Entitled ESI beneficiaries to get treatment under Modicare

The release said PMJAY beneficiaries may get in-house medical treatment services as per Ayushman Bharat-approved packages from underutilised ESI hospitals and the National Health Agency (NHA) will make payment to ESIC directly.

The Employees' State Insurance Corporation (ESIC) decided to provide cashless secondary and tertiary medical care services under Ayushman Bharat package rates to "entitled" ESI beneficiaries in the "newly-implemented areas of 102 designated districts" through PMJAY-empanelled hospitals.

It will be implemented in states where Pradhan Mantri Jan Arogya Yojana (PMJAY) has been adopted.

An official release said that ESI beneficiaries will be dealt through PMJAY logistics/IT facilities for registration, billing and other services and medical expenditure as is done for PMJAY beneficiaries up to a limit of Rs 5 lakh.

Beyond this, an individual case will be channelled to the ESIC for approval for further expenditure.

The release said PMJAY beneficiaries may get in-house medical treatment services as per Ayushman Bharat-approved packages from underutilised ESI hospitals and the National Health Agency (NHA) will make payment to ESIC directly.

The state governments running ESIS medical scheme will be requested to enrol ESIS hospitals under Ayushman Bharat scheme for providing medical services to PMJAY beneficiaries similar to ESIC hospitals, it added.