Insured persons and their dependants are entitled to full medical care from day one of taking up employment in any factory or establishment covered under the ESI Act 1948. The comprehensive package includes primary medical care, specialists and diagnostic services, in-patient care with provision for all super specialist facilities. The scheme provides full range of medical care, namely;
- Out-Patient services
- Diagnostic services
- Specialists services
- Hospital service through a network of ESI dispensaries & Panel clinics, diagnostic centers and ESI Hospitals.etc
The package covers all aspects of health care from primary to super-specialist facilities as detailed below:-
- Out patient treatment
- Domiciliary treatment
- Super-speciality treatment
- Specialist consultation and diagnostic facilities
- In-Patient treatment
- Free supply of drugs and dressings.
- X-ray and laboratory investigations
- Vaccination and preventive inoculations
- Ante-natal care, confinement and post natal care
- Ambulance Service or conveyance charges for going to hospitals, diagnostic
centers, etc. wherever admissible
- Free diet during admission in hospitals
- Free supply of artificial limbs, aids and appliances for physical rehabilitation
- Family welfare services and other national health programe services
- Medical certification
- Special provisions including super-speciality treatment.
For super-speciality treatment such as
- Open Heart Surgery, Neuro Surgery, Bone Marrow Transplant, Kidney Transplant or specialized investigations like CAT scan, MRI, Angiography etc.
- Referral arrangements have been made with the reputed , premier hospitals of the country. The total cost of such treatment, diagnostic facilities or surgical intervention is borne by the ESI Scheme.
- Though medical care is provided, by and large, to the beneficiaries in modern system of medicine (Allopathic), facilities in indigenous systems such as (i) Ayurveda (ii) Unani (iii) Homoeopathy & Siddha are also being provided to the insured persons, on demand in many areas
- Extension of medical cover to the Retired and Disabled Insured Persons and their spouses (Rule 60 & 61 of ESI Central Rules – 1950).
- The scheme also provides for a comprehensive medical cover to the retired and disabled insured persons and their spouses on pre-payment of a nominal contribution of Rs.120/- per annum, per couple, provided that the insured person was in continuous insurable employment for at least 5 years before retirement. The scheme, thus, offers total medical cover to the retired and disabled employees without any upper ceiling on expenditure at a very low premium when compared with medical cover schemes introduced by some other insurance agencies in the business of medical insurance.