To submit the ESIC Medical Acceptance Card Form, you can either email it to the designated HR or insurance department. For those submitting from factories, hand-delivering to the facility's HR office is also an option. Please ensure that the completed form includes all necessary signatures and information to avoid delays in processing.

For 2024, ensure form submissions align with any respective deadlines laid out by your employer or ESIC policies. Important deadlines may include enrollment periods for health services and regular updates required for existing insurance information.

The purpose of the ESIC Medical Acceptance Card Form is to document the medical eligibility of insured persons under the Employees' State Insurance Corporation. It serves as a formal request for inclusion in a doctor's list for medical services. This enables seamless access to healthcare benefits for employees and their dependents.

• 1. Full Name: The complete name of the insured person.
• 2. Father or Husband's Name: The name of the insured person's father or husband.
• 3. Factory Name: The name of the factory or establishment where the insured is employed.
• 4. Residential Address: The current residential address of the insured person.
• 5. Insurance Number: The unique insurance number assigned to the person.
• 6. Reference Number: Any additional reference number linked to the insured's account.
• 7. Doctor's Code Number: The registration code for the verifying doctor.
• 8. Doctor's Signature: The signature of the doctor verifying the details.

Failing to submit the ESIC Medical Acceptance Card can lead to delays in accessing medical services. Unprocessed forms may result in an inability to receive necessary treatment. It is crucial to ensure timely submission to avoid any disruption in healthcare access.

• Delayed Medical Services: Without submission, insured individuals may experience delays in receiving medical care.
• Loss of Coverage: Failure to complete and submit could lead to lapses in medical coverage.
• Complications in Claims: Incomplete forms can create complications for claims processing.

• 1. Changing Doctors: Use this form when you want to switch to a new registered doctor.
• 2. New Insurance Enrollment: Required during initial enrollment into the ESIC medical services.
• 3. Address Updates: Use this form to update your residential address for insurance records.