ESIC Issues Circular on Enhanced Scrutiny for SST Cases

The Employees’ State Insurance Corporation (ESIC) has issued a circular emphasizing the need for strict verification and scrutiny of documents in Super Specialty Treatment (SST) cases. In response to recent instances of fraud involving high-cost treatments, the ESIC is implementing enhanced measures to ensure only genuine cases receive SST benefits. The circular outlines comprehensive checks, particularly for cases where the diagnosis date precedes ESIC registration, and mandates rigorous scrutiny to prevent potential collusion between employers and pharmaceutical companies. These steps aim to protect the integrity of ESIC’s healthcare provisions and ensure that resources are allocated to deserving insured persons (IPs) and their families. This notification was published on 28/08/2024.