How To Use ESI Card In Private Hospital

Employees who are contributing to employee state insurance scheme will need to get an ESIC Pehchan card. ESIC Pehchan card is like an id card for the employee which will be required to get ESIC benefits in ESI hospital and also in private hospitals.

ESIC Id card is also known as Pehchan card. If you don’t have ESIC Pehchan card till now then read this article on how to get ESIC Pehchan card. Here we are going to learn about how to use ESI card in hospitals and how to claim bills in private hospitals.

How To Use ESI Card In Private Hospital

  • ESI benefits can be availed for both employees and their family members. For every ESIC insured person, Two ESIC cards will be alloted. Both cards are same and one card is for the insured person and another card is for family members of the insured person.
  • Whenever insured persons and their family members are going to get treatment then they need to show their ESIC Pehchan card to the respective authorities in ESIC dispensaries or private hospitals.

How To Use ESI Card In Hospital

  • Employees and their family members who have minor health problems can directly visit their ESIC dispensary to get treatment. If the case is major then the doctors of ESI dispensary will recommend a private hospital.
  • Sometimes when accidents happen inside or outside the organization then the employer needs to generate ESI accident report. In the meantime, employee has to be admitted in nearby ESIC dispensary.
  • Generally, when accidents happen in inside the companies then the employer will generate accident report immediately. But when it happens outside then either employee or his colleagues or family members need to intimate the employer about the accident.
  • Then the employer will generate ESIC accident report online and ESIC inspector will verify the details. At present, it is very easy to generate ESIC accident report online.
  • But sometimes it is not possible to intimate the employer during some major health problems, at that time insured person or his family members has to be admitted in any private hospital and later they can claim the hospital bills.
  • But remember here insured person needs to prove that there is no availability of ESIC dispensaries during the incident and bills will be paid as per government hospital rates.
  • Insured persons claim their private hospital bills by submitting ESI reimbursement form to their ESIC regional office along with all medical bills.

Also read: Atal Bimit Vyakti Kalyan Yojna Scheme Details

ESIC Benefits For Insured Person & Family Members

Medical BenefitFrom the first day of joining in ESI scheme both insured
person and his or her family members will get ESIC
medical benefits.
Sickness BenefitsInsured persons who have a certified sickness can get
70% of wages up to 91 days a year. In order to become
eligible for this, they should have78 days contribution period
in 6 months.
Extended Sickness BenefitSickness benefit is extendable to Two years with
80% of wages for 34 malignant & long term diseases
Enhanced Sickness BenefitInsured persons can get 100% of wages during vasectomy
and tubectomy. During the vasectomy, this benefit is given for 7
days and for tubectomy, it is 14 days.
Maternity BenefitInsured pregnant woman can get full wages up to 26 weeks
during pregnancy.
Temporary Disablement BenefitInsured persons can get 90% average daily wages as
long as they suffer from disablement.
Permanent Disablement BenefitDuring permanent disablement insured person can get 90%
of wage as a monthly payment.
Dependents BenefitWhen the death of an insured person happens due to employment
then dependents will get 90% of wage as monthly payments

Still, if you have any questions about how to use ESI card in the hospital then the below FAQs may help you…

1) Can an insured person get treatment without ESIC Pehchan card?

Yes, insured persons and their family members can get treatment without ESIC Pehchan card, but they need to get temporary id card(print counterfoil) from their employer and remember Aadhar numbers of insured persons and their family members must be linked with ESI number.

2) Can I claim private hospital bills in ESI scheme?

Yes, the insured person can claim private hospital bills by submitting ESI reimbursement form but you don’t get exact bill amounts, because bills will be cleared as per government hospital rates.

3) Can a woman employee claim maternity benefit under the ESI scheme?

Yes, woman employees can get the full salary which includes basic wage, DA, HRA, and other cash allowances and incentives for 26 weeks. An insured woman can claim their maternity benefits by submitting ESIC maternity claim form 19.

4) Will my family members get ESI treatment if their details are not present in ESIC card?

There is no need to register new family members each time in ESIC card, tell their details to your employer, once your employer adds their details and Aadhar numbers in ESIC portal then they will be automatically covered under ESIC scheme without ESIC card.

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