ESI Corporation Forms on Website

For the convenience of employers/employees, ESI Corporation Forms can now be downloaded from ESI Corporation Website:

i)  www.esic.org.in            ii) www.esic.nic.in

SI No	Name of Dispensary	Pincode	Tel.No	SI No	Name of Dispensary	Pincode	Tel. No
72	Ernakulam	682018		82	Thoppumpady	682006	2231852
73	Fort Kochi	682001		83	Karimugal	682303
74	Kalamassery	682024		84	Thrippunithura	682301
75	Cochin Special Economic Zone, Kakkanad			85	Udyogamandal		2555542

THRISSUR

SI No	Name of Dispensary	Pincode	Tel.No	SI No	Name of Dispensary	Pincode	Tel. No
86	Alagappanagar	680302	2851345	94	Kuttanalloor
87	Alloor	680683	2880267	95	Mala	680735
88	Chalakkudy	680307		96	Mulamkunnathukavu	680581
89	Chavakkad	680512		97	Olarikkara	680012	2361239
90	Irinjalakkuda	680125		98	Ollur	680306	2352349
91	Karuvannur	680711	2342280	99	Poonkunnam	680002	2381742
92	Koratty	680308	2832029	100	Vadakkancherry	680589
93	Kunnamkulam	680517

Palakkad				Idukki
SI No	Name of Dispensary	Pincode	Tel.No	SI No	Name of Dispensary	Pincode	Tel. No
101	Chittur	678101		108	Thodupuzha	685584
102	Kanjkode	678621			Malappuram
103	Ottappalam	670101		109	Kuttippuram	679571
104	Palakkad	678012		110	Malappuram	676519
105	Parali	678612		111	Nilambur	679329
106	Shornur	679121		112	Vazhakkad	673640
107	Walayar	678624		113	Kottakkal

Kozhikode

SI No	Name of Dispensary	Pincode	Tel.No	SI No	Name of Dispensary	Pincode	Tel. No
114	Beypore	673015		120	Kainatty, Vadakara	673004
115	Chakkorathukulam	673006		121	Chemancherry	673321
116	Chalappuram	673002		122	Kunnathupalam	673011	2430835
117	Cheruvannur	673631		123	Mavoor	673661	2483123
118	Chungam	673631		124	Meenchanda	673018	2402241
119	Eranhipalam	673006		125	Puthiyara	673002	2302694

Kannur

SI No	Name of Dispensary	Pincode	Tel.No	SI No	Name of Dispensary	Pincode	Tel. No
126	Azhikode	670009		131	Mangattuparamba	670562
127	Chonadam	670641		132	Melechovva	670006
128	Dharmadom	670106		133	Pappinisserry	670561	2778103
129	Kannur	670004		134	Payyannur	670307
130	Kuthuparamba	670643		135	Thaliparamba	670241
				136	Valapatanam	670010	2778091

Kasargod

What is the procedure to be followed by the ESI beneficiaries to avail super speciality treatment?

The ESI beneficiary should first approach the Medical Officer of the ESI Dispensary to which he/she is attached with all his/her medical records including the concerned specialist’s advice that treatment at super speciality hospital is essential.

The Insurance Medical Officer will the give a letter to the beneficiary for getting eligibility certificate from the local office of the ESI Corporation. The IMO informs him/her on all the procedural formalities to be followed, gives him three photo affixed identity certificates and refers him/her to the Superintendent of the nearby ESI Hospital.

The Superintendent of the ESI Hospital will then examine the patient and verify all the records produced by him. If the case is found to be genuine, he will give a preference letter to the concerned department of the super speciality hospital. The reference letter will contain the details such as name of the patient, two identification marks, home address, name of Insured Person, relationship to the patient, Insurance Number, name of work place, eligibility, diagnosis, clinical history, investigations done, treatment given and the need for reference.

The patient will then attend the super speciality hospital where he is examined and an estimate of the required treatment is issued.

The following documents are then submitted in original and sufficient copies to the Director of Insurance Medical Services for scrutiny and sanction.

If the application is in order, the Director of Insurance Medical Services will forward it to the Government for sanction of teh estimated amount. Once Govt. sanction is accorded, it will be sent back to Director of Insurance Medical Services to meet the expenses from Revolving Fund. The Director of Insurance Medical Services will forward the sanction order to the Regional Director, ESI Corporation, Thrissur for the issue of cheque. The RD will send the cheque favouring the head of the Medical Institution to the Director of Insurance Medical Services, who in turn will send it to the concerned hospital and also inform the Insured Person immediately.

Once the treatment is completed the bills for the utilized amount, demand draft in favour of RD, ESIC, Thrissur for the unutilized amount, utilization certificate and treatment certificate are to be sent to the Director of Insurance Medical Services by the Hospital authority.

3.  What is the procedure for availing treatment from Regional Cancer Centre? (Treatment on credit)

The reference letter is obtained from the Superintendent, ESI Hospital, as above and the patient can straightaway start treatment at the RCC. Copies of the reference letter and other documents are forwarded to the Director of Insurance Medical Services by the Superintendent.

Once treatment is completed RCC will submit the bills with copies reference letter, entitlement certificate, identification certificate and the treatment certificate to the Director of Insurance Medical Services. The bills are passed and sent to the Government for sanction. The sanction order is sent to the RD for payment. On receiving the cheque from RD, Thrissur, the Director of Insurance Medical Services will forward it to the Regional Cancer Centre.

4. Which are the Hospitals in the State where ESI beneficiaries can avail super speciality treatment>

i. All Medical College Hospitals (Government)

ii. Regional Cancer Centre

iii. Sree Chithira Thirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram

iv. Amritha Institute of Medical Sciences & Research Centre, Kochi

v. Fathima Hospital, Kozhikode

5. What is the procedure for getting money re-imbursed for purchasing medicines which are not available in ESI Institutions from outside?

First the details of all drugs purchased should be entered in an essentiality form. The bill and the essentiality form should then be countersigned by the doctor who prescribed it affixing seal. The bill, essentiality form, doctor’s prescription and an application in white paper should then be submitted to the IMO of the Dispensary.

Treatment under Regulation – 96A

Regulation 96-A reads as follows:- claims of expenses incurred in respect of medical treatment of Insured Person and his family may be accepted in circumstances and subject to such conditions as the Corporation may be general or special order specify.

The following conditions have been laid down under this regulation:

A list of Types of cases for which re-imbursement is permitted is given below: -

1.  Serious cases of accident or illness admitted directly into recognized hospital’s where owing to the clinical condition of the patient, being unconscious or otherwise, it was not possible to reveal his identity; as an ESI patient and the hospital authorities recovered hospital expenses directly from the patient or the employer.

2.  Serious cases of accident / illness where a beneficiary was admitted directly at a Private Hospital or in a non-recognized Hospital where admission in a hospital recognized under the scheme would have seriously jeopardized his health like sudden heart attacks, fracture of the spine, cerebral hemorrhage etc.

3.  Expenditure incurred on investigation for blood transfusion which is not available in the ESI Hospitals.

4.  In respect of specialized examination, laboratory test, X-ray, other imaging services etc, recommended by specialist and which is beyond the scope of the facilities available in the ESI/empanelled Hospitals.

State Public Information Officer and State Assistant Public Information Officer or the Insurance Medical Services Department as per Right to Information Act 2005 are the following: - 

District	State Public Information Officer	Asst. Public Information Officer
Thiruvananthapuram	Dr. V.A John, Joint Director, O/o the Director of Insurance Medical Services, Trivandrum	Sri. N.Rajeev, Head Clerk| O/o the Director of Insurance Medical Services, Trivandrum
Kollam	Smt. K.C.Prabhadevi, Senior Supdt, O/o the RDD, Kollam	Sri. R.Unnikrishnan, U.D Clerk O/o the RDD, Kollam
Pathanamthitta	Dr. Bindu. K. Gopal, IMO ESI Dispensary, Kadampanad	Smt. Monikkamma Joseph, Head Clerk
Alappuzha	Dr. R.Ajitha Nair, Supdt ESI Hospital, Beach Ward, Alappuzha	Smt. P.R.Prasannakumari, Junior Supdt. ESI Hospital, Alappuzha
Kottayam	Dr. M.C. Mathew, Supdt ESI Hospital, Vadavathur	Sri.K.Sudarsanalal, Junior Supdt ESI Hospital, Vadavathur
Idukki	Dr. Binny James Dantes, IMO ESI Dispensary, Thodupuzha	Smt. Annamma Eapen, U.D Clerk ESI Hospital, Thodupuzha
Ernakulam	Smt. K.Vanaja, Senior Supdt. O/o the RDD, Ernakulam	Sri. P.K.Dileep, U.D Clerk O/o the RDD, Ernakulam
Palakkad	Dr.K.S.Vijayasree, Supdt. ESI Hospital, Palakkad	Smt. V. Valsala, Head Clerk ESI Hospital, Palakkad
Kozhikode Wayanad	Sri. P.P.Apputty, Senior Supdt. O/o the RDD, Kozhikode	Sri.M.Vijayan, U.D Clerk O/o the RDD, Kozhikode
Kannur	Dr. K. Sukumaran, Supdt. ESI Hospital, Thottada	Sri.A.Sivaprasad, U.D.Clerk ESI Hospital, Thottada
Kasargod	Dr. Subha, IMO ESI Dispensary, Kasargod	Sri. Purushothaman, U.D Clerk ESI Dispensary, Kasargod