ESI Reimbursement form is used to claim medical expenses when the insured person gets treatment in private hospitals and expenses incurred during purchases of medicines from Bazar due to non-availability of some medicines in ESI. The Insured person or employer of the insured person should inform the ESI dispensary before admitting the patient to the private hospital and in most cases, if the private hospital not referred by the ESIC officer of the particular ESIC dispensary then the claim will get rejected.
However, it may happen that we could not get the facilities provided by multi-specialty hospitals in ESI hospitals. In such types of cases, it is better to give prior intimation to ESI medical officers and take their reference.
Haryana ESIC Medical Reimbursement Form PDF Download
How to Fill ESIC Medical Reimbursement Claim Form
After downloading the ESI Reimbursement Form, we need to know how to fill this ESIC reimbursement form. This form consists mainly of 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.