ALL INDIA ESIC PENSIONERS' FEDERATION

1402 SECTOR 8 , FARIDABAD 121006 INDIA

 
 

PENSIONERS MEDICAL SCHEME

 

DRAFT ESIC-PENSIONERS' MEDICAL SCHEME

 

1. INTRODUCTION

 

These rules will be known as ESIC-Pensioners' Medical Scheme Rules and will collectively form the ESIC-Pensioners' Medical Scheme (ESIC-PMS). It will be

 

effective from 01/04/06.All the decisions / instructions issued before its implementation regarding provision of medical facilities to ESIC-Pensioners will stand superseded by this scheme.

 

2. SCOPE

 

(A) Facilities under this scheme will be available to all the pensioners and family  pensioners of ESI Corporation including their dependant family members subject

 

to fulfillment of conditions laid down in this scheme.

 

(B) The term "dependant family member" under sub rule (A) shall include members as defined by the Govt. of India for its pensioners.

 

3. E.S.I.C.-PMS AN OPTIONAL SCHEME

 

The Employees State Insurance Corporation-PMS will be an optional scheme and a pensioner may or may not opt for this scheme.

 

A. A pensioner will be required to apply within 3 months from the date of retirement if he/she wants to become a member of the ESIC-PMS. Applications

 

received after 3 months of date of retirement will not normally be entertained.

 

B. Pensioners who have retired before the introduction of this scheme but have not opted for life time membership of any of the earlier medical schemes will be

 

given one time option to apply for the membership of this scheme within 3 months from the date of its implementation and, after that no request of such

 

pensioner will normally be considered for membership of ESIC-PMS.

 

C. ESIC-Pensioners who are already life time members of an earlier medical scheme of ESIC Pensioners will automatically become members of ESIC-PMS

 

unless they opt otherwise, subject to fulfillment of conditions given in this scheme.

 

D. A pensioner not opting for this Scheme within the prescribed period of three months and if the authority considers his joining the scheme subsequently, he

 

shall be entitled for super specialty treatment only after the “waiting period” of six months from the date of his joining of the scheme.

 

E. A pensioner not opting for this scheme shall be paid a Fixed Medical Allowance of Rs. 100/-P.M. subject to revision from time to time.

 

4. CONTRIBUTION AND BENEFIT PERIOD

 

A. All pensioners who opt to avail medical facilities under this scheme will have to pay contribution on the basis of option based either on basic pay last

 

drawn original pension at the rates given in Schedule 1 which is subject to revision from time to time:

 

(i) If contribution is paid on the basis of original pension, all elements except dearness relief shall be taken into account. The entitlement would be in

 

accordance with the rate of contribution paid.

 

(ii) If contribution is paid as a one time lump sum it will be ten times the annual contribution payable at the time of retirement and permanent whole life medical

 

card will be issued.

 

(iii) In respect of those beneficiaries who have already retired, the lump sum amount will be worked out on a pro-rata basis, at current rates assuming

 

average life expectancy at 68 years.

 

B.(i) The benefit period will be the same as in the case of Central Govt. Pensioners i.e. from 1 st January to 30th June and from 1st July to 31st December.

Contribution is required to be paid for the entire benefit period irrespective of date of joining the Scheme. The Contribution should be deposited by the

 

beneficiaries by 30th November and 31st May for the benefit periods of January to June and from July to December respectively.

 

(ii) Contribution shall be deposited in ESIC Fund Account No.1 in advance for a minimum period of six months.

 

5. MEDICAL CARD AND INDEX CARD

 

(A) The Card Issuing Authority shall obtain duly filled in application forms and requisite documents from the applicant three months before the date of

 

retirement of the official. The cost of photographs will be borne by the pensioners concerned.

 

(B) The applications so received will be processed and card will be issued to the concerned office 30 days before the date of retirement of the official. If the

 

official intends to get a medical card for whole life he / she should send bank draft / challan for an amount equivalent to the subscription for the period of ten

 

years. Where contribution has been paid for some years under the existing scheme medical card for the whole life shall be issued on payment of

 

contribution for the remaining years at a time.

 

(C) The issuing authority for medical card will also issue an index card to the pensioner in the prescribed format . The index card will be handed over by the pensioners

 

to the Incharge of concerned dispensary/hospital. The Medical Officer Incharge/  / Medical Superintendent of the concerned Dispensary / Hospital shall keep a

 

record of treatment provided to the pensioners in the index card.

 

(D)Duplicate medical card in place of card lost shall be issued by the authority who had issued the original medical card to the pensioner on receipt of report

 

regarding loss of medical card and an application for the issue of duplicate medical card along with following documents :-

 

(i) Copy of FIR/ Complaint lodged with the Police Station.

 

(ii) A bank draft in favour of ESIC fund A/c no. 1 or challan for Rs. 25/- as cost of duplicate Card alongwith photographs.

 

(E) The duplicate medical card shall also be issued in place of a mutilated card. The pensioner/family pensioner shall send the mutilated card along with application

 

form to the card issuing authority. The authority shall prepare a duplicate card in place of the mutilated one containing exactly the same particulars that was

 

available in the mutilated card. No charge will be collected for the issue of duplicate card in lieu of mutilated Card, if the card was issued five years prior to

 

the date of application for such request. In other cases, a fine of Rs. 25/- will be collected.

 

(F) The pensioner must apply for issue of medical card within three months from the date of the retirement and in cases where the pensioner is already holding

 

medical card, he should renew the card within three months from the date of expiry of card. If the medical card is renewed after the expiry of three months

 

(grace period), the pensioner will not be entitled for any medical reimbursement / benefits for that period of treatment between the actual date of renewal of the

 

card and the date on which the card was due for renewal. The renewal of medical cards of pensioners will be done from the date of payment of

 

contribution by them and not with retrospective effect, in case the card is not got revalidated within the grace period of three months.

 

The pensioners will not be eligible for reimbursement of medical expenditure for the period for which the medical card has not been renewed.

 

(G) No change of dispensary is permissible except on change of residence of the card holder. When there is a change of residence involving change of

 

dispensary, the pensioner should present an application in duplicate to the card issuing authority in the prescribed form together with medical card. The card

 

issuing authority shall make entry in the medical card and attest the same in the appropriate column. Then the pensioner shall submit two forms to the Medical

 

Officer Incharge of the concerned dispensary. The Medical Officer Incharge will make entry in his records and then handover the index card to the card holder

 

with the direction to handover the index card to the Medical Officer Incharge of the new dispensary.

 

(H) The Regional Director/ Medical Superintendent will be the authority to decide as to which will be the nearest Dispensary / Hospital under these Rules and he

 

will also issue medical card to such pensioner under intimation to the Incharge of the concerned Dispensary or Medical Superintendent of the concerned hospital

 

as the case may be .

 

6.

MEDICAL INSTITUTIONS AVAILABLE FOR TREATMENT OF ESIC

PENSIONERS.

 

A. Pensioners residing within eight kilometers of an ESIC/ESIS Dispensary/ESIC/ESIS Hospital shall avail medical facilities through that dispensary/ hospital

 

in the first instance.

 

B. If the residence of the pensioner is at a distance of more than 8 kms. from thenearest ESIC/ESIS dispensary / ESIC/ESIS hospital, he will have the option to

 

avail medical facilities through any other approved* dispensary/ hospital nearest to his residence.

 

C. In case any particular treatment is not available in such a Dispensary and hospital, the hospital may refer the patient to any of the recognized *hospitals

 

where such treatment is available .

 

D. In the event of emergency the ESIC pensioners / eligible family members may report to nearest hospital where required facility is available and inform the

 

recognized* dispensary/ hospital and card issuing authority about the admission to the non-recognized hospital. In case a pensioner takes treatment from a

 

hospital to which he is not attached in emergent circumstances, the reimbursement within the ceiling for such treatment in a recognized*/* approved

 

hospital shall be considered only when emergency is certified by the competent authority of ESIC.

 

E. If a pensioner while at outstation requires emergency treatment, he will avail the same from the nearest hospital and the amount shall be reimbursed as per rates

 

of the nearby approved *hospital as provided in

Schedule 2.

F. The members of ESIC-PMS will be eligible for medical facility from any approved*hospital under any system of medicine recognized for employees of the

 

Corporation.

 

G. If a pensioner, takes treatment from a hospital which is not recognized under the scheme, in non- emergent circumstances, no reimbursement shall be made

 

and the entire expenses will be borne by the pensioner.

 

Note:- For the purpose of these Rules, a recognized/approved dispensary/hospital shall include all ESIS dispensaries and Hospitals, any other

 

Hospitals recognized by ESIC/ESIS for the Insured Persons, or for the employees of ESIC/ESIS including those recognized under CGHS and

 

CS(MA) Rules in respect of which the Director General or any other authority has entered into an agreement under Rule 9, in addition to

 

ESIC Institutions. A dispensary shall also include an AMA appointed under the above Rules or appointed by the Competent Authority

 

specifically under these Rules.

 

7. ENTITLEMENT TO VARIOUS CLASS OF ACCOMMODATION FOR INDOOR TREATMENT

 

(i) Pensioners who are provided medical facilities through ESI institutions shall remain entitled to the ward available irrespective of their contribution slab or

 

status.

 

(ii) A Pensioner who is referred by the ESI Hospital to any other recognized /approved hospital shall be entitled to the class of accommodation as per the

 

schedule-3

 

(iii) In cases where reimbursement is allowed after relaxation, reimbursement of accommodation charges shall be as per entitlement to various wards or actual

 

amount spent by the pensioner, whichever is less.

 

(iv) Any amount spent over and above the rates applicable as per entitlement will be borne by the applicant pensioner.

 

(v) The pensioner shall apply in the prescribed proforma enclosing the requisite documents to the Card Issuing Authority for reimbursement of expenses for

 

treatment taken from an eligible hospital.

 

8. COST OF FOOD / TONIC ETC. AND SOME RESTRICTED MEDICINES NOT REIMBURSABLE.

 

(i) The cost of preparations which are not medicines but primarily food, tonics, toilet preparations or disinfectants shall not be reimbursed.

 

(ii) Expensive drugs, laxatives and proprietary preparations for which drugs of equal therapeutic value are available, shall not be reimbursed.

 

9. POWERS OF THE DIRECTOR GENERAL TO REMOVE DIFFICULTIES

 

Notwithstanding any thing contained in these Rules, the Director General may adopt any provisions as applicable to the pensioners of the Govt. of India or

 

otherwise from time to time and exercise such powers and delegate any of them to authorities subordinate to him. The Director General or any other authority to

 

whom the power is delegated may also enter into agreement with the appropriate authority in respect of a dispensary/hospital/AMA for providing

 

medical facilities to ESI pensioners on terms and conditions as mutually agreed upon.

 10. POWER TO RELAX.

 The Director General shall have the power to relax any of the provisions laid down in the rules. A pensioner, however, can not claim relaxation of the rule

 as a matter of right. The reimbursement of medical expenditure after relaxation of the rules by the Director General shall be restricted to the approved rates.

 11. TRANSITIONAL PROVISIONS

 These rules shall be effective from 01.04.06. Reimbursement claims already decided shall not be reopened. Cases wherein the contingencies have

 arisen on or before 31/03/06 shall be regulated in accordance with the instructions then applicable in those cases.

 SCHEDULE – 1

 The rates of contributions chargeable under ESIC-PMS are given below.

 

However, these rates may be revised from time to time by the Director General.

 

Pay Range(last pay drawn)   Pension / Family Pension      Rate of monthly contribution

 Pay upto Rs. 3,000                Upto Rs. 1,500                                       15

 

Rs. 3,001 to Rs, 6,000              Rs. 1,501 to Rs. 3,000                           40

 

Rs. 6,001 to Rs. 10,000            Rs. 3,001 to Rs. 5,000                           70

 

Rs. 10,001 to Rs, 15,000          Rs. 5,001 to Rs, 7,500                           100

 

Rs. 15,001 and above              Rs, 7,501 and above                             150

 

A pensioner will have option to pay contribution either based on his last pay drawn or based on his present pension (excluding Dearness Relief).

 SCHEDULE – 2

 STATEMENT SHOWING THE CEILINGS ON THE VARIOUS ITEMS OF TREATMENT  WHERE REIMBURSEMENT IS ALLOWED IN RELAXATION.

 (1) The rates approved by the ESIC in respect of the hospitals recognized by ESIC. 

(2) The rates approved by State Govt./CGHS/CS(MA)Rules whichever is lower or applicable. 

SCHEDULE – 3

S.No.  Rate of Monthly contribution paid         orresponding Ward in approved  Hospitals 

1                Upto Rs. 15/                                                         - General 

2                 Rs. 40                                                                 /- General 

3                 Rs. 70/                                                                 - General/Semi-private as available 

4                 Rs. 100/                                                                 - Private 

5                 Rs. 150/                                                                 - Private or above as available 

The eligibility of pensioners covered under clause 3 (C) for the purpose of Schedule 3 shall be reckoned on the rates per month at which whole life

contribution was then paid by the pensioner

 

 

EMPLOYEES' STATE INSURANCE CORPORATION

 

PANCHDEEP BHAWAN, C.I.G. ROAD, NEW DELHI

 

No:- D-12/16/1/2003-E-VI Dated 13.01.2006

 

M E M O R A N D U M

 

Subject:- Extension of medical facilities to E.S.I.C pensioners through the E.S.I.C

 

Pensioners' Medical Scheme (E.S.I.C.- PMS).

 

The Standing Committee of the ESI Corporation, in its meeting held on

 

13th Dec., 2005, has approved certain medical facilities to the pensioners of the 

E.S.I.C. under the name and style of "The E.S.I.C. Pensioners' Medical Scheme,

 

2006" which shall come into force w.e.f. 1st April, 2006.

                                                The Scheme is optional and contributory in nature. Pensioners opting for the scheme shall be required to apply within 3 months from the date of retirement, if they want to avail of the scheme. Those who have retired before introduction of this scheme but are not life time members of any earlier medical  schemes will be given one-time option to apply for the membership of this scheme within 3 months from the date of its implementation i.e., 1/4/2006.Pensioners who are already life time members of an earlier medical scheme for E.S.I.C. Pensioners shall automatically become member of E.S.I.C. Pensioners'Medical Scheme unless they opt otherwise. The option once exercised by apensioner shall be final and cannot be revoked.

 

                     Pensioners not opting for the scheme shall continue to be eligible for payment of fixed medical allowance @ Rs. 100/- per month.

 Pensioners opting for this scheme shall pay contribution in advance for a minimum period of six months at the following rates:- 

Pay Range Pension/FamilyPension                               Rate ofmonthlycontribution 

Pay upto Rs. 3000 /Upto Rs. 1500                                          15 

Rs. 3001 to Rs. 6000 /Rs. 1501 to Rs. 3000                             40 

Rs. 6001 to Rs. 10000 /Rs. 3001 to Rs. 5000                           70 

Rs. 10001 to Rs. 15000/ Rs. 5001 to Rs. 7500                         100 

Rs. 15001 and above Rs. 7501 and above                              150 

A pensioner will have the option to pay contribution either based on his last pay drawn or based on his present pension (excluding Dearness Relief). 

For entry in the scheme, pensioners shall be required to apply in the prescribed application form (Annexure-A) along with a photograph to the 

designated card issuing authority. The cost of photograph will be borne by the pensioner. The card issuing authority shall intimate the pensioner about the 

medical card and the index card for submission to the Medical Officer Incharge etc. The procedure for obtaining a duplicate medical card shall also be issued by 

the card issuing authority. 

     Pensioners residing within eight kilometers of an E.S.I.C./ESIS Dispensary/Hospital shall avail medical facilities through that dispensary/hospital 

in the first instance, in absence of which he will have the option to avail the facilities through any other approved dispensary/hospital nearest to his 

residence. In case, any particular treatment is not available in such dispensaries/hospitals, they m ay refer the patient to any of the recognized 

hospitals where such treatment is available. If a pensioner takes treatment from a hospital which is not recognized in non-emergent circumstances, no 

reimbursement shall be made and the entire expenditure will be borne by the  pensioner. Pensioners who are provided medical facilities through ESI institutions shall remain entitled to the available ward irrespective of their entitlement. 

Those who are referred to any other recognized hospitals shall be entitled to the class of accommodation as shown below:- 

Sl.No.   Rate of Monthlycontribution paid            Corresponding Ward inapproved Hospitals 

1.        Upto Rs. 15/-                                        General 

2.        Rs. 40/-                                                General 

3.        Rs. 70/-                                                General/Semi-private as available 

4.        Rs. 100/-                                              Private 

5.        Rs. 150/-                                              Private or above as available 

All decisions/instructions issued hitherto shall stand modified upon implementation of this scheme w.e.f. 1/4/2006. 

There shall be a designated Nodal Officer for each State/UT who will be empowered for reference to other approved hospital in case the facility is not 

available in ESI hospitals. The communication in this regard shall follow shortly. 

The reimbursement will be restricted to the rates approved by E.S.I.C./State Govt./CGHS/CS(MA) Rules, whichever is lower or applicable. The 

cases where contingencies have arisen on or before 31.03.2006 shall be regulated in accordance with the instructions in force prior to 1/4/2006. 

Reimbursement claims already decided shall not be reopened. A copy of the scheme is sent herewith the request to bring the contents of 

the scheme to the notice of all concerned. 

Encl:- E.S.I.C. Pensioners' Medical Scheme 

(S.K. Sinha) 

JT. DIRECTOR 

For Director General

 

HEAD-lJ.UARTERS OFFICE

 

EMPLOYEES' STATE INSURANCE CORPORATION

 

PANCHDEEP BHAWAN :C.LG MARG: NEW DELHI

 

(ISO 9001:2008 CERTIFIED)

 

emaD: Id-admin2@eaie.Di~.fn

 

No. D-12/16/1I03-E-VI                                                                                                                        Dated-:2. 6- 8-2010

 

To

 

A.C. (NTA), All Regional Diredonl Jt. Dfrectors In-charge,

 

D(M)DI DM NoidalSSMCI M.S. of ESIC Model Hospitalsl ODCs.

Sub:ESIC Pensioners Medical Scheme - Grant of Fixed Medical Allowance.

 

Sir,

 

Consequent upon revision of Fixed Medical Allowance being paid to Central Government Pensioners by Central Govt., the matter regarding revision of FMA was under examination of this office. Accordingly, the decision of ESI Corporation is conveyed for enhancing the Fixed Medical Allowance being paid to Pensioners eligible under ESIC Pensioners' Medical Scheme, 2006 from Rs. 100/- to Rs.3001- per month. Other conditions for grant of FMA shall remain the same.

 

The revision is to be effective from 01.09.08.This issues with the approval of Director General in concurrence with the Financial Commissioner.

 

The contents of this letter may be sent to all pensioners individually and the pensioners association of your region. This may be placed in your websites also.

 

The receipt of this letter may please be acknowledged.

 

Hindi version will follow.

 

Yours faithfully,

 

 

 

~C"~ .•

 

( SUNIL TANEJA )

 

JOINT DIRECTOR

 

FOR DIRECTOR

 

 

 

 

                   It is informed that Ministry of Health & Family Welfare has issued circular dated 14/5/2018 prescribing time-lines for settlement of medical claims of CGHS pensioner beneficiaries. The circular has been issued in CGHS in compliance of the directions of Hon'ble Supreme Court of India in their Judgement in WP (Civil) No. 694 of 2015 between Shiva Kant Jha Vs UOI delivered on 13th April, 2018 and in supercession of earlier guidelines in the matter. The circular was examined in ESI Corporation and guidelines prescribing similar time-lines are issued for pensioners / family pensioners covered under

ESIC Pensioners' Medical Scheme, 2006 as per the details below :

  • Pensioners/family pensioners enrolled under ESIC-PMS-2006 shall submit the medical claims to the concerned Nodal Officer i.e. Regional Director / Director (I/c) / Director(M) Delhi / Director (M) Noida / Med. Supdtt. of ESIC hospitals. The claims shall be issued serial number and are to be processed / examined by the Nodal Officer as per rules, If found reimbursable, the claims shall be sent to the DDO for payment to the beneficiary by ECS. The payment shall be completed within 30 days of submission of the medical claims to the Nodal Officer.
  • Medical claims requiring approval of higher authorities / Medical Committee :
  • Total time within 45 days in Delhi / Noida
  • Total time within 60 days in other cities.
  • The Nodal Officer shall thoroughly check the papers initially for completeness of the requisite documents before accepting the claim papers to ensure that the claim papers are not returned subsequently for want of some documents. Care shall be taken not to reject medical claims of pensioners on minor technical objections, if they fall under procedural lapses,

which can be condoned. This issues with the approval of Director General.

The receipt of this letter may please be acknowledged. Hindi version will follow.

Yours faithfully,

2

( Prabha Saini ) Asst. Director

CIRCULERS4

Feary

MEAD QUARTERS OFFICE

HAAN Us SAT fevaraT

EMPLOYEES'STATE INSURANCE CORPORATION

(An I8O 9001-2000 certified organisation)

Gary Haat, O.3TS.sh. Fret, aS fa een-2

No: D-12/16/1/03-E-V! ,                  Dated: 25/08/08

To

All Regional Directors/ Joint Directors I/c Director(M) Delhi/ Director(M) Noida, ES! Corporation.

Sub: _ Salient features of ESIC-Pensioners Medical Scheme — Reg.

Sir, ,

A copy of DO letter of even No. dated 22.08.2008 signed by Add!. Commissioner (P&A) is enclosed herewith on the above subject. All Nodal Officers of ESIC-PMS of ESI Corporation are requested to issue the enclosed DO letter to all the pensioner pertaining to their unit after making requisite number of copies.

This issues with the approval of Add!. Commissioner (P&A).

Yours faithfully,

na * ms B51 R07 (M. NANDA} SECTION OFFICER

. mgt Mia Oo a nesy F ome “ow Soe gs

 

B.K. SAHU 45105 §) ADDITIONAL COMMISSIONER

 EMPLOYEES’ ST. ATE INSURANCE CORPORATION

PANCHDEEP BHAVAN: C.1.G. ROAD:NEWDELHI-110002. http://esic.nic.in

No. D-12/16/1/,2003-E .VI                Dated : 22° August,2008

Dear Shri/Smt

              It is a matter of immense pleasure to address the elders of the ESIC, each of whom have made a contribution towards building the organisation. It is in regard to your Medical Scheme that I felt the need for addressing you individually. As you are aware, the Standing Committee of ESIC in its meeting held on 13/12/05 approved scheme for medical facilities to the pensioners of ESIC under the name of style of “The ESIC-PMS 2006” and it came into force on 1/04/06. Subsequently, a number of instructions were issued adding more features to the scheme. Publicity was also given through the press so that every pensioner of the Corporation is aware of it.

However, it appears from the queries that are being generated and received, that many of the pensioners are still not aware of the scheme. I availed of the opportunity to address you personally to apprise of its salient features, which are as follows:-

  1. Pensioner opting for this scheme shall pay contribution in advance for a minimum period of 6 months as per rates mentioned in the scheme circulated vide instructions No.D-12/16/1/03-E.VI_ dated 13/01/06.
  2. | ESIC-PMS Scheme is an optional one and a pensioner may or may not opt for the scheme irrespective of the location of his residence.
  3. Pensioner not opting for the Scheme will be paid Fixed Medical Allowance @ Rs.100 P.M.
  4. Pensioners who retired prior to 31/03/08 and are not member of ESIC-PMS or lifetime member of any earlier medical scheme shall have one time option enrolment to the Scheme til ee after which no request will be considered.

0-l2-0 8 5. poet rit be the Nodal officer the case of pensioners in and around Delhi i in matters regarding references to other Hospitals and RDs/JDs Incharge in the case of pensioners in other states.

  1. Pensioners joining the scheme after a period of 6 months after retirement (which is subject to acceptance by the competent authority) shall be entitled for super speciality treatment only after a short “waiting period” of 6 months from the date of joining the Scheme.
  2. Medica! institutions for availing treatment under the ESIC-PMS shall include following :- 5
  • All ESI Hospitals and Dispensaries including ODCs etc. run by the ESI Corporation and the State Govts., as agreed to by the State Govt
  • All hospitals and other facilities recognized by the CGHS and CS(MA) Rules.

 

o | cr a . a aa (iii) | All Hospitals/Dispensaries/AMA etc. approved/recognized by the ESIC/ESIS , authorities for the treatment of IPs and their employees or any other medical

institution recognized by the Nodal officer specifically under the Rules 9 of the ESIC-PMS

  1. Pensioners residing within a distance of 8 Kms. of ESIC -Dispensary/Hospital/ODC centers shall avail medical facilities through our medical institutions at the first instance. In case, any particular treatment is not available in such institution the patient shall be referred to any of the recognized institution where the required treatment is available.
  2. The ESIC-PMS beneficiaries shall be entitled for treatment of any kind from any Govt. Hospital, Dispensary or any other facility maintained by Central, State or local bodies for which no formal recognition or agreement shall be necessary. The rate of reimbursement in these cases will be made on actual basis subject to the entitlement of the pensioner for various facilities. Reimbursement under ESIC-PMS shall be

restricted to the rate as actually recognized institution/rates specified by CGHS/CSMA as the case may be or the rates contained in the agreement the Nodal Officer has entered into with such institution whichever is less except in the case of food/tonic some restricted medicines etc..

  1. A member of the ESIC PMS, who is not resident within 8 Kms. of any ESIC institution irrespective of distance of residence may request f or his attachment to any of the medical institution/ AMAs, as per para-7 including an ESIC institution.
  2. Noda! officers are empowered to reimburse the claims in respect of emergency treatment availed by you in any hospital irrespective of the distance from his residence if the hospital concerned has certified the Medical emergency and Nodal Officer in consultation with MR/SMC/MS of ESIC Hospital is satisfied about emergent condition. However, reimbursement in such cases will be made as per CGHS/ CSMA approved rates or actual expenditure whichever is less.

Corporation has also approved presentation of a memento worth Rs.5000/- (a silver medallion) on superannuation through Regional Directors.

While I am not able to accommodate exhaustive details of the scheme here, | believe | have managed to bring out some of pivotal aspects of the scheme. We have also published all

the instructions issued on the website. I am also sure that our officers will be glad to guide you in case you find difficulty in availing the benefits.

With Y. t ve4 at, Yours Sincerely, eed

(B.K. SAHU)

 

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ALL INDIA ESIC PENSIONERS FEDERATION (REGD) 0