Scale of Medical Benefit
The scale of Medical Benefit under section 57 of Act to be provided to the IPs and members of their families is to be prescribed by State Government in consultation with the Corporation under Section 58(1 & 3) of Act under State Medical Benefit Rules. An IP and/or a member of his family does not have the right to claim Medical Services over and above those which have been so prescribed. The beneficiaries are entitled to reasonable medical, surgical and obstetric treatment.The Corporation aims at providing uniform scale of Medical Care to the Family members in all implemented areas as the rates of the contribution paid by the employees and the employers are the same throughout the country.
- To Insured Persons:- IPs are entitled to avail treatment in ESI Dispensary/Hospital/Diagnostic Centre and recognised institutions, to which he is attached such as:-
- Outpatient treatment
- Domiciliary treatment by visits at their residences.
- Specialists Consultation.
- In-patient treatment(Hospitalisation)
- Free supply of drugs dressings and artificial limbs, aids and appliances.
- maging and laboratory services.
- Integrated family welfare, immunisation and MCH Programme and other national health programme etc.
- Ambulance service or re-imbursement of conveyance charges for going to hospitals, diagnostic centres etc.
- Medical Certification and
- Special provisions.
- To Family Members of Insured Persons:- While in all implemented areas, IPs are entitled to medical care as detailed above, members of a family of an IP are entitled to one or other of the following scales of Medical Benefits:-
- "FULL" Medical Care i.e., all facilities as for IPs including hospitalisation.
- "EXPANDED" Medical Care i.e., all facilities as for IPs except hospitalisation. A small number of IPs in the States of Gujarat and Bihar fall under this category.