The Employees State Insurance Corporation (ESIC) has decided to provide super speciality treatment to retired employees, if they are subscribing to the medical scheme at the time of their retirement.
The decision was taken at the recent 171st ESIC meeting chaired by the Labour and Employment Minister, Mr Bandaru Dattatreya. The new
facility is likely to be made available from 1st April, 2017.
As many as 2.13 crore family units of workers employed with 7.83 lakh factories and establishments across the country are subscribing to the
ESI scheme for medical care and cash benefits. The total beneficiary population of the ESI Scheme is over 8.28 crore.
Currently, the retired insured persons and their spouses get in-house Medical Facility Benefit on payment of Rs.120 per annum. The
corporation has approved extending the facility of Super Speciality Treatment (SST) to them, subject to certain eligibility conditions.
To be eligible for the post-retirement SST benefit, an Insured Person (IP) should have been eligible for SST during his qualifying period of
insurable employment before retirement. Only IPs and their spouses shall be eligible for treatment. The IPs should enrol for the benefit
under Rule 61, within one month of their retirement.
The option to join the new benefit shall be one-time on retirement, the ESIC said on Monday. No enrolment shall be allowed thereafter.
A retired IP who opted out any time after retirement shall not be eligible to rejoin on any subsequent date.
The ceiling of expenditure on the SST, and all referrals to tie up hospitals in a financial year, may be restricted to Rs.10 lakh. An
overall ceiling of Rs.15 lakh may be fixed for SST in life time, for both the IP and spouse.
The IPs already retired but not enrolled so far may be allowed one time opportunity to join the scheme within a period of three months.
However, they shall be eligible for SST only after a gestation period of six months. Widows of deceased IPs receiving medical facilities as
dependent benefit, are likely to get the SST benefit.
An actuarial study has made a rough assessment of Rs.1700 per month for a Rs.10 lakh cover to retired members and spouses for SST.
However, the monthly contribution to be paid to avail SST along with medical benefits by the retired IPs will be decided later by the
Ministry of Labour & Employment.