CLINICS REQUIRED FOR MEDICAL CARE TO INSURED PERSONS UNDER ESI
Applications are invited from private doctors running clinics / nursing homes to
provide primary medical care to ESI beneficiaries in areas of Kalpetta, Sulthanbatheri,
Mananthavadi and Meenangadi (in Wayanad District) on ESI Terms & Conditions by
25th July, 2011. Approximate number of ESI beneficiary units attached to the areas are as
follows:-
Kalpetta - 1000
Sulthanbatheri - 1300
Mananthavadi - 450
Meenangadi - 250
For more details contact State Medical Commissioner, ESI Corporation,
Panchdeep Bhavan, Thrissur - 20.
Terms and conditions of service of Empanelled Private Clinics
Some of the important terms and conditions to be Empanelled Clinics / Medical
Practitioners here in after called as Insurance Medical Practitioners (IMP)
(a) ECs/IMP is responsible to treat
The persons for whose treatment ECs/IMP is responsible:-
i. all persons whom he has accepted or agreed to accept for inclusion in his list
and who have not been notified to him by the Director / SMC / BOM as having
ceased to be on their list;
ii. all persons who have been assigned to him and who have not been notified to
him as having ceased to be on his list;
iii. any Insured Person who needs treatment in case of an accident or other
emergency; and
iv. all persons for whom he may be required under the terms of the Allocation
Scheme to provide treatment pending their acceptance by or assignment to
the clinic.
(b) Range of service by ECs/IMP
i) The ECs/IMP is required to render to his patients all proper and necessary
treatment of the kind of General Medical Practitioners.
ii) The ECs/IMP is required to arrange for the confinement of an insured
woman / woman beneficiary on his list either by himself or by a registered
midwife or a trained dai, for which such separate fee, as the State
Government may specify will be paid for the person who conducted the
confinement.
iii) In the case of an emergency, including abnormal or difficult maternity cases,
the ECs/IMP is required to render whatever services are possible having
regard to the circumstances, in the best interest of the IP & family members.
(c) Home Visit by IMP
An IMP is required to visit and treat an IP & family members at his residence
whom he has accepted on his list and whose condition is such, that he / she
cannot reasonably be expected to come to his clinic.
(d) Medical Certificate
An IMP is required to issue to his patients free of charge, any certificate
reasonably required in respect of sickness, maternity, employment injury and
death under Regulations or as may be required from time to time by the
Corporation or Director / SMC.
(e) Maintenance of Records
An IMP is required:
i) to keep such records as the State Government or Director / SMC may, from
time to time specify in consultation with the Corporation.
ii) to maintain a medical record in respect of each insured person on his list on the forms laid down by the Corporation for the purpose and in accordance
with the instructions issued by the Corporation in this behalf from time to
time.
iii) to furnish returns in such forms as may be laid down by the Corporation or
the State Government or the Director / SMC.
iv) upon knowledge of the death of an insured person, to forward the medical
record to the Director / SMC within seven days.
v) to accept ESIC-86, TIC, ESIC-37, 105, 166, 48 etc. as prescribed by the
Corporation.
(f) Consultation etc, with Medical Referee
An IMP is required:
i) to furnish in writing to the Medical Referee (MR) within such reasonable
period as the later may specify any clinical information which he may require
with regard to any insured person to whom the IMP has issued or declined to
issue a medical certificate.
ii) to meet the MR, at his request for the purpose of examining in consultation
any patient in respect of whom the IMP has sought the advice of the MR.
iii) to afford the MR access at all reasonable time to the IMP’s clinic or other
place where the records required by these terms of services are kept for the
purpose of the inspection of such records and to furnish to the MR such
records or necessary information with regard to any entry therein, as he
may request; and
iv) to answer any enquiries of the MR with regard to any prescription or
certificate issued by the IMP or to any statement made in any report
furnished by him under these terms of services.
(g) Arrangements for Practice
i) An IMP shall not carry on any insurance practice elsewhere other than at
his place of residence, or at the clinic stated in his application except upon
conditions which appear to the Director / SMC or on appeal, to the State
Government to be such as to enable his obligations under these terms of
service and in particular his obligation to visit his patients, to be adequately
carried out. Any condition so imposed may include a requirement that the
insured persons on the list of the IMP are to be notified at IMP’s expense of
any special arrangements under which his practice is carried on.
ii) An IMP shall make all necessary arrangements for securing the treatment
of his patients when he is unable for any cause e.g. temporary absence
from home or other reasonable cause to give treatment personally and
shall inform the Director / SMC, the MR and the Local Office of the
Corporation of any standing arrangements for that purpose and he shall not
absent himself from his practice for more than one week without first
informing the Director / SMC of proposed absence and of the person or
persons responsible for conducting his practice during such absence.
(h) Acceptance of fees
An IMP shall not demand or accept any fee or other remuneration in respect of
any medical treatment, whether under these terms of service or not, rendered to
beneficiaries except as provided under the rules.
Capitation Fee
They will be given capitation fee per IP unit per annum for the IP units attached
to them as decided by ESI Corporation. However they may quote expected capitation
fee in their application.
Medicines to be kept:
List of Medicines to be kept by the IMP is shown separately.
Period of Contract
The period of contract will be for one year initially or till the ESI Corporation starts
its own dispensary / arrangement. The period of contract can be terminated by either
party by giving 3 months notice. All the disputes will be under Trichur Jurisdiction
For more details click here or visit http://esic.nic.in
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