Executive Summary:
This notification announces user charges and other details for a scheme related to medical facilities under the Employees State Insurance (ESI) Act of 1948. It follows a draft notification published on April 15, 2019, with no objections received. The notification is effective as of July 22, 2019, and concerns availment of medical services in underutilised ESIC hospitals by Non-Insured Persons.
Key Points / Main Content:
User Charges for Medical Facilities:
* Outpatient Department (OPD) consultation: Rs 10 per consultation.
* Inpatient Department (IPD) care: 25% of Central Government Health Scheme (CGHS) packaged rates applicable for the city (or neighbouring city/state if not available).
* Medicines: Provided at actual cost, if available.
Definition of Underutilised Hospital:
* An ESIC Hospital where bed occupancy is less than 60% during the last two financial years.
Operational Modalities:
* The Director General will specify the names of underutilised hospitals and their operational modalities from time to time.
Impact Analysis:
Non-Insured Persons:
* Impact: Can avail medical services in underutilised ESIC Hospitals.
* Action Required: Pay the specified user charges for OPD and IPD services.
ESIC Hospitals:
* Impact: Underutilised hospitals (bed occupancy less than 60%) will provide services to Non-Insured Persons.
* Action Required: Implement the user charges for Non-Insured Persons and follow operational modalities specified by the Director General.
Director General, Employees State Insurance Corporation:
* Impact: Responsible for specifying the underutilised hospitals and their operational modalities.
* Action Required: Determine and communicate the list of underutilised hospitals and their operational guidelines.
Key Entities Referenced
Employees State Insurance Act, 1948: A labour welfare legislation in India providing for financial protection to employees in certain contingencies.
Employees State Insurance Corporation: A statutory body administering the Employees' State Insurance Scheme.
New Delhi: The location where the notification was issued.
Gazette of India: Official government gazette where the notification was published.
Other Beneficiaries and Members of Their Families Medical Facilities Scheme 2010: A scheme providing medical facilities to certain beneficiaries and their families.
Central Government Health Scheme: A health scheme by the Central Government of India providing comprehensive medical care facilities to central government employees and pensioners.
S. RAVICHANDRAN: Additional Commissioner, as indicated in the document.
Mayapuri, New Delhi: Location of the Government of India Press.
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3746 GI/2019 (1)2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC. 4]
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[िवYापन-III/4/असा./142/19]
EMPLOYEES’ STATE INSURANCE CORPORATION
NOTIFICATION
New Delhi, the 2nd July, 2019
No. 12/13/1/2019-P&D.—Whereas draft notification further to notify the rate of user charges and
other details of the scheme was published as required under sub-section (1) of section 97 of the Employees’
State Insurance Act, 1948 (34 of 1948) in the Gazette of India Part III, Section 4 dated 15.04.2019 for inviting
objections and suggestions from all persons likely to be affected thereby till the expiry of period of thirty days
on which the notification was published, are made available to the public:—
And whereas, the said Gazette Notification was made available to the Public on 27.05.2019
No objections and suggestions were received from any of the person likely to be affected;
Now therefore in exercise of the powers conferred under Sub-para 6 of the “Other beneficiaries and
members of their families medical facilities scheme 2010” as notified vide G.S.R. 654(E) in the Gazette of
India Extraordinary [Part II Section 3(i)] dated 04th August 2010, the Director General, Employees’ State
Insurance Corporation hereby notifies the rate of user charges and other details of the scheme referred to in
Section 73D of the Employees’ State Insurance Act, 1948 (34 of 1948) as the Central Government has
approved the availment of medical services in the under-utilised ESIC Hospital by Non-Insured Persons as
other beneficiaries in the “Other Beneficiaries and Members of Their Families Medical Facilities Scheme
2010” framed under Section 73-B of the ESI Act, 1948 :—
1. Out-Patient Department (OPD) Consultation at the rate of Rs 10/- (Rupees Ten Only) per
consultation.
2. In-Patient Department (IPD) care at the rate of 25% (Twenty Five per cent) rates of Central
Government Health Scheme (CGHS) packaged rates applicable for the city (If not available the
rate of the neighbouring city or the State).
3. Medicines shall be provided (if available) at the actual cost.
4. An underutilised Hospital for the purpose of this notification shall be the ESIC Hospital where the
bed occupancy is less than 60 % during the last two financial years.
5. The name of underutilised hospitals and their operational modalities shall be as specified by
Director General from time to time.
S. RAVICHANDRAN, Addl. Commissioner
[ADVT.-III/4/Exty./142/19]
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.