The Tamil Nadu Health Department is in the process of improving the services of the Employee State Insurance Hospitals in the state, and has delegated more powers to the officials for speedy reimbursement of ESI benefits to help 15 lakh odd employees in the state.
As per a new Government order, the District Medical Officers (DMO) now have powers to sanction ESI reimbursement bills up to Rs.75, 000, instead of the earlier Rs.5, 000 limit. Further, the medical officers are allowed to send bills directly to the DMO for clearance.
According to sources, this is with a view to help the employees reimburse their medical bills within one-month time. There were complaints that the bills were delaying for many months, as the bills have to be forwarded to the Regional Administrative Medical officer (RAMO), who in turn forward it to DMO for approval. Any bills beyond Rs.5000 were to be forwarded to the ESI headquarters in Chennai for clearance.
The officials have been mandated to conduct review meetings every month to look at the claims and sanction the amounts within a month's time, provided all the required papers are correct. In the case of errors or problems, the officials have to get the papers by contacting the concerned employee through telephone, instead of the routine red tape postal communications. Each of the official has been mandated to clear the claim files within seven working days.
Sources said ESI coverage had been further widened to include specialty and super-specialty treatments, and has included more diseases and claims under the purview of ESI benefits, without any ceiling on maximum claims. Once an ESI approved doctor refers patients for specialty and super-specialty treatments, the employee can avail the ESI benefits from select corporate and private hospitals identified under the scheme. Further, the Government has come out with a new list of clinical tests, and those eligible for ESI could claim refunds for those tests, said sources.
Tamilnadu has about nine ESI hospitals and 179 ESI dispensaries.