The Scheme provides full range of medical care, namely; (i) Out-patient services (ii) Specialists’ services; and (iii) Hospital services; through a network of dispensaries, diagnostic centres and ESI Hospitals, etc.  Super-specialities are provided to the beneficiaries through the country’s most advanced medical institutions for which payments are made directly by the Employees’ State Insurance Corporation to the institution concerned.

         An Insured Person and his family members become entitled to medical care from the date he enters the insurable employment and the entitlement continues as long as the insured person is in insurable employment or is qualified to claim sickness, maternity or disablement benefit.  The entitlement to medical care is extended upto two years to persons suffering from 34 specified chronic or long term diseases.  Medical treatment to persons, who go out of coverage during the period of treatment, is not discontinued till the spell of sickness ends.  All Insured Persons and members of their families are entitled to full and comprehensive medical care package consisting of;

• Out patient treatment;
• Domiciliary Treatment (treatment by visits at their residences ;)
• Specialist consultation;
• In patient treatment;
• Free supply of drugs, dressings, artificial limbs, aids and appliances;
• X-ray and laboratory investigations;
• Vaccination and preventive inoculations;
• Ante-natal care, confinement and post-natal care;
• Ambulance service or conveyance charges for going to hospitals, diagnostic centres, etc. wherever admissible;.
• Family welfare services and other national health programme services;
• Medical certification; and
• Special provisions including super-specialist facilities.


Extension of medical cover to the Retired (Old Age Medicare) and Disabled Insured           Persons and their spouses

              The scheme provides for a comprehensive medical cover to the retired and disabled insured persons and their spouses on payment of a nominal sum of Rs.120/- per annum per couple.  The scheme, thus, offers total medical cover to the retired and disabled without any upper ceiling of expenditure at the lowest premium when compared with medical cover schemes introduced by some other insurance agencies.

              With a view to ensuring that the medical facilities are of the required standard, the Employees’ State Insurance Corporation has appointed medical experts such as Medical Referees and the Senior State Medical Commissioners who conduct periodic inspections of dispensaries, hospitals and panel clinics.  There is also a high powered committee known as General Purposes Sub-Committee of the E.S.I. Corporation comprising representatives of parliament, employers, employees, medical profession, State Govts. and the E.S.I. Corporation, that visits E.S.I. institutions periodically and holds meetings with the representatives of employers, employees and the State Govt., to advise and suggest measures for improving the medical services under the Scheme.