Whenever an ESI hospital doesn’t have required medical facilities for the treatment of an insured person and his family members then they will be referred to the ESIC tie-up hospitals to ensure full medical care. These hospitals include both the public and private sectors in the country with cooperation with the state government.
In order to avail ESIC super specialty treatment the insured person needs to submit an eligibility certificate from the concerned insurance medial officer or the ESI hospital.
Eligibility Criteria for ESIC Super Speciality Treatment
- The insured person will become eligible for ESI super specialty treatment when he has 6 months insured employment in ESIC from the date of registration of ESIC and 78 days contribution to ESI in One ESIC contribution period.
- His family members will become eligible for ESIC super specialty treatment when he has 1 year insured employment and 156 days ESIC contribution including Two ESI contribution periods (78 days in each ESI contribution period.)
- Once the insured person fulfills the above criteria then he and his family members will become eligible for ESI super specialty treatment in the following ESIC benefit period.
ESIC Contribution Period & Benefit Period
|ESIC Contribution Period||ESIC Benefit Period|
|April – September||October – March|
|October – March||April – September|
How to Check ESI Super Speciality Treatment Eligibility Online
Step 1: ESIC members can check their eligibiltiy for ESIC super speciality onlitn at ESIC IP Portal, for that Go tot ESIC IP portal and login with your ESI number.
Step 2: Now in home page click on entitlement to benefits.
Step 3 : Now the insured person can check whether him or his family members are eligible for ESIC super speciality treatmetn or not.
List of Diseases Coverd Under ESIC Super Speciality Treatment
|Infectious Diseases||1. Tuberculosis|
|Neoplasms||5. Malignant diseases|
|Endocrine, Nutritional and Metabolic Disorders||6. Diabetes Mellitus-with proliferative retinopathy/diabetic foot/nephropathy.|
|Disorders of Nervous System||7. Monoplegia|
11. Intracranial Space
12. Occupying Lesion
13. Spinal Cord
15. Parkinson’s disease
17.Gravis/Neuromuscular 18. Dystrophies
|Eye Diseases||18. Immature Cataract with vision 6/60 or less|
19. Detachment of Retina
|Diseases of Cardiovascular System||21. Coronary Artery Disease:- (a) Unstable Angina|
(b) Myocardial infarction with ejection less than 45%
22. Congestive Heart Failure- Left , Right
23. Cardiac Valvular Diseases with failure/complications
24. Heart disease with surgical intervention along with complications
|Chest Diseases||25. Bronchiectasis|
26. Interstitial Lung Disease
27. Chronic Obstructive Lung Diseases (COPD) with congestive heart failure (Cor Pulmonale)
|Diseases of The Digestive System||28. Cirrhosis of liver with ascites/chronic active hepatitis|
|Orthopaedic Diseases||29. Dislocation of vertebra/prolapse of intervertebral disc|
30. Non union or delayed union of the fracture
31. Post Traumatic Surgical amputation of lower extremity
32. Compound fracture with chronic osteomyelitis
|Psychoses||33. Sub-group under this head are listed for clarification (a) Schizophrenia|
(a) Endogenous depression
(a) Manic Depressive Psychosis (MDP)
|Other Diseases||34. More than 20% burns with infection/complication|
35. Chronic Renal Failure
36. Reynaud’s disease/Burger’s disease.
How to Avail ESIC Super Speciality Treatment Benefit
- Whenever the insured person or family members of the insured person get sick then first they need to visit their concerned ESI dispensary or ESIC hospital along with their ESIC Pehchan card.
- Depending upon the severity of the disease availability of the facilities in the ESIC hospital the medical officer will make a decision to refer the insured person or family members to the ESIC tie-up hospitals for super specialty treatment.
- Once the medical officer takes a decision then he will issue a certificate of reference, with that certificate insured persons can avail of this facility.