On February 11, 2025, the Employees’ State Insurance Corporation (ESIC) issued an important circular regarding the financial support for the repair or replacement of cochlear implants for its beneficiaries. This policy change is aimed at providing better healthcare benefits to those in need of such specialized medical devices.
Key Highlights of the Circular:
- 100% Expenditure Coverage: ESIC has approved bearing 100% of the cost up to a ceiling of ₹5,35,000 for the repair or replacement of cochlear implants for its beneficiaries, on a cashless basis. This means that eligible beneficiaries will not need to pay out of pocket for these procedures, which are often expensive.
- Scope of Coverage: The coverage extends to:
- Repair and replacement of cochlear implants, including components like speech processors, microphones, and other wearable parts (excluding cords and batteries).
- This will be provided on a cashless basis, meaning that beneficiaries will not need to pay upfront and can receive the procedure without having to wait for reimbursement.
- Eligibility: For the cochlear implant upgrade or replacement to be covered, the opinion of two ENT surgeons from a government hospital must be obtained, confirming that the procedure is necessary. This decision aligns with the guidelines provided by the Central Government Health Scheme (CGHS).
- Ceiling Limit: The maximum coverage amount per beneficiary will be up to ₹5,35,000, which is the ceiling limit approved by ESIC.
- Compliance with CGHS Guidelines: This scheme will be governed by the same guidelines as the Central Government Health Scheme (CGHS) guidelines, which are designed to ensure that the procedure is carried out with due medical standards.
- Implementation: The Regional Directors and Medical Superintendents of ESIC hospitals are tasked with sanctioning and approving the costs under this policy. The approval process will be carried out in a cashless manner, unlike CGHS, which typically requires reimbursement.
- Monthly Reporting: A report on the cases approved and sanctioned under this policy will need to be submitted to the ESIC Headquarters by the 7th of every month.
This new policy will provide significant relief to ESI beneficiaries who need cochlear implants, a critical device for those suffering from severe hearing loss. Cochlear implants are essential for restoring hearing capabilities, especially for individuals whose hearing aids or other devices are no longer effective.
By covering 100% of the costs for the repair or replacement of these implants, ESIC is ensuring that beneficiaries who need these devices can access them without facing financial barriers. The cashless facility will also simplify the process for beneficiaries, making it easier and faster to receive treatment.
This decision reflects ESIC’s commitment to ensuring the well-being of its beneficiaries, particularly those in need of specialized medical assistance, by reducing financial burdens related to essential treatments like cochlear implants.
