ESIC to cover beneficiaries’ costs at empanelled hospitals in areas lacking its own facilities

The Employees State Insurance Corporation (ESIC) has said that it will bear all expenses for consultation, investigation and admission for insured persons and their dependents at an empanelled hospital if the ESIC’s own healthcare facility is not available within a 10-km radius of the beneficiary’s residence.

“In cases where investigation or admission for indoor treatment is required, the empanelled hospital will obtain the permission from the ESI approving authority through an online system within 24 hours and provide cashless treatment to the beneficiary,” the ESIC said in a statement.

As of March 2018, ESIC had around 13 crore beneficiaries eligible to avail ESI benefits.

For getting cashless outpatient department (OPD) services from such empanelled hospitals, the beneficiary has to carry the ESI e-pehchan card or health passbook along with Aadhaar or any government-issued identity card.

“Such beneficiaries may seek reimbursement of purchased medicines prescribed during OPD consultation through nearest dispensary-cum-branch office (DCBO) or regional office of the ESIC where DCBO is not available,” it said.

ESIC said efforts are constantly being made to strengthen the ESI medical care infrastructure in the vicinity of beneficiaries’ residences, as there has been a sizeable increase in the number of ESI beneficiaries after the expansion of ESI scheme in newer areas.

“To ease the hardship being faced by ESI beneficiaries in availing medical services in case of non-availability of ESIC’s health care infrastructure such as hospital or dispensary or insured medical practitioner within a radius of 10 km of their residences, such ESI beneficiary can now avail medical care services from nearby ESI empanelled hospitals (pan-India) without the need for any referral from ESI dispensary or hospital,” it said.