This notice informs all ESIC user locations about the ongoing policy for Super Specialty Treatment (SST) for insured persons (IPs) and their families, following the circular dated August 18, 2020. In line with the Hon’ble High Court’s directives, the Employee State Insurance Corporation (ESIC) provides SST from the first day of employment. However, there have been recent fraudulent activities exploiting this provision, particularly regarding costly treatments like enzyme replacement therapy and cancer care, through dishonest entries in the ESIC system. This notification was published on July 25, 2024.
To protect the integrity of SST provisions, the following measures must be strictly enforced: thorough verification of high-cost treatment cases; increased scrutiny to uncover potential collusion between employers and pharmaceutical firms; stringent assessment criteria for SST approvals; regular audits to detect fraud; and detailed document verification for all new cases. Compliance with these guidelines is essential to ensure that genuine IPs and their families receive the benefits they deserve while safeguarding the system against exploitation.
