell of sickness ends.
The scheme provides for a comprehensive medical cover to the retired and disabled insured persons and their spouses on payment of a nominal sum of Rs. 120/- per annum per couple. The scheme, thus, offers total medical cover to the retired and disabled without any upper ceiling of expenditure at the lowest premium when compared with medical cover schemes introduced by some other insurance agencies.

Benefit: All Insured Persons and members of their families are entitled to full and comprehensive medical care package consisting of:
  • Outpatient treatment
  • Domiciliary Treatment (treatment by visits at their residences)
  • Specialist consultation;
  • In patient treatment;
  • Free supply of drugs, dressings, artificial limbs, aids and appliances;
  • X-ray and laboratory investigations;
  • Vaccination and preventive inoculations;
  • Ante-natal care, confinement and post-natal care;
  • Ambulance service or conveyance charges for going to hospitals, diagnostic centers, etc. wherever admissible;
  • Family welfare services and other national health programme services;
  • Medical certification
  • Special provisions including super-specialist facilities.
With a view to ensuring that the medical facilities are of the required standard, the ESI Corporation has appointed medical experts such as Medical Referees and the Senior State Medical Commissioners who conduct periodic inspections of dispensaries, hospitals and panel clinics. There is also a high powered committee known as General Purposes Medical Sub-Committee of the E.S.I. Corporation comprising representatives of parliament, employers, employees, medical profession, State Governments. and the E.S.I. Corporation, that visits E.S.I. institutions periodically and holds meetings with the representatives of employers, employees and the State Govt., to advise and suggest measures for improving the medical services under the Scheme.

Claim procedure: For availing the medical facility for self or any of the declared dependants an insured person has to produce the temporary identification certificate issued by the ESIC Branch Office on taking insurable employment. This temporary identity certificate is thereafter replaced with a family photo identity card that carries the photographs and other particulars of the family member and the insured person. Failure to obtain the permanent card or its non production at dispensary/hospital can result in deprivation of medical care.
It is also to be borne in mind that dispensary is the base point for availing medical facilities. The reference for specialist treatment of diagnostic investigations is made by the ESI dispensary itself to the concerned hospital. It is only in extreme emergency or at odd hours when the dispensary is closed that the insured person/dependant can report at the Emergency Deptt. of an ESI hospital directly but should not fail to produce his/her photo identity card.
All medicines are issued free of cost by the dispensary to which an IP is attached. However, in case of non-availability of prescribed drugs at the hospital/dispensary an insured person can purchase the medicines from local market if so advised and submit such claim to the dispensary for reimbursement.