Posted on 02nd Aug 2018 | 2909 views

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ESIC medical reimbursement claim form

ESI is scheme implemented by the ministry of labor and employment it for protection social security of the employees in this scheme the employee will contribute 4.75% from his salary and employer will contribute 1.75% towards employee ESI. This payment can be claimed later in time of unexpected events or sickness or maternity etc... employers, in order to draw benefits from this scheme particular from issued ESIC i.e. employee state insurance corporation to be filled and submitted to use these benefits, .employee the insurance corporation is a government entity which governs every state insurance fund .ESIC medical reimbursement claim form issued for claiming benefits for sickness and temporary disablement or maternity.

ESIC medical reimbursement claim form

ESIC medical reimbursement form downloads

ESIC medical reimbursement form download can be downloaded from the ESIC official website www.ESIC.in but it has to be submitted to the nearest ESIC regional office in the which establishment the employee must be under its jurisdiction

ESI reimbursement

There is a difference between medical reimbursement and medical claim. Medical reimbursement is for medical expenses incurred by the employee in day to day medicines and doctor prescription and only bills and prescripts are required to fill up medical reimbursement form. Medical claim is an insurance policy is used when an employee needs hospitalization expenses these expenses directly remitted to the hospital, not the employee. to avail medical claim particular individual needs to be hospitalized at least for 24 hrs some exceptions can be made conditions like cataract surgery .as for medical reimbursement employee is provided with 15000 RS as payment for the expenses but it can be more than the payment will be taxable. The employee needs to submit original medical bills for any kind of medical expenditure

Medical bill format for reimbursement

medical bill format for ESIC reimbursement contains following details

Filled claim form

Medical Certificate/ Form signed by the doctor who is treating an employee

Discharge card (original), availed at the hospital.

All bills and receipts (original)

Accident case, then the FIR

Medico-Legal Certificate (MLC

Investigation report


Cash memos availed at pharmacies/ the hospital.


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