Introduction
The Employees’ State Insurance Corporation (ESIC) Medical Reimbursement Form PDF is a document that is used to claim reimbursement of medical expenses incurred by an employee or their family members. This form is used to claim reimbursement of medical expenses incurred for treatment of an illness or injury, or for preventive health care. The form is available for download from the ESIC website and can be filled out and submitted to the ESIC office for processing. The form requires the employee to provide details of the medical expenses incurred, the diagnosis and treatment received, and the amount of reimbursement being claimed. The form also requires the employee to provide proof of the medical expenses incurred, such as receipts or bills. Once the form is submitted, the ESIC office will review the claim and process the reimbursement accordingly.
ESIC Medical Reimbursement Form PDF [Download]
The ESIC Medical Reimbursement Form is a document used by employees of the Employees’ State Insurance Corporation (ESIC) to apply for reimbursement of medical expenses. The form is available for download in PDF format and can be filled out online or printed and filled out manually. The form requires the employee to provide details such as name, address, date of birth, and other personal information. The employee must also provide details of the medical expenses incurred, including the date, amount, and type of expense. The form must be signed and submitted to the ESIC office for processing.
ESI Reimbursement form is used to claim medical expenses when the insured person gets treatment in private hospitals. The Insured person or employer of the insured person should intimate the ESI dispensary before joining the patient in the private hospital and in most of the cases if the private hospital not referred by insurance officer of the particular ESIC dispensary then the claim will get rejected.
In general, we couldn’t get the facilities provided by multi-specialty hospitals in ESI hospitals. In such cases, it is better to give prior intimation to ESI medical officer and take their reference.
Download ESI Medical Reimbursement Claim Form in PDF Format
You may also like: Is it possible to do ESI number search by name
How To Fill ESIC Accident Report Form 12 In Online
Required Documents Along With ESI Reimbursement Form
- All the medical bills like operation charges, pharmacy charges, room service charges, and ICU charges, etc.
- Discharge card from the private hospital where the insured person got treatment.
- Emergency Certificate.
- ESIC Pehchan Card of the insured person.
- A letter from the employer side regarding accident cause and request to release the claim amount.
- Bank passbook xerox copy of an insured person.
How to Fill ESIC Medical Reimbursement Claim Form
After doing ESI Reimbursement Form download we need to know how to fill this ESIC reimbursement form. This form consists mainly Two parts one part has to be filled by IMP ( Insurance Medical Practitioner ) or IMO ( Insurance Medical Officer ) and the second part has to be filled by hospital authorities where the insured person was treated.
ESIC Medical Reimbursement Form
The Employees’ State Insurance Corporation (ESIC) provides medical reimbursement to its insured persons and their dependents. The ESIC Medical Reimbursement Form is used to claim reimbursement for medical expenses incurred by the insured person or their dependents. The form is available for download from the ESIC website.
What is the ESIC Medical Reimbursement Form?
The ESIC Medical Reimbursement Form is a form used to claim reimbursement for medical expenses incurred by the insured person or their dependents. The form is available for download from the ESIC website. The form must be filled out and submitted to the ESIC office along with the relevant documents and bills.
What information is required to fill out the ESIC Medical Reimbursement Form?
The ESIC Medical Reimbursement Form requires the following information:
- Name of the insured person
- Name of the dependent
- ESIC number
- Details of the medical expenses incurred
- Receipts and bills for the medical expenses
Where can I download the ESIC Medical Reimbursement Form?
The ESIC Medical Reimbursement Form is available for download from the ESIC website. The form can be downloaded in PDF format.
Conclusion
The ESIC Medical Reimbursement Form is used to claim reimbursement for medical expenses incurred by the insured person or their dependents. The form is available for download from the ESIC website. The form must be filled out and submitted to the ESIC office along with the relevant documents and bills.
