MEDICAL BENEFIT

>> What is Medical Benefit? 

Medical benefit means the medical attendance and treatment to the insured persons covered under the Act and their families as and when needed. This is the only benefit provided in kind through the State Governments (except in Delhi), and uniform to all as per their requirement without linking it to their wages and contributions. 

>> What is the scale of Medical Benefit?

Full range of Medical, surgical & obstetric Treatment consisting of out-door treatment, in-patient treatment, supply of all drugs and dressings, pathological and radiological investigations, pre-natal and post-natal care super specialty consultation & treatment, ambulance services, provision of artificial appliances etc. 

>> How long is Medical benefit available? 

The insured person and his family are entitled to the Medical Benefit from the very first day of his/her joining the insurable employment. A person who is covered under the scheme for the first time is eligible for medical care for self and family for three months. If he/she continues in insurable employment for three months or more, the benefit is admissible till the beginning of the corresponding benefit period. If contributions were paid/ payable for not less than 78 days in the said contribution period, medical benefit is admissible till the end of the corresponding benefit period. If the Insured person is In ESI coverage for at least 2 years, and contributed for not les than 156 days, and is suffering from any of the 34 specified long term diseases, the medical benefit is admissible till the incapacity lasts or for a period of 3years for self and family. 

>> How a temporary or casual employee who works for 3 or 4 days and leaves the employment is entitled to  the medical care? 

If he leaves the employment before his registration process is completed, the employer may provide him with a 'certificate of employment' consisting of his date of employment, date of leaving, family particulars etc. in form ESIC-86. Based on this certificate that person and his family can avail ‘medical benefit' forr a period of 3 months. 

>> If the insured person's family is residing in another place in the same State or another State, how the family can avail the medical benefit? 

"the family is residing in any other place either in the same State or different State, based on the declaration of the insured person and certified by the employer, the family is provided with a 'family identity card' for receiving medical benefit from ESI Dispensary in the area in which it is residing. After IT rollout, the 'Family' is issued a separate 'smart card'. By producing this smart card, the family can avail the medical benefit from any ESI Dispensary/ Hospital either at their place of residence or in any other part of the country. 

>> How to get medical benefit when an Insured person is leaving for another station for a temporary period? 

While leaving the station, the insured person may obtain a certificate of employment from his employer in ESIG-105, and carry the same with him along with his identity card. 

Based on this, the insured person can avail the medical benefit in any ESI Dispensary/Hospital across the country. After the introduction of IT rollout, 'Pehchan Card' for self and family is being issued. With this, the insured person and his family can avail the 'medical benefit' in any ESI Dispensary/ Hospital throughout the country.