Question : Empanelling of New Private Hospitals

(a)whether more private, non-Government sector hospitals are being empanelled to ensure better facilities to the beneficiaries in the absence of super specialty facilities in several ESI hospitals;
(b)if so, the details thereof;
(c)whether the Government has received complaints from the beneficiaries regarding the present reimbursement process, for treatments availed from private hospitals;
(d)if so, the details thereof along with the action taken by the Government on said complaints; and
(e)the other corrective steps taken/being taken by the Government in this regard?

MINISTER OF STATE(IC) FOR LABOUR AND EMPLOYMENT
(SHRI BANDARU DATTATREYA)

(a) & (b): State Medical Commissioners (SMCs) and Directors Insurance Medical Services (DsIMS) have been instructed to make tie-up arrangements for each Employee State Insurance (ESI) hospital such that each Super Specialty discipline should have two tie-up hospitals having such Specialties subject to maximum of 5 tie-up hospitals with each Hospital. It has also been decided that the respective SMCs may empanel, over and above the ceiling of 5 tie-up hospitals, as per requirement and with due justifications.

(c) to (e): Though immediate action is taken to redress the individual complaints, the ESI Corporation has reviewed the standard procedure and issued guidelines on 22.6.2016 streamlining the process of reimbursement of medical claims in respect of Insured Persons/ beneficiaries for the treatment taken outside the State/Region. For medical reimbursement of treatment taken by the ESI beneficiaries in case of emergencies from a non-ESI/private hospital, the instructions were earlier issued according to which bills are reimbursed as per CGHS approved rates after ascertaining emergency and entitlement.

********