ESIC beneficiaries can avail health services in private hospitals: Know types of facilities allowed and not allowed

New Delhi: The Employees' State Insurance Corporation (ESIC) on has now allowed its beneficiaries to avail health services directly in any nearby private hospital in case of emergency.

As per the existing practice, the insured persons and beneficiaries (family members) are required to go to an ESIC dispensary or hospital to obtain referral for hospitalisation in empanelled as well as non-empanelled private hospitals.

What is the difference in facilities that ESIC subscribers can avail?

ESIC subscribers would be able to visit empanelled as well as non-empanelled private hospitals for emergency treatment. However, the only difference is that treatment will be cash-less in the empanelled private hospitals. There would be reimbursement as per Central Government Health Services (CGHS) rates in non-empanelled private hospitals.

What is the criteria for getting health services directly in any nearby private hospital?

Subscribers are allowed to get health services in non-empanelled private hospitals in case there is no ESIC or empanelled private hospital within 10 km range without the need for referral from an ESI dispensary or hospital.  

In such cases if admission for indoor treatment is required, the empanelled hospital will obtain time bound permission from the ESI approving authority through an online system. 

Super speciality services in cardiology including nephrology, urology and oncology will be strengthened in select ESIC hospitals in Delhi/NCR and this will be extended to other ESIC hospitals across the country in a phased manner.

ESIC will engage Hospital Managers with specialisation in hospital management or hospital administration or health care administration for maintenance, housekeeping, patient assistance, patient safety and other ancillary activities in ESIC hospitals across the country.

ESIC will also  engage the services of project management consultant for monitoring and facilitating execution of hospital and dispensary construction projects of ESIC from the stage of concept plan to the commissioning of the project.

ESIC has around 26 under-construction hospitals and 16 at the conceptual stage. The states run 110 hospitals for which the ESIC pays service charges. They would continue services as per the existing arrangement.