ESIC Super Speciality Treatment Eligibility in 2020

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

ESIC Super Speciality Treatment Eligibility
  • 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 PeriodESIC Benefit Period
April – SeptemberOctober – March
October – MarchApril – 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.

ESIC IP Portal Login

Step 2: Now in home page click on entitlement to benefits.

How to Check ESIC Super Speciality Treatment Eligibility

Step 3 : Now the insured person can check whether him or his family members are eligible for ESIC super speciality treatmetn or not.

ESIC Super Speciality Treatment Eligibility

List of Diseases Coverd Under ESIC Super Speciality Treatment

Infectious Diseases1. Tuberculosis
2. Leprosy
3.Chronic Empyema
4. AIDS
Neoplasms5. Malignant diseases
Endocrine, Nutritional and Metabolic Disorders6. Diabetes Mellitus-with proliferative retinopathy/diabetic foot/nephropathy.
Disorders of Nervous System7. Monoplegia
8. Hemiplegia
9. Paraplegia
10. Hemiparesis
11. Intracranial Space
12. Occupying Lesion
13. Spinal Cord
14. Compression
15. Parkinson’s disease
16. Myasthenia
17.Gravis/Neuromuscular 18. Dystrophies
Eye Diseases18. Immature Cataract with vision 6/60 or less
19. Detachment of Retina
20. Glaucoma
Diseases of Cardiovascular System21. 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
Cardiomyopathies
24. Heart disease with surgical intervention along with complications
Chest Diseases25. Bronchiectasis
26. Interstitial Lung Disease
27. Chronic Obstructive Lung Diseases (COPD) with congestive heart failure (Cor Pulmonale)
Diseases of The Digestive System28. Cirrhosis of liver with ascites/chronic active hepatitis
Orthopaedic Diseases29. 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
Psychoses33. Sub-group under this head are listed for clarification (a) Schizophrenia
(a) Endogenous depression
(a) Manic Depressive Psychosis (MDP)
(a) Dementia
Other Diseases34. More than 20% burns with infection/complication
35. Chronic Renal Failure
36. Reynaud’s disease/Burger’s disease.

source: https://www.esic.nic.in/extended-sickness-benefit

How to Avail ESIC Super Speciality Treatment Benefit

  1. 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.
  2. 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.
  3. 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.

Leave a Comment