The Employees' State Insurance Corporation (ESIC) provides a wide range of benefits to its members, including medical care, maternity benefits, unemployment benefits, and disablement benefits. One of the most important medical benefits provided by ESIC is surgery coverage.
Introduction
The Employees’ State Insurance Corporation (ESIC) is a social security scheme for Indian workers. It provides various benefits, including medical care, sickness, maternity, and disability benefits. One of the most important benefits is coverage for surgery.
What surgeries does ESIC cover?
ESIC covers a wide range of surgeries, including:
- General surgery, such as appendectomy, hernia repair, and gallbladder surgery
- Orthopaedic surgery, such as joint replacement surgery and spine surgery
- Cardiovascular surgery, such as heart bypass surgery and valve replacement surgery
- Neurological surgery, such as brain surgery and spinal cord surgery
- Ophthalmic surgery, such as cataract surgery and glaucoma surgery
- Cancer surgery, such as breast surgery, lung cancer surgery, and colon cancer surgery
- Pediatric surgery, such as cleft lip and palate repair and congenital heart defect surgery
In addition to these general categories, ESIC also covers a number of specific surgeries, such as:
- Caesarean section
- Vasectomy
- Tubectomy
- Laser surgery
- Cosmetic surgery for medical reasons
Who is eligible for ESIC coverage?
Any employee who earns a monthly salary of up to ₹21,000 is eligible for ESIC coverage. The employer must contribute a certain percentage of the employee’s salary to the ESIC fund. The employee is also required to contribute a small percentage of their salary.
How to get ESIC coverage for surgery
Suppose you are eligible for ESIC coverage and you need surgery. In that case, you will need to get a referral from your doctor. The referral will need to be submitted to your employer, who will then submit it to the ESIC office. Once the referral is approved, you will be able to get surgery at an ESIC hospital or at a private hospital that is empanelled with ESIC.
What are the costs of ESIC surgery?
The cost of ESIC surgery depends on the type of surgery and the hospital where you have the surgery. However, in general, ESIC surgery is very affordable. ESIC covers the cost of the surgery itself, as well as the cost of hospitalization, medicines, and other related expenses.
Benefits of ESIC coverage for surgery
There are many benefits of having ESIC coverage for surgery. Some of the key benefits include:
- Affordability: ESIC surgery is very affordable. ESIC covers the cost of the surgery itself, as well as the cost of hospitalization, medicines, and other related expenses.
- Quality: ESIC hospitals provide high-quality medical care. ESIC surgeons are highly qualified and experienced.
- Convenience: ESIC hospitals are located all over India. This means you can get surgery conveniently, even if you live in a rural area.
- ESIC beneficiaries referred for surgery at a non-ESIC hospital may also be eligible for reimbursement of the surgery cost. However, the reimbursement amount will be subject to certain limits.
- ESIC beneficiaries undergoing long-term treatment or requiring complex surgery may be eligible for financial assistance from ESIC.
- ESIC beneficiaries can visit the ESIC website or contact the ESIC branch office for more information on surgery coverage and benefits.
Example:
A 35-year-old man named John is an ESIC beneficiary. He has been diagnosed with appendicitis and requires surgery. John goes to an ESIC dispensary and obtains a referral from a doctor to see a specialist. The specialist assesses John’s condition and determines that surgery is necessary. The specialist issues a medical certificate, which John submits to the ESIC branch office.
John is then referred to an ESIC-affiliated hospital for surgery. He is admitted to the hospital and undergoes surgery without having to pay any upfront costs. After surgery, John is discharged from the hospital and continues to receive follow-up care at the ESIC dispensary.
John is able to get the surgery he needs without having to worry about the cost of treatment. He is grateful for the ESIC coverage, which has given him access to quality healthcare and financial assistance.
Conclusion
ESIC coverage for surgery is a very valuable benefit. It provides affordable and high-quality medical care to Indian workers. If you are eligible for ESIC coverage, please take advantage of it.
FAQs
How to find an ESIC hospital
To find an ESIC hospital near you, you can visit the ESIC website or call the ESIC toll-free number at 1800-11-44-77.
How to get a referral from your doctor
If you need surgery, your doctor will need to give you a referral. The referral will need to include the following information: Your name and date of birth Your ESIC number The type of surgery you need The reason why you need surgery Your doctor will also need to sign and stamp the referral.
How to submit the referral to your employer
Once you have a referral from your doctor, you need to submit it to your employer. Your employer will then submit it to the ESIC office.
What happens after the referral is submitted
Once the referral is submitted, the ESIC office will review it. If the referral is approved, you will be sent a letter with instructions on how to get surgery.
What to do if your referral is not approved
If your referral is not approved, you can appeal the decision. The appeal must be submitted to the ESIC office within 30 days of receiving the decision.
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