Compliance with ESIC Pensioners' Medical Scheme - A Crucial Directive

Notification No.: D-12/17/05/2018-E-VI

Introduction

The Employees' State Insurance Corporation (ESIC) has recently issued a circular addressing the ongoing issues related to the compliance of the ESIC Pensioners' Medical Scheme (PMS) 2006. This scheme, which was revised in 2021, is designed to ensure that pensioners and their families receive the necessary medical facilities, almost on par with the Central Government Health Scheme (CGHS). However, recent complaints have highlighted a lack of adherence to these guidelines by some Nodal Officers and ESIC doctors.

Key Points of the Circular

1. Background of the Scheme: The ESIC Pensioners’ Medical Scheme was originally implemented to provide comprehensive medical coverage to pensioners and their families. The 2021 revision further enhanced these provisions, making the scheme more aligned with the benefits offered under CGHS.

2. Complaints Received: ESIC has been receiving complaints from pensioners and pensioners' forums regarding the non-compliance of the revised guidelines. These complaints indicate that certain Nodal Officers and ESIC doctors are not following the procedures laid out by the ESIC Headquarters, causing inconvenience to the pensioners.

3. Revised Guidelines of 2021: The revised guidelines, effective from May 25, 2021, include provisions for cashless super-specialty treatment, emergency medical treatment, and treatment at both ESIC and private hospitals. The guidelines also cover treatment on a reimbursement basis, ensuring that pensioners receive the best possible care without undue financial stress.

4. Directive for Compliance: The circular strongly urges all Nodal Officers and ESIC doctors to adhere strictly to the guidelines issued by the ESIC Headquarters. This is crucial to ensuring that pensioners receive their entitled medical benefits without any delays or complications.

5. Action Required: Regional Directors and Nodal Officers are instructed to monitor and ensure full compliance with the ESIC Pensioners' Medical Scheme. Any lapses in following the prescribed procedures could result in disciplinary actions.

Conclusion

The ESIC Pensioners' Medical Scheme is a vital lifeline for retired employees and their families. The recent circular (Notification No. D-12/17/05/2018-E-VI) underscores the importance of strict compliance with the scheme's guidelines to ensure that pensioners continue to receive the care they deserve. ESIC is committed to addressing the concerns raised and ensuring that all officials follow the established protocols to maintain the scheme's integrity and effectiveness.

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