Enhancement of reimbursement ceiling on medical expenditure incurred by State ESI Schemes
EMPLOYEES’ STATE INSURANCE CORPORATION
(ISO 9001-2008 CERTIFIED)
PANCHDEEP BHAWAN, C.I.G MARG, NEW DELHI – 110002.
E-mail : [email protected], Website : www.esic.nic.in
File no, Pt.V-13(14)38/09-Med.I(ESIC/SC)
All SSMCs /SMCs/DMD / DMN/RDs / MSs, ESI Corporation
All Principal Secretary Labour/ Health (dealing State ESI scheme)
All DIMSs/AMOs, State ESI Scheme
Sub: Enhancement of reimbursement ceiling on medical expenditure incurred by State ESI Schemes.
Sir / Madam,
Under ESIC 2.0, ESIC, is expanding its medical services with improved quality and equipping its own as well State run. facilities to maximize the medical benefits for ESI beneficiaries. During the meetings held with the State Govts, it was opined that reimbursement ceiling on medical expenditure is insufficient to rollout the medical benefits under ESIC 2_0.
Accordingly, ESI Corporation in its 170th meeting held on 15th December, 2016 has approved the enhancement of ceiling on medical expenditure incurred by State ESI Schemes, as under:
a) Increase in per capita ceiling of sharing expenditure w ith State Governments u/s 58 (3) from Rs. 2150 to Rs. 3000 per IP with sub ceiling of Rs. 1250 for “Administration” and Rs, 1750 for “Others” for the year 2017-18.
b) From 2018-19 “Administrative” sub-ceiling will be increased in line with CPI within the overall ceiling of Rs. 3000/- per capita.
c). The ceiling of Rs. 3000/- will be fixed from 2017-2018 to 2019-20 and reviewed annually from 2020-21 on the basis of WPI and expenditure pattern of the States.
d). The State Govt. shall present Project Implementation Plan (PIP), in accordance with the guidelines issued by ESIC time to time, by 31st October every year for the next financial year for its inclusion of the Budget of the Corporation. The PIP should contain the proposal for next Financial year and the progress made during the first six months of the current year.
i. No scheme should be included which has not been duly approved by the ESIC,
ii. Should it be proposed, during the course of a financial year, to finance any scheme which has not been included into the estimates of that year, the sanction of the ESIC shall he obtained to the method for financing it.
iii. The funds shall not be appropriated for expenditure on any item which has not been approved,
iv. The PO ESIC, is authorised to re-appropriate funds from one primary unit of appropriation to another.
e) Funds for 2017-18, will be released as per current ceiling of Rs.2150/- for the first quarter. However, the PIPs for the year 2017-18 should be submitted by 31st January, 2017 to the ESIC for release of fund as per revised ceiling.
f) The plan submitted would be duly monitored by ESIC, for effective impiementation. The funds shall be released on quarter]y basis in accordance with the letter No. V-24/11/10/2001-Med-I issued on 19th April, 2016.(enclosed).
This is for your information and further necessary action.
(Dr. Naveen Saxena)