Benefits

Medical Benefits   Medical Benefit is the most important of all the benefits available to an Insured Person under ESI. In this state medical benefit is imparted through the Directorate of ESI (Medical Benefit) Scheme under the Department of Labour, Government of West Bengal. The package of medical benefit consists of primary care, secondary care including hospitalization and tertiary care i.e. Super Specialty services though in house facilities, as well through tie up arrangements with reputed Medical Institutions in the state. Besides above supply of Drugs & Dressings is made free of cost, treatment aids like spectacles, hearing aid, denture etc. are supplied to beneficiaries free of cost. There is provision of ambulance service, immunisation and vaccination service at all the ESI centres implemented in the state. The ESI (Medical Benefit) Scheme also participates in National Health Programmes like RNTCP for control of TB and HIV/ AIDs control programme. There is one Blood Bank for collection and supply of blood to the beneficiaries.   Primary Care           For imparting primary care there is a net working of 584 Insurance Medical Practitioners (IMPs) and 41 Service Dispensaries (SDs) dispersed through out the implemented areas in the state. There is also one dispensary for imparting primary care at Khargapur. The primary care net work provides primary level consultation and supply of Drugs & Dressings to the beneficiaries on advice by the ESI doctor.       Secondary Care           Specialist consultation is made available to the beneficiaries through specialist OPDs situated at all the ESI hospitals within the state. The specialist OPDs besides offering consultation also supply 7 days starter medicine to the beneficiaries on the spot.       Diagnostic Infrastructure           All the ESI hospitals have its own in house diagnostic infrastructure like X-ray, USG, clinical pathology, Hematology, Bio Chemistry & Bacteriology. A few of the hospitals also have facilities in Histo-Pathology. Modern investigations like CT Scan, M R I, Angiography, Endoscopy, E R C P etc. are arranged through tie up institutes dispersed though out the implemented area.       In-Patient Care           There are 3335 indoor beds commissioned in 13 ESI hospitals under ESI (Medical Benefit) Scheme. Besides there is one ESI Corporation hospital imparting secondary care run by ESI Corporation directly.       Super Speciality treatment through Tie-up mechanism from premise institutes in the State           The ESI beneficiaries in the state are provided Super Specialty Care in the disciplines of Cardiology including Pacemaker implantation, Neurology, Nephrology (Dialysis), Hand Surgery, Diabetology at the Maniktala ESI Hospital. Services in the discipline of Oncology is provided through Sealdah ESI Hospital. All the other Super Specialty services like Cardiothoracic surgery, Neuro surgery, Reconstructive surgery are provided to the beneficiaries by Cash Less system by tie up arrangement with premier private Institutions in the state.       Supply of Drug & Dressins on advice by ESI doctor           Drugs & Dressings are procured by this Directorate from Firms approved by the Central Rate Contract of ESI Corporation. Total of 378 items of medicine are procured and distributed through 13 ESI hospitals, 41 dispensaries and 11 Rajya Bima Ousadhalaya (RBOs) in the state. Any items of medicine felt necessary for treatment of beneficiaries beyond the list of above 378 drugs are procured through local arrangement and supplied on need based fashion. Post transplantation medicine, Chemotherapeutic agents even human immunoglobulin are procured and supplied to beneficiaries based on need.       Supply of Spectacles, Hearing Aid through office of the AMO           The IPs and beneficiary members of ESI are supplied Spectacles & Hearing Aid through the Office of the Administrative Medical Officer based on recommendation by Scheme Specialist, report of Optometry / Audiometry and certificate from IMP / IMO for obtaining such benefit the IP concerned is required to be in entitled position.       Reimbursment of expenses at ESI approved rates where drugs/services could not be provided           Though detailed arrangements have been made to make Medical Benefit a Cash Less one still in emergencies beneficiaries may have to obtain service from institutions beyond ESI. Such cost of medical treatment is reimbursed to IPs through all the Service Dispensaries, ESI hospitals and Office of the Administrative Medical Officer. Based on the claimed amount reimbursement bill up to Rs.5000/- is received through the dispensaries and paid through the Superintendents. Reimbursement claim above Rs.5000/- is received by the Office of the AMO and paid in due course. The reimbursement so made is subject to the IP entitled and the reimbursement is made strictly at the Govt. approved rate.       Ambulance services on advice by ESI doctor           Ambulance services are available to the beneficiaries at each of the ESI centre implemented in the state. Whenever such services despite being recommended by ESI doctor is not available due to any reason, reimbursement of transportation cost is done as per existing Govt. rate.         Immunisation & recenctions at each ESI Hospital OPD         RNTCP programme implementation though all SDs and Hospitals         HIV-AIDS care through VCCTC at Kamarhati & Maniktala ESI Hospital and STD clinics at Bandel, Uluberia, Budge Budge, Sealdah, Baltikuri & Maniktala ESI Hospitals         Collection & Supply of Blood through Blood Bank at Maniktala ESI Hospital         All diagnostic tests through ESI Hospitals and Tie up arrangments.