Doctor's Ready Reference 
Ready Reference for IMOs and IMPs

Facilities available from ESI Corporation to State Govt. for administering Medical Care/Benefit to Insured Persons :-
1.   ESI Corporation will now incur total expenditure on setting up of ISM Unit (Ayush) in ESI Hospitals/Dispensaries for the first five years instead of three years. Decision of the Corporation taken in 134th Meeting held on 21.12.05 conveyed by ESIC, vide letter no. U-16/13/6/15/05-ISM dt. 10.01.06.
2.    Items for which expenditure is shared outside the ceiling on Medical Care.
a) Initial Equipments for ESI Hospital

The limit on expenditure for the purpose of providing initial equipment at the time of commissioning a new hospital is given below :
Upto 50 beds Rs. 60 lakhs
For 51 to 100 beds Rs. 85 lakhs
For 101 to 250 beds Rs. 100 lakhs
For 500 and above beds Rs. 150 lakhs
 
b) Initial Equipment for ESI Dispensary/Specialist Centre

i) At the time of opening a new dispensary/specialist center the non- recurring cost of initial equipment, furniture will be provided from the shareable pool, outside the ceiling, according to norms given below :
2 doctor dispensary Rs. 1.50 lakhs
3 doctor dispensary Rs. 1.75 lakhs
4 doctor dispensary Rs. 2.00 lakhs
5 doctor dispensary Rs. 2.00 lakhs
A Diagnostic/Emergency Centre Rs. 10.00 lakhs
 

ii) Rs. 14,000/- one time sanction to all dispensaries for basic equipments like Stethoscope and BP equipment etc. to be borne by the ESiC.

(c) Initial Equipment for Annexes/Detention Wards :

The limit on expenditure for purchases of initial equipment in Annexes/ Detention Wards/Ordinary Wards, attached to the dispensaries is Rs. 25,000/-per bed.

(d) Replacement of Costly Equipments :-

The expenditure on purchase of additional equipment in an already commissioned ESI hospital, under special circumstances, e.g. replacement of an X-Ray machine, or on expansion of the hospital, like addition of a new department, should be done under shareable pool, outside the ceiling, any equipment costing Rs. 25,000/- or above is to be considered as a costly equipment for this purpose.

You are all aware that the Corporation is spending huge amount on Medical Benefits. The Expenditure on Medical Care during the year 2006-07 is 56 crores odd lakhs. Let us work together to provide Benefits to the right person in right time. The Corporation has introduced Photo Identity Card system w.e.f April 2001 to avoid impersonation. If the Registration Clerk of the Dispensary/IMP verifies the TIC/PIC/ESIC- 37/ other Forms produced by Insured Person with a little care and patience, it would not only help in providing better services to the IPs but also enable the Dispensary to advise the IP correctly. Certain points regarding Medical Benefit which are available in Medical Manual are briefly reiterated hereunder for a quick reference.

1. Issue of Live List: The Regional Office/Branch Office will issue a Live List of Insured Persons for each Benefit Period. The IMO/IMP should keep the MREs in respect of Insured Persons whose Insurance Numbers do not find place in Live List uner 'EXIT RUN'.

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If the IPs are entitled as per the Supplementary lists sent from time to time by Regional Office/Local Office the MREs should be replaced in 'ENTITLED RUN' duly writing in Red-Ink "RE-ENTITLED FROM ___________________________ ON THE BASIS OF "

2. Issue of Temporary Identification Certificate: A person on becoming an Insured Person for the first time will be issued with a Temporary Identity Card as per which he and his family members are eligible for Medical Benefit for a period of 3 months and where such person continues for 3 months or more he shall be entitled to Medical Benefit till the beginning of the corresponding Benefit Period. The Insured Person may be asked to produce the certificate of continuous employment by way of a letter from employer/ESIC-37.

3. Registration on ESIC-86 : Some times an Insured Person may need treatment before receipt of Temporary Identification Certificate. He receives such treatment on production of ESIC-86 (Certificate of Employment - Annexure 40) from his employer. I.M.P. should register such cases and prepare Temporary Acceptance Cards and forward the same to A.M.O.

As such Temporary Medical Acceptance Card does not contain the Insurance Number, it should not be placed in the main run in the I.M.P.'s cabinet but should be kept in'the compartment at the back in the same way as the new acceptances.

If any person he or she who identifies himself or herself as an Insured Person without having authenticated documents may be given medical treatment with an advice to produce the Identity Card during next visit.

4. Duplicate Identity Card : According to Regulation 18 of the ESI (General) Regulations, 1950, in case of Loss, defacement or destruction of an Identity. Card the Insured Person shall report the matter to the appropriate Branch Office and the Corporation may issue a Duplicate Identity Card subject to such conditions and on payment of such fee as may be determined by Director General.

Whenever a Duplicate Identity Card is issued to Insured Person an intimation to this effect will be sent to IMO/IMP concerned. On receipt of this intimation the IMO/IMP should make an entry on the MRE of the Insured Person "Duplicate Identity Card No. issued on ___________". If any person approaches the IMO/IMP with the original card i.e. after issue of DIC the same should be ceased and the matter may be informed to the concerned Branch Office Manager.

5. ESIC-37s : At times an Insured Person reports to the IMO/IMP for treatment on the ground that he is continuing in service and his contributions are being regularly deducted, such IPs may be advised to contact his employer to obtain Form ESIC-37. The IMO/IMP should himself re-entitle the I.P. on the basis of ESIC-37. This Card has to tbe completed on its reverse 'ESIC-Med-7A' and sent to concerned Amo's Office. The MRE should be taken out of 'EXIT-RUN' and placed in 'ENTITLED-RUN' with an entry in Red-Ink 'Re-entitled on the basis of ESIC-37". The ESIC-37 issued in respect of an Insured Person is valid for 9 months from the date mentioned under (i) or (ii) on the Form. Hence the Insured Persons may not be insisted for production of ESIC- 37 on every visit.

If ESIC-37s are obtained the IMO/IMP should invariably check whether all the Columns are duly filled in, whether the irrelevant Columns are struck off, whether the Code No., Name, Insurance Number and Branch Office are written properly, whether the IP is in continuous/ Re-employment or paid contribution for more than 78 days in the preceeding Contribution Period, and whether the Authorised signatory has signed the ESIC-37 with Office Seal and date.

6. Super-Speciality References : The Standard of Medical Care under the ESI Scheme provides for Specialist Consultation to Insured Persons and their families. Where such consultation is required, the IMOs/IMPs should refer such cases to ESI Hospitals. If the treatment required for IP is not available in ESI Hospitals, medical superintendent will refer the Insured Person to recognized Corporate Hospitals for SUPER- SPECIALITY TREATMENT.

While referring such cases the IMOs/IMPs should invariably varify the Live List issued by Regional Office/Branch Office and should intimate the eligibility position of the Insured Person in his referral Letter to ensure his prompt treatment.

7. Domiciliary Treatment: The Insured Person and his Family Members are entitled to free Medical Attendance by IMO/IMP at their residence when the condition of the patient is such that he/she can not reasonably be expected to attend the Dispensary/Clinic. But in partice no IMO/IMP is conducting any domiciliary visit. Such visits may be conducted to cater the needs of the sick IPs/Family Members, which will create confidence among the IPs on the scheme. The IMOs/IMPs are required to maintain a record of Domiciliary Visits in a Register, month-wise.

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8. Occupational Diseases : Many of the Occupational Diseases as mentioned in the Illrd Schedule of the ACT are not being reported to the Corporation by majority of the IMOs/IMPs. Occupational disease for all practical purpose is treated at par with Employment Injury. The Insured Person suspected of having Occupational Disease may be referred to the Branch Office duly filling in B. 1-1. After receipt of such references from Dispensary/ESI Hospitals, the Local Office/Regional Office in turn will refer the Insured Person to Occupational Disease Centre, ESIC Hospital, Diamond Harbour Road, Joka, 24 Parganas (S) for confirmation of diagnosis and treatment so as to prevent further deterioration of the condition of the Insured Person.

9. Entitlement of Family Member : In accordance with the definition of family under section 2(11), only minor Children are entitled to treatment. Entitlement will cease on the attainment of age of 18 years and in case of receiving Education upto attaining age of 21 years. The IMO/IMP can himself delete the names of children who attain majority in case of a daughter who get married before the age of 18 years from Identity Cards.

10. Medical Treatment to IPs & Family Members : The Insured Persons are entitled to get continued Treatment once started till the spell of sickness ends and in case of long term ailment as long as the patient requires active treatment even if during the treatment the Insured Person becomes disentitled to Medical Care. But the family members of I.P. are not entitled to this provision which has been extended to IPs only.

11. Medical Benefit Under Rule 60 & 61 : Medical Benefit is extended to Insured Persons who ceases to be an insurable employment on account of Permanent Disablement and IPs retired on Superannuation under Rule 60 & 61, of the ESI Central R ules, 1950. Hence on Receipt of Annexure-D in Dispensary from Branch Office, the Insured Person and his/her Spouse are to be provided with Medical benefit for the period mentioned therein.

12. Supply of Medicines to Insured Persons: There is a general complaint from Insured Persons that Medicines as prescribed by specialist are supplied only for one or two days at a time and they are facing lot of difficulty to visit Dispensary frequently from far of places. Therefore the IMOs/IMPs are requested to supply medicines to Insured Persons for number of days keeping in view the distance of IP's residence and the disease of Insured Persons. As per Satyam Committee's Report TB Patients shall not be required to come frequently to collect medicine. In their cases, distribution shall be on a monthly basis as is the practice adopted in respect of chronic cases.

13. Lax Certification : Though it is very essential that every I.P. who is genuinely sick must receive medical certificate, it is equally essential that no certificate should be issued to an I.P. who is actually not in need of abstention from work on medical grounds. Lax Certification not only has serious repercussions on the financial resources of the Corporation, but also adversely effect the production of the Industry and economy of the country. Sometimes it may be difficult to check malingering because of the fact that some I.P.s show vague symptoms like indigestion, nervousness, pain in some part of the body diarrhoea etc. In case the Doctor is not satisfied with the genuineness of a case, it would be proper to refer the patient to the Medical Referee for opinion about necessary abstention on Medical Grounds. Doubtful cases, may, sometimes be referred to Hospital for investigation & inpatient treatment. The Doctor should therefore, exercise due caution in issuing certificates so as to ensure that no certificate is issued without sufficient medical justification.

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14. Health Check-up Camps : The IMOs/IMPs may conduct periodical Health Check-up Camps in each center undertheir jurisdiction by taking the assistance of Social Security Organisations like Rotary Clubs/Red- Cross Society and Big employers in that area. This will be beneficial to the I.Ps and their families for whom Dispensary is set up at a distance place.

15. Seminars : The IMOs/IMPs should interact with the Branch Office Managers in conducting seminars of the Insured Persons/Employers at all the Centres covered under the jurisdiction. They should conduct these Seminars involving participation and active cooperation of the Branch Office Managers and with the assistance of the Trade Unions of the Centre.

16. Issue of Eligibility Letters: The Branch Office Managers are authorized to issue Eligibility Letters for Medical Treatment and for super-speciality treatment or reference by AMO/IMO I/C/IMP.

The E.S.I. Scheme is aimed at the welfare of the lower and middle class industrial worker. Full Medical care is provided to the insured persons and his family members in addition to the other case benefits. Let us work together to the welfare of the industrial worker and to keep away the criticism on the scheme. The suggestions for improvement of the scheme are always invited.

LET US NOT JUST REMEMBER - BUT PRACTICE

1. Be Polite & Courteous to insured persons.

2. Be punctual over give room for harassment.

3. Provide minimum amenities to insured persons like sitting arrangement, toilets, drinking     water etc.

4. Utilised the contribution agency for proper repairs & maintenance of our own buildings. For     rented buildings, pursue the land lord to do yearly white washing etc.

5. We have to build up together the image of the scheme by providing best available service     to the insured persons and their families.

"SOCIAL SECURITY IS NOBLE CAUSE! LET US FEEL PROUD WE ARE A PART OF THE ENVIABLE SYSTEM"

(Dr. Hardial Singh) Addl. Commissioner & Sr. State Medical Commissioner Regional Director E.S.I. Corporation, West Bengal, (DR. P. B. Salim, I.A.S.) Director E.S.I. (MB) Scheme West Bengal

(Sri G. C. JENA)
ADDL. COMMISIONER
E.S.I. CORPORATION,
WEST BENGAL
(DR. S. K. CHOUDHURY)
SR. STATE MEDICAL COMMISSIONER
REGIONAL DIRECTOR
E.S.I. CORPORATION,
WEST BENGAL
(DR. P. B. SALIM, I.A.S.)
DIRECTOR E.S.I. (MB) SCHEME
WEST BENGAL
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a)   For ESI Hospital
b)   For ESI Dispensary
c)   For Annexes Wards
d)   Equipments Replace
1.   Issue of Live List
2.   Identy. Certificate
3.   Reg. on ESIC-86
4.   Duplicate Identity Card
5.   ESIC-37s
6.   Super-Speciality
7.   Domiciliary Treatment
8.   Occupational Diseases
9.   Family Member
10. Medical Treatment
11. Medical Benefit
12. Supply of Medicines
13. Lax Certification
14. Health Checkup Camps
15. Seminars
16. Eligibility Letters
Forms for Medical
List of IMPs
ESI (MB) Office
Reg. Sub Reg. Office
SMC (EZ) & MR of ESIC
Branch Offices