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Medical
Benefit
Super
speciality treatment
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Procedure to be followed by the
ESI beneficiaries to avail Super
speciality medical treatment |
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The insured person shall approach the ESI Dispensary to which he/she is
attached, and the Medical Officer shall issue a referral letter to the IP to
approach the concerned empanelled medical institution.
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If the IP/beneficiary
need medical attention during the non working hours of the concerned ESI
Dispensary, they may directly approach the nearest ESI Hospital for getting
referral letter. If there is no ESI Hospital situation nearer to the IP’s
place of living, the IP shall approach the nearest Govt. Hospital for
getting referral letter.
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In the case of an
emergency the IP/beneficiary can get Medical attention just by producing
his/her ESI identity card at the designated private medical institution,
shall produce necessary referral letter and other relevant documents within
48 hours. (If any case referral letter is a must to avail treatment under
package deal
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The IP/beneficiary shall
produce the referral letter along with the ESI Identity Card at the
designated private medical institution and avail the treatment without
paying any amount from out of his/her pocket. However any facility, other
than the items included in the package deal shall be borne by the
IP/beneficiary.
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While referring the
IP/beneficiary to the concerned Empanelled Medical institution, Medical
Officer incharge has to verify whether the IP/beneficiary is eligible for
treatment.
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The IP shall produce all
the relevant documents demanded by
the designated hospital and extend his/her co-operation to the hospital
authorities.
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The designated hospital
after imparting treatment to the IP/beneficiary shall raise the claim bill
directly to the Directorate where it will be settled.
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