Asked Questions and Answers
Where should a newly enrolled ESI beneficiary report for
benefits and what are the different types of services available?
record envelopes of all ESI beneficiaries are kept in the
respective ESI dispensaries. Primary outpatient medical
care, certificates for sickness benefits and reference to
ESI Hospitals for those who need hospitalization or specialist
consultation are given from here. Medical reimbursement
claims are settled here. All ESI beneficiaries should first
approach the Medical Officer of the ESI dispensary for availing
any medical benefit under the ESI scheme except in case
of emergencies when they can go directly to the ESI Hospitals.
2. What is the procedure to be followed
by the ESI beneficiaries to avail super speciality treatment?
ESI beneficiary should first approach the Medical Officer
of the ESI dispensary to which he/she is attached with all
his/her medical records including the concerned specialist’s
advice that treatment at super speciality hospital is essential.
The Insurance Medical Officer will then give a letter to
the beneficiary for getting eligibility certificate from
the local office of the ESI Corporation. The IMO informs
him/her on all the procedural formalities to be followed,
gives him three photo affixed identity certificates and
refers him/her to the Superintendent of the nearby ESI Hospital.
The Superintendent of the ESI Hospital will then examine
the patient and verify all the records produced by him.
If the case is found to be genuine, he will give a reference
letter to the concerned department of the super speciality
hospital. The reference letter will contain the details
such as name of the patient, two identification marks, home
address, name of insured person, relationship to the patient,
insurance number, name of work place, eligibility, diagnosis,
clinical history, investigations done, treatment given and
the need for reference.
The patient will then attend the super speciality hospital
where he is examined and an estimate of the required treatment
All the documents are then submitted to the Director of
Insurance Medical Services for scrutiny and sanction. The
documents are as follows:-
1) The insured person’s request
2) Forwarding letter of the ESI Hospital Superintendent
3) Reference form filled by the Superintendent
4) Entitlement certificate
5) Identification certificate (with photo and two identification
6) Medical records
7) Medical report and estimate from the super speciality
8) Certificate of non-availability of treatment from Medical
College in the case of private hospitals
the application is in order, the DIMS will forward it to
the Government for sanction of the estimated amount. Once
Govt. sanction is accorded, it will be sent back to DIMS
to meet the expenses from the Revolving Fund. The DIMS will
forward the sanction order to the Regional Director, ESI
Corporation, Thrissur for the issue of cheque. The RD will
send the cheque favouring the head of the Medical Institution
to the DIMS, who in turn will send it to the concerned hospital
and also inform the insured person immediately.
Once the treatment is completed the bills for the utilized
amount, demand draft in favour of RD, ESIC, Thrissur for
the unutilized amount, utilization certificate an treatment
certificate are to be sent to the DIMS by the hospital authority.
What is the procedure for availing treatment from Regional
Cancer Centre? (Treatment on credit)
reference letter is obtained from the Superintendent, ESI
Hospital as above and the patient can straightaway start
treatment at the RCC. Copies of the reference letter and
other documents are forwarded to the DIMS by the Superintendent.
Once treatment is completed RCC will submit the bills with
copies reference letter, entitlement certificate, identification
certificate and the treatment certificate to the DIMS. The
bills are passed and sent to the Government for sanction.
The sanction order is sent to the RD for payment. On receiving
the cheque from RD, Thrissur, the DIMS will forward it to
the Regional Cancer Centre.
Which are the Hospitals in the State where ESI beneficiaries
can avail super speciality treatment?
1) All Medical College Hospitals (Government)
2) Regional Cancer Centre, Thiruvananthapuram
3) Sree Chitra Thirunal Institute for Medical Sciences And
4) Amritha Institute of Medical Sciences and Research Centre,
5) Fathima Hospital, Kozhikode (private)
What is the procedure for getting money reimbursed for purchasing
medicines which are not available in ESI institutions from
the details of all the drugs purchased should be entered
in an essentiality form. The bill and the essentiality form
should then be countersigned by the doctor who prescribed
it affixing seal. The bill, essentiality form, doctor’s
prescription and an application in white paper should then
be submitted to the IMO of the dispensary. Treatment from
Institutions other than ESI institutions should be on reference.
6. How can the ESI beneficiaries help the department to
improve its function and service?
with the staff of the ESI institutions for overcoming their
difficulties and limitations to serve you better. The benefactors
and the Insurance Medical Service employees should work
together to achieve the great aims of this noble scheme.
The IMS department welcomes the feedback from the insured
persons by way of constructive suggestions and criticism.
7. Whom to contact for settling questions of eligibility?
Corporation determines the eligibility of an employee to
receive ESI benefits.