The Hindu : ESIC plans new policy to include more workers

Online edition of India's National Newspaper
Tuesday, Apr 08, 2003

Southern States

Southern States - Tamil Nadu

ESIC plans new policy to include more workers

By Our Special Correspondent

CHENNAI April 7. The Employees State Insurance Corporation (ESIC) is to introduce a new policy with a reduced premium for bringing more workers under its net, the Director-General of the Corporation, Ajay Dua, said here today.

Talking to newsmen, Dr. Dua said the total annual contribution by an insured person and his employer was 6.5 per cent of the total emoluments, covering both the medical and cash benefits.

In the new policy, the insured person would be given an option either to avail the cash or the medical benefit.

As the annual premium for the new policy would be less than 6.5 per cent, he hoped that more employers and workers would opt for it. As its introduction required an amendment to the existing ESI Act, the Corporation had written to the Central Government.

Admitting that medical facilities in some of the ESI hospitals under the control of State Governments were not satisfactory, Dr. Dua said this was primarily due to lack of funds. To provide additional flow of funds, the Corporation had planned to increase its annual contribution to the State for an insured person from Rs. 600 to Rs. 700 which would generate more funds for improving medical facilities in ESI hospitals in their States.

This apart, the Corporation had increased the direct-controlled ESI hospitals from 9 to 25 with improved medical facilities. Besides, it had increased the number of private hospitals where the insured person could undergo treatment and avail the reimbursement facility. This, he said, would give him more freedom to choose the hospital.

Thanks to the constitution of a revolving fund, it was now possible to reimburse the entire expenses incurred by insured persons for speciality and super-speciality treatment in hospitals identified by the State and the Corporation.

He cited the case of an insured person in Tamil Nadu who got Rs. 16.80 lakhs towards full reimbursement of medical expenses for bone marrow transplantation in a corporate hospital in Chennai.

In the reimbursement of medical expenses for super speciality the criteria was the eligibility of medical treatment and not the amount of contribution by the insured person.

He said that funds were not a constraint for the Corporation as it had unutilised money to the tune of Rs. 600 crores.

The Special Secretary, Labour and Employment, Swaran Singh, said the State Government had simplified the system of reimbursement to enable the insured person to get his claims within seven days.

Now a medical officer could send the bill of the insured person to the Director of Medical Services directly for early clearance. If there was delay on the part of any official stringent action would be taken against him.

Earlier, Dr. Dua declared open a golden jubilee arch in front of the ESI regional office here to commemorate 50 years of its services to the working class.

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