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Wednesday, June 19, 2019

FOR SUPER SPECIALITY TREATMENT TO TIE-UP HOSPITALS AND EXPENDITURE TO BE INCURRED BY EMPLOYEES’ STATE INSURANCE CORPORATION DIRECTLY



In the Employees’ State Insurance (General) Regulations, 1950, a new Regulations 96C shall be inserted as under : 

REGULATION 96C
REFERRAL FOR SUPER SPECIALITY TREATMENT TO TIE-UP HOSPITALS AND
EXPENDITURE TO BE INCURRED BY EMPLOYEES’ STATE INSURANCE
CORPORATION DIRECTLY

Subject to the provisions of the Act and the Regulations, the Corporation or State Government may refer a beneficiary to any tie-up arranged medical facilities, where cost of such facility is borne directly by the Corporation and where the fund permits.

1.An Insured Person should have completed a minimum of six months of insurable employment from the date of registration and have contributed not less than seventy eight (78) days in the relevant contribution period including in which registration was made. However, where the facility has been extended to his family members, an Insured Person should have completed a minimum of one year of insurable employment and have contributed for not less than seventy eight (78) days in each of the two (2) contribution period and such benefit shall be available to an Insured Person or a beneficiary in the corresponding benefit period.


2. Provided further that an Insured Person with employment injury or Insured Woman with complications arising out of maternity or those in receipt of extended sickness benefit under the Act shall be eligible as per the relevant contributory conditions and in case of family of extended sickness beneficiaries, they shall also be eligible as long as the benefit period corresponding to contribution period covered in extended sickness by more than half of the contribution period.

Notification:- 👉ESIC Amendment on Superspeciality




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