A very good move is made by ESIC Dept has given approval for allowing ESI beneficiaries to seek medical services from the nearby empaneled hospital directly without a referral, in case of Non-availability of ESIC Health care i.e. Hospital/Dispensary/IMP, etc. within a radius of 10 KM of his/her residence
1. ESIC impaneled hospitals as per the following operational guidelines:-
2. ESI beneficiaries of those areas (newly as well as already implemented) where no ESIC/ESIS health care delivery facility i.e. hospital, dispensary, IMP, etc. exists within the radius of 10 KMs of IPs residence, shall be eligible.
3. ESI beneficiaries of such areas may approach the nearest ESIC impaneled hospital with an ESI card or print out of online Health Passbook or “ePehchaan The letter” issued by the employer for availing the required medical consultation.
4. Once the ESI beneficiary attends the impaneled hospital, the prima face verification regarding the identity of the beneficiary in terms of genuineness shall be ascertained by the impaneled Hospital after cross verifying with the Aadhaar card or any Govt. issued photo I Card. Additionally, the eligibility shall be verified through the UTI application by feeding in the IP Number. UTI portal has been integrated with the Panchdeep Module of ESIC. This verification shall be done by the person authorized by the impaneled hospital for such purpose.
5. Once the OPD consultation of the beneficiary is carried out, the impaneled hospital shall upload the photo of the IP / beneficiary and photocopy of the Aadhaar on the UTI portal along with the bill raised at the CGHS rate. Further, as and when Aadhaar is implemented, an Aadhaar based online verification system shall be devised and incorporated into the system.
Such Beneficiaries may seek reimbursement of purchased medicines prescribed during OPD consultation through the nearest DCBO or Regional office where DCBO is not available. Further, an online system shall be developed in due course for the processing and settlement of such reimbursement claims.
( This means Once u take the treatment from the nearest nearby empaneled hospital and as the medicines & the treatment cost which is spent will be reimbursed at the CGHS rate as defined )
COURTESY: PRAKASH CONSULTANCY SERVICES