**Executive Summary:**
This notification from the Employees' State Insurance Corporation (ESIC) announces draft regulations to amend the Employees' State Insurance General Regulations, 1950. It concerns referrals for super-specialty treatment to tie-up hospitals and the associated expenditure borne by ESIC. The public has 30 days from the date the Gazette is available to submit objections or suggestions.
**Key Points / Main Content:**
* **Amendment Purpose:** To introduce a new Regulation 96C in the Employees' State Insurance General Regulations, 1950.
* **Regulation 96C: Referral for Super-Specialty Treatment**
* Allows the Corporation or State Government to refer a beneficiary to tie-up hospitals for super-specialty treatment.
* The cost of such treatment will be directly borne by the ESIC, subject to fund availability.
* **Eligibility Criteria:**
* **Insured Person:** Must have completed a minimum of six months of insurable employment from the date of registration.
* Must have contributed for at least 78 days in the relevant contribution period, including the period of registration.
* **For Family Members:** The insured person must have completed one year of insurable employment.
* Must have contributed for at least 78 days in each of the two contribution periods.
* The benefit is available to the insured person or beneficiary in the corresponding benefit period.
* **Objections and Suggestions:**
* Any objections or suggestions regarding the draft regulations must be submitted within 30 days of the Gazette's publication.
* Submissions should be addressed to Shri S. Ravichandran, Additional Commissioner PD, ESIC, New Delhi.
**Impact Analysis:**
* **ESIC:**
* *Impact:* Will bear the cost of super-specialty treatments at tie-up hospitals, manage referrals, and consider public feedback on the draft regulations.
* *Action Required:* Implement the new Regulation 96C, process referrals, and review/address any objections or suggestions received.
* **State Governments:**
* *Impact:* May be involved in referring beneficiaries to tie-up hospitals.
* *Action Required:* Coordinate with ESIC in the referral process.
* **Insured Persons & Beneficiaries:**
* *Impact:* Provides access to super-specialty treatments at tie-up hospitals, subject to eligibility criteria.
* *Action Required:* Ensure they meet the eligibility criteria (contribution and employment period) to avail of the benefit; submit objections/suggestions on the draft regulation if desired.
* **Tie-up Hospitals:**
* *Impact:* Will provide super-specialty treatment to referred beneficiaries, with costs covered by ESIC.
* *Action Required:* Coordinate with ESIC regarding patient referrals and billing procedures.
Key Entities Referenced
Employees' State Insurance Corporation: A statutory body responsible for administering the Employees' State Insurance scheme in India.
Employees State Insurance Act, 1948: The legislative act that governs the Employees' State Insurance scheme in India.
Employees' State Insurance General Regulations, 1950: Regulations supplementing the Employees' State Insurance Act, 1948.
New Delhi: The location of Employees' State Insurance Corporation, Panchdeep Bhawan.
Shri S. Ravichandran: Additional Commissioner PD, Employees' State Insurance Corporation.
Panchdeep Bhawan: Office address of Employees' State Insurance Corporation at C.I.G. Marg, New Delhi.
Regulation 96C: A new regulation to be inserted in the Employees' State Insurance General Regulations, 1950 regarding referral for super speciality treatment to tie-up hospitals.
State Government: The State Government that may refer a beneficiary to a tie-up arranged medical facilities
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7146 GI/2018 (1)2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC. 4]
EMPLOYEES' STATE INSURANCE CORPORATION
NOTIFICATION
New Delhi, the 26th November, 2018
No. N-12/13/1/2016-P&D.—The following draft regulations further to amend the Employees’ State Insurance
(General) Regulations, 1950, which the Employees' State Insurance Corporation purposes to make in exercise of the
powers conferred under sub-section (1) of Section 97 of the Employees’ State Insurance Act, 1948 (34 of 1948), is
hereby published under 59A of the said Act for information of all persons likely to be affected thereby and notice is
hereby given that the said draft regulations will be taken into consideration after expiry of a period of Thirty days from
the date on which copies of the Official Gazette in which this notification is published, are made available to the
public:—
1. Any objection or suggestion, which may be received from any person in respect of the said draft regulations
within the period specified above, will be considered by the Employees' State Insurance Corporation.
2. The objections and suggestions, if any, may be addressed to Shri S. Ravichandran, Additional Commissioner
(P&D), Employees' State Insurance Corporation, Panchdeep Bhawan, C.I.G. Marg, New Delhi-110002
(e-mail: dir-pnd@esic.nic.in )
DRAFT REGULATIONS
In the Employees' State Insurance (General) Regulations, 1950, a new Regulations 96-C shall be inserted as
under:
Regulation 96C: REFERRAL FOR SUPER SPECIALITY TREATMENT TO TIE-UP HOSPITALS AND
EXPENDITURE TO BE DIRECTLY INCURRED BY EMPLOYEES' STATE INSURANCE CORPORATION.
Subject to the provisions of the Act and the Regulations, the Corporation or State Government may refer a beneficiary to
a tie-up arranged medical facilities, where cost of such facility is borne directly by the Corporation and where the fund
permits; an Insured person should have completed a minimum of six months of insurable employment from the date of
registration and have contributed not less than seventy eight (78) days in the relevant contribution period including in
which registration was made. However, where the facility has been extended to the family members, an Insured Person
should have completed a minimum of one year of insurable employment and have contributed for not less than seventy
eight (78) days in each of the two (2) contribution period and such benefit shall be available to an insured person or a
beneficiary in the corresponding benefit period.
S. RAVICHANDRAN, Addl. Commissioner (P&D)
[ADVT.-III/4/Exty./392/18]
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064
and Published by the Controller of Publications, Delhi-110054.