TYPE OF MEDICAL BENEFITS PROVIDED UNDER ESI SCHEME

Updated on : 2020-Nov-26 13:17:22 | Author :

Type of Medical Benefits provided under the ESI Scheme

The Employees’ State Insurance scheme provides full treatment within the shape of medical attending, treatment, medication and injections, specialist consultation, and hospitalization to Insured Persons and additionally to their dependents.

Medical profit is on the market to an mortal and dependants from the day of entry into insured employment. A large infrastructure comprising Hospitals, Dispensaries, annexes, Specialist center, Model Dispensaries- cum- Diagnostic Centre (MDDC)IMP clinics, and arrangements with utterly completely different health establishments is providing treatment to beneficiaries. The vary of medical services provided covers preventive, promotive, curative, and rehabilitative services. Insured Persons and their families are being provided full medical care which includes outpatient/ inpatient and specialized medical care, drugs and dressings as per the requirement of the patient.

 

1. Outpatient medical aid through the service system and panel system

 

The out-patient medical aid under the ESI scheme is provided either through the service system i.e. through dispensaries established under the scheme for the exclusive use of the Insured Persons and their families, manned by regular Medical Officers who aren't allowed non-public follow or through a panel of personal Medical Practitioners who are referred to as Insurance Medical Practitioners Under the Panel System, Medical Practitioners are approved to act as panel doctors. A panel doctor is predicted to own his own consulting area and clinic. He’s additionally needed to take care of sure minimum prescribed standards in relation to the clinic. The insured person has the selection of registering himself with any panel doctor of his feeling. Every panel doctor is allowed to own up to a thousand science family units on his list. Under the panel system, the doctor is predicted to relinquish medicines to the Insured Persons, from his own clinic. Special and dear medicines are distributed through a panel of approved chemists also as state government Medical Stores, who are paid directly by the scheme.

At present, the panel system is in operation in West Bengal and Maharashtra (except Nagpur area), Goa in certain areas, Gujarat (Ahmadabad), M.P, Punjab, Andhra Pradesh, Assam, Tripura, and Karnataka.

 

The IMPs under the panel system are paid a capitation fee for providing medical care to the Insured Persons and beneficiaries. The Corporation has approved that the State will decide the number of tax fees to be paid to IMPs.

 

The provision for Super specialty services for beneficiaries is especially through tie-up arrangements with supposed health establishments.

Tie – up arrangement has been created with over 800 hospitals across india.

 

The Corporation has jointly established revolving funds in all States except Meghalaya, Pondicherry, Chandigarh (U.T), maharashtra, and Rajasthan on the consent of State Govt. for making advance payments/reimbursements in respect of specialty treatment. The Corporation has jointly extended the scope of the fund to include the requirment of medication and Dressings, Equipment, and repair & maintenance.

ESIC has developed its own drug formulary. All medicine & dressings and conjointly vaccines prescribed by doctors are equipped freed from charge.

 

Insured person and their dependants are supplied with artificial limbs, aids, and appliances. All Diagnostic facilities together with high-end investigations like PET angiography, CT s Scan & imaging are being provided to beneficiaries either within the house or through tie-up medical specialty & imaging Centers.

 

2. Immunization

 

The Corporation has embarked upon an enormous program of immunization for kids of Insured Persons. Below this program, preventive immunization and vaccines are given against diseases like diphtheria, peruses, Polio, Tetanus, Measles, Mumps, Rubella, infectious disease, hepatitis B, etc. The policy of immunization is to follow the National guidelines / Programmes.

 

3. Family welfare services

 

The Corporation has been enterprise provision of Family Welfare Services to the beneficiaries of the scheme. The ESI Corporation has put together extended cash incentives to Insured Persons to push acceptance of the sterilization technique by providing illness money profit capable full wage for a quantity of seven days for excision and fourteen days for Tubectomy.

The amount of profit is permissible is extended on the far side the higher than limits within the event of any complications once birth prevention Operations.

 

4. Sharing of Expenditure of medical aid

Expenditure on treatment is shared between ESI Corporation and conjointly the govt inside the quantitative relation of 7:1 at intervals the prescribed ceiling that is revised from time to time. The present ceiling w.e.f. 1.4.2009, is Rs.1200 per IP relatives each year with a pair of subheads Rs.700/- beneath body and Rs.500/- as others. An Employees’ State Insurance Corporation in its 154th meeting hung on 15.12.2011 has approved the improvement of the ceiling for providing medical profit to the beneficiaries from Rs. 1200/- to Rs. 1500/- per IP each year w.e.f. 01.04.2012 with the subsequent bifurcation:-

 

1. Administrative expenditure: Rs. 900/- per IP each year.

 

2. Alternative expenditure: Rs.600/- per IP each year.

 

In addition to the present, the Corporation has conjointly approved compensation of Rs. 200/- per IP each year to the State Governments, wherever the bed occupancy in all the State ESI Hospitals is quite seventieth throughout the all over yr. This compensation is given to the State Governments to facilitate the optimum utilization of the prevailing infrastructure and conjointly to encourage them to produce workers and instrumentality as per ESIC Norms. This quantity are going to be non-shareable and can completely be completely borne by ESI Corporation. Further, this amount are going to be untied and State Governments are going to be absolve to use it on any subheads i.e “Administrative” or the ‘others’.

 

5. Extra Incentive to government supported the performance of State ESI scheme

In addition, the Corporation has additionally approved that an incentive of Rs.50/- per ip once a year with100% sharing of ESIC are going to be given to the State Govts. supported the performance of the precedingfinancial year as per the subsequent criteria:-

 

1. States having average occupancy of70% and on top of in ESI Hospitals of State.

Rs.15 per ip once a year

 

2. States wherever the employees is provided as per ESIC norms and standards in respect of each dispensaries and hospitals. Rs.20/-per ip once a year.

 

3. accomplishment of seventy fifth targets or Rs.10/- per ip per on top of for implementation of ESI scheme in New Areas within the State as fixed below the phased program by ESIC annually.

 

4. States that get their all hospitals stratified / ISO certified. Rs.5/- per ip once a year. ESI Corporation has additionally earmarked a separate fund allocation of Rs.20/- per ip extended family once a year for promotion of preventive health services along side activity health services. In addition, the ESI Corporation has additionally taken a call that w.e.f. 1.4.2009, the full expenditure below the top Administration are going to be shared, between the ESIC and also the State Govt. within the ratio of 7:1, subject to fulfillment of certain specified conditions.

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