BENEFITS UNDER ESI SCHEME.

Medical Benefit :

The Scheme provides full range of medical care to Insured person and family, through a network of ESI Dispensaries & Panel clinics, diagnostic centres and ESI Hospitals etc. Super speciality facilities are provided to the beneficiaries through recognised advanced medical institutions empanelled for the purpose on referral basis. The

Corporation has set up a revolving fund in most of the States to ensure smooth flow of funds for super-speciality treatment of ESI beneficiaries. All Insured Persons and members of their family are entitled to free, full and comprehensive medical care under the Scheme. The package covers all aspects of health care from primary to super speciality facilities. 

Sickness Benefit :

Sickness Benefit represents

periodical cash payments made to

an IP during the period of

certified sickness occurring in a

benefit period when IP requires

medical treatment and attendance

with abstention from work on

medical grounds. 

 

The maximum duration of Sickness Benefit is 91 days in two consecutive benefit periods. There is a waiting period of 2 days which is waived if the insured person is certified sick within 15 days of the spell for which sickness benefit was last paid. The sickness benefit rate is roughly equivalent to 50% of the average daily wages of the insured person. 

Maternity Benefit 

Maternity benefit consists of periodical cash payments in case of confinement or miscarriage or sickness arising out of pregnancy, confinement, premature birth of child or miscarriage, to an insured woman as certified by a duly appointed medical officer or mid wife.  

Disablement Benefit 

Disablement benefit is admissible for disablement caused by employment injury. At the first instance, temporary disablement benefit is payable as long as the temporary disability lasts. If the employment injury results in partial or total/permanent disability, permanent disablement benefit is payable till the death of the insured person. 

Dependant Benefit

Dependants' benefit consists of periodical payments to dependants of an insured person who dies as a result of an employment injury sustained as an employee under the ESI Act. 

There are no contributory conditions for qualifying to this benefit. Thus, if a person

dies of employment injury even on the first day of his employment, his dependants are entitled to the benefit

Funeral Expenses 

Funeral expenses are in the nature of a lump sum payment upto a

maximum of Rs. 2500/- made to defray the expenditure on the

funeral of deceased insured person. The amount is paid either to the

eldest surviving member of the family or, in his absence, to the person who

actually incurs the expenditure on the funeral.

CONTRIBUTION

Contribution is the amount payable to the Corporation by the Principal Employer in respect of an employee and comprises the amount payable by the employee and the employer. 

t is obligatory on the part of the employer to calculate and remit ESI Contribution comprising of employers' share 4.75% plus employees' share of 1.75% which is payable on or before 21st of the following month, to the month to which the salary relates. If the employee is drawing upto Rs.50/- as daily average wage, he is exempt from the payment of his share of contribution. The employer is however to pay employer's share of 4.75% of the salary received/receivable by the employee.

Recovery of contribution

In the first instance the Principal Employer is to pay employers' share of contribution in respect of every employee whether employed directly or through immediate employer. The employees' share may thereafter, be recovered  by making deduction from their wages for the wage period for which contribution is, however is payable. No such deduction may be made from any wages other than those relating to the period in respect in which contribution is payable. 

Exemptions 

Exemption Under Section 88 of the Act is granted by the "Appropriate Government" to employees, or class of employees, who remain away from their Hqrs. for more than 7 months in a year, and those employees who are posted in non-implemented areas.

Exemption Under Section 90 can be granted to a factory / establishment belonging to any local authority such as a Municipality / Corporation, etc. if employees in any such factory/establishment are otherwise in receipt of benefits substantially similar or superior to the benefit. provided under the Act.

Seasonal Factory

Seasonal Factory means a factory which is exclusively engaged in one or more of the following manufacturing processes, namely, cotton ginning, cotton or jute pressing, decortication of groundnuts, manufacture of coffee. indigo, lac, rubber, sugar (including gur) or tea or any manufacturing process which is incidental to or connected with any of the aforesaid processes and includes a factory which is engaged for a period not exceeding seven months in a year:

In any process of blending, packing, or repacking of tea or coffee; In such other manufacturing processes as the Central Government may, by

notification in the official gazette, specify.

Employees working in the following seasonal processes have been exempted by Central/State Governments under Section 88 of the Act -

Re-drying un-manufactured leaf tobacco, Salt manufacture,

Ice manufacturing in certain States and Wool pressing with or without cotton pressing and ginning.

Decortications involved in groundnut/walnut processing.

BENEFITS AT A GLANCE

Benefit Contributory conditions Duration RateSickness benefit   more info  

Payment of contribution for atleast 78 days in the relevant contribution period

91 days in any two consecutive benefit periods 

Standard benefit rate (not less than 50% of daily wages)

Extended Sickness benefit (ESB)   more info    

Continuous employment for a period of 2 years and payment of contribution for at least 156 days in 4  contribution periods.  

up to 2 years in deserving cases 140% of the standard benefit rate (not less than  70% of daily wages.

Enhanced Sickness Benefit   more info  

Payment for atleast 78 days in the relevant contribution period

7 days for vasectomy and 14 days for tubectomy extendable in case of post operative complication etc.  

Twice the standard benefit rate.

TemporaryDisablement Benefit   more info  

No condition.   Till the incapacity lasts 140% of the Standard Sickness Benefit rate (not less than 70% of daily wages)

Permanent disablement benefit   more info  

No condition for life Upto 140% of the Standard Sickness Benefit rate. 

Dependant's benefit   more info  

No condition To widow/widows for life or until remarriage. To legitimate or adopted son/ unmarried daughter till age of 18 years.To legitimate infirm son.To legitimate adopted son/unmarried infirm daughter till infirmity lasts.   To widowed mother

Upto 140% of the Standard Sickness Benefit rate (not less than  70% of  daily wages to be divided among the dependants in the prescribed ratio.

more info  

Maternity benefit   more info  

Payment  of contribution for 70 days in immediately preceding two consecutive periods.

12 weeks of which not more than six can  precede the expected date of confinement; 6 weeks for mis-carriage and additional one month for sickness arising out of confinement, premature birth of child or miscarriage

Double the Standard Benefit rate (Not less than full wages)

more info

Medical Benefit   more info  

No condition. IP and his family is eligible from the day one of his insurable employement.  

To start with for a period of 3 months or till the spell of treatment lasts whichever is later and thereafter based on payment of contribution

Full medical care. Facilities including hospitalisation for insured person and family.

more info

Other Benefits

Funeral Expensesmore info  

No condition . Diseased IP should be an IP on the date of death.

One time payment Actual expenditure on funeral not exceeding Rs. 2500/-

Rehabilitation allowancemore info  

No condition For each day on which insured person remains admitted in Artificial limb centre for fixation / repair or replacement of artificial limb.

Double the standard sickness benefit rate but not less than  full wages

Vocational  Rehabilitationmore info  

Insurable employment upto 40% permanent disablement and below 45 years age.

Till such training lasts at a recognised centre / institute

 

Medical Benefit to disabled insured

On payment of Rs. 10 per month in lumpsum for one year

Period for which contribution is paid till attaining the age of

Full medical care for self and spouse only. 

personsmore info  

in advance superannuation

Medical Benefit to retired persons more info  

On payment of Rs. 10 per month in lumpsum for one year in advance (who leave insurable employment  on attaining the age of superannuation after being insured for not less than five years)

Period for which contribution is paid

Full medical care for self and spouse only. 

Confinement expensesmore info  

No condition other than insurable employment of self/spouse. 

Rs. 1000 is paid as a lumpsum grant towards confinement expenses to an insured woman, wife of insured person.

payable for two confinements only

Benefits[claims]

Every claim for a benefit payable under the Act is to be made in writing to the appropriate Branch Office on form appropriate for the purpose of the benefit for which the claim is made. Assistance for filling in the claim form in case of insured persons who cannot do so themselves will be provided at the Branch  Office.

Claim forms for sickness benefit, temporary disablement benefit and maternity benefit are printed at the bottom/on the reverse of the appropriate certificates issued by the IMO/IMP. These forms are available at each Branch Office and will be supplied free of cost