Dear all,
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 empanelled hospitals as per 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 nearest ESIC impaneled hospital with 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 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 impanelled hospital for such purpose.
5. Once
OPD consultation of the beneficiary is carried out, the impanelled h
ospital shall upload
the photo of IP
/ beneficiary and photocopy of Aadhaar on UTI portal along with bill raised at 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 nearest DCBO or
Regional office where DCBO is
not available. Further, an online system shall
be developed in due course for 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 )