ESIC Claim in Private Hospital

Can covid-19 pandemic be claimed under ESIC after treatment done by employee in private hospital…

2 Likes

1. Whether Covid-19 sickness covered under ESI?

ESIC has not specifically come up with notification stating whether treatment for Covid-19 is covered under ESIC or not.

However, various queries were raised with the ESI authorities regarding the same, and some officials which are reliable sources have informed that, **definition of sickness under ESIC does not specifically exclude Covid-19 and hence it is implied that treatment of covid-19 will be covered under ESI Act.

Further, ESIC has dedicated few of its hospitals and have also set up laboratories for Covid-19 treatment.

Stakeholders are requested to confirm this point from ESIC authorities or take second opinion as there is no official notification from ESI Corporation as on date of this article.

2. ESIC allows non-Covid medical services from tie-up hospitals

ESIC beneficiaries may now avail non-covid medical services including emergency and non-emergency through tie-up hospitals during the period for which concerned ESIC hospital functions as dedicated Covid-19 hospital.

ESI beneficiaries can be referred to tie-up hospitals for providing prescribed secondary/SST consultation/ admission / investigation during the period for which concerned ESIC hospital functions as dedicated Covid-19 hospital.

This service can be availed directly without referral letter.

All treatment / procedure will be given in ESIC tie-up hospitals even if there is no ESI tie-up for any specific treatment / procedure.

3. ESIC hospitals where medical services were earlier curtailed resume to work

Medical services from ESIC Hospitals which are designated to provide Covid treatment and where medical services were earlier curtailed in view of corona pandemic resume t work w.e.f 5th May 2020. The social distancing norms and safety precautions will be observed as per instructions of Government of India.

4. ESIC allows Insured Persons to purchase medicines from private chemist during the lock down

In order to ease out the hardship of ESI beneficiaries in this tough time, ESIC has allowed the purchase of medicines by beneficiaries from private chemists during the lockdown period and its subsequent reimbursement by ESIC.se medicines from private chemist during the lock down

In order to ease out the hardship of ESI beneficiaries in this tough time, ESIC has allowed the purchase of medicines by beneficiaries from private chemists during the lockdown period and its subsequent reimbursement by ESIC.

2 Likes

Hi @Akila

As mandated by the ESI Act, treatment has to be taken only from the ESIC hospitals or dispensaries. However, in case of emergency, if the treatment is taken from a private hospital, you can raise a claim with the ESIC subject to ESIC approval.

1 Like
Powered by | India's No.1 Payroll and HR Software.
9000+ Clients
150 Cities
10 Lakh+ Users