THE ESI Scheme

The ESI Scheme applies to persons who work in factories and other establishments where 10 or more persons are employed.
The procedure for submission of medical re-imbursement bills for such insured persons are:
1)Full authority is vested with the State Government concerned to reimburse expenditure in respect of medical treatment of IP and his family.
2)It may be left to the discretion of the State Government to decide the Authority within their machinery who will approve the expenditure in question
3)To submit a re-imbursement claim bill/bills an IP has to write an application to the Administrative Medical Officer, ESI Scheme, through the concerned Insurance Medical Officer i/c, ESI Scheme Dispensary along with the claim bill format which is available at Dispensary.
4)They have to mention the cause of diseases.
5)They have to submit a clear Xerox copy of Insured Person (IP) card, Bank Details i.e.–name of the bank, branch, IFSC code, Account number and the phone number of IP along with the bill/bills.
6)The time limit for submission of claims of re-imbursement is 1 year from the date of discharge from the hospital.

Recent changes:
1)IP Reimbursement Bill separate register should be maintained and all details of received bills should be made in it.
2)The time limit for submission of claims of re-imbursement is 3 months of discharge from the hospitals as compared to the earlier one year.
3)The scrutinized bills after being verified by the Chief Medical Officer should be forwarded to the Regional Administrative office within 1 month from the date of receiving the bill from the IP.