[Padmini Veeranki]

Just to add

In simple steps first check answers to the below questions,

How was the GMC enrollment done, I am sure the employee would have been communicated about the coverage and limit before issuing the card. Which itself is evidence that the employee is aware of band movement ( out of ESI Bracket).

Check whether the hospitalization was in ESI network hospitals. Then,

Check why the employee didn’t flash an ESI card for hospitalization if he/she was not aware of the Band movement (this will give you the answer if the person is playing games).

Second, In case the hospitalization in ESI based hospital you Check when the ESI was terminated, in most cases the ESI is active for 6 months even though payment has not been made. so if not terminated and the card is active, you can ask the employee to give his ESI card for a record to the hospital.

Having said the above, You can resort to legal action or involve a labor expert to resolve this, which again involves consultant fees and legal fees. If the difference amount is not huge, take it as a special case and clear the same from management on a compassionate basis.

Hope this helps. In case you need to discuss this in length I am available please drop me a note at veeranki10@gmail.com

[Padmini Veeranki]

Dear Shraddha

It’s important to address it with care and fairness.

Firstly, we should review the circumstances and facts surrounding the case. If the employee genuinely wasn’t aware of the GMC policy or wasn’t educated about it despite the policy being available in the employee self-service portal, it indicates a potential communication gap. It’s crucial to investigate whether there was a breakdown in communication or if the employee was not provided with adequate information about the policy transition.

Here’s a suggested approach:

Review the Communication: Examine the records of communication regarding the policy transition. Ensure that the employee received the necessary notifications and had access to the policy details.

Assess the Situation: Consider the medical exigency and the extent to which the expenses exceeded the employee’s eligibility. If the employee’s request is reasonable and genuinely due to a lack of awareness, it may be appropriate to assist.

Educate and Communicate: If the review reveals a communication gap, take steps to educate the employee about the policy and its coverage. Ensure that they understand the policy details going forward.

Consider Exceptional Assistance: In exceptional cases where it’s clear that the employee was genuinely uninformed, and the expenses are significant, you may consider assisting the employee with a one-time exception. However, clearly communicate that this is an exception and not a policy precedent.

Policy Review: Use this situation as an opportunity to review your communication and onboarding processes regarding policy changes. Ensure that employees are adequately informed and educated about any transitions in timely manner

Prevent Misuse: To prevent potential misuse, emphasize the importance of adhering to policies and procedures. Reiterate that exceptions will only be considered in cases of genuine lack of awareness.

I hope the above helps

[Padmini Veeranki]

Hi Priya,

Can you specify the objective behind this ? so i can help.