PRESENTATION

BYREGIONAL OFFICE,

ESI CORPORATION

EMPLOYEES’ STATE INSURANCE SCHEME

A Unique Social Security Scheme for

Employers & Workers

EMPLOYEES’ STATE INSURANCE CORPORATION

Regional Office : Andhra Pradesh5-9-23, Hill Fort Road, Adarsh Nagar,

Hyderabad – 500063

Tele : 23232356 to 59

Web Site : www.esic.nic.in / www.apesic.nic.in

ESI SCHEME

The promulgation of Employees‟ State Insurance Act, by the

Parliament in 1948, was the first major legislation on

comprehensive social security for workers in Independent India.

The Act envisages social protection of workers deployed in

the organized sector in conceivable contingencies, such as

sickness, maternity death or disablement due to employment

injury.

Based on the principle of “pooling of risks and resources”, the

unique, multidimensional health Insurance Scheme guarantees

a fair deal to the covered members by providing full medical

facilities to the beneficiaries, besides adequate cash

compensation to insured persons for loss of wages or earning

capacity in times of physical distress arising out of sickness or

employment injury.

UNIQENESS OF ESI SCHEME

It covers all types of employees – Permanent, Temporary,

Casual, whether employed directly by the Principal employer or

through Contractors in covered Factories / Establishments.

It covers from the Day 1 of his employment, irrespective of

whether he/she has paid the contribution which enables receipt

of medical benefit (including for family members), disablement

benefit and dependent benefit.

Single Contribution, Multiple Benefits –

Medical care for self and dependent family

members

Cash Benefits – Sickness, Maternity, Disablement,

Dependent benefits, Funeral Expenses, Un-

employment Allowance etc.

Scale of Medical Care – Both outdoor and indoor treatment,

all types of investigation and pathological tests, supply of

medicines and super specialty treatment in tie-up Hospitals,

extended sickness benefit for long-term diseases.

No pre-enrollment medical examination for registration as

beneficiary under the scheme.

Medical care for retired / permanent disabled IPs who have

rendered at least 5 years Insurable Employment

Occupational Disease related treatment and cash

compensation with Corporation presently having 5 occupational

disease centers at Pune, Delhi, Kolkata, Chennai and Nagda

(MP).

FIELD INFRASTRUCTURE

All India

(29 States / UTs)

Andhra

Pradesh

ROs 23 1

SROs 37 2

Branch Offices 627 38

Pay Offices 177 6

Inspection Divisions 383 31

MEDICAL INFRASTRUCTURE

All India Andhra

Pradesh

ESI Hospitals 150 8

ESI Beds 22823 1421

ESI Dispensaries / ISM Units 1403/93 150

Insurance Medical Officers 7340 144

Insurance Medical Practitioners 1380 62

Tie Up Hospitals 800+ 85

Model Hospitals run by ESIC 34 2

NO. OF FACTORIES / ESTT. COVERED

14

90

16

39

2445

19

37

19

71 17

01

35

01

0

500

1000

1500

2000

2500

3000

3500

4000

2007 2008 2009 2010 2011 2012 2013

ANDHRA PRADESH

30

29

4

26450

62588

12167

36511

137018

859720

20000

40000

60000

80000

100000

120000

140000

160000

2007200820092010201120122013

ALL INDIA

NO. OF INSURED PERSONS

(In Lakhs)

7.4

5

8.1

8.9

10.13

12.42

14.24

15

.04

0

2

4

6

8

10

12

14

16

2007 2008 2009 2010 2011 2012 2013

ANDHRA PRADESH

10

1

120

129

143

155

171

186

0

20

40

60

80

100

120

140

160

180

200

2007 2008 2009 2010 2011 2012 2013

ALL INDIA

APPLICABILITY OF ESI ACT U/S 1(5) & 2(12)

Sec 2(12) - Non-Seasonal Factories Employing 10 or More

persons.

Sec 1(5) - Motor Road Transport, Preview Theaters including

Cinemas, News Paper Establishments, Shops and Private

Medical and Educational Institutions in implemented areas,

employing 10 or more persons.

Govt. of India vide its notification dated 20/7/2009 has expanded ESI scheme to all

center PSUs, involving Contract Casual Workers.

Employees of the aforesaid factories and Establishments in receipt of wages not

exceeding Rs. 15,000/- per month (excluding remuneration for over time) are covered

under the Act.

Permanent Disabled Employees in receipt of Wages upto Rs. 25,000/- per month.

EXTENSION OF ESI SCHEME TO THE

CENTRAL GOVT ESTABLISHMENTS

The Central Govt has extended the provision of ESI Act to all

Contract and Casual Employees of following establishments

belonging to or under the control of the Central Government.

Shops, Hotels, Road Transport Establishments, Cinema

including theatre preview, News Paper Establishments, etc. as

notified by the Central Govt. under section 1(5) of the Act from

time to time.

OBLIGATIONS OF THE PRINCIPAL EMPLOYERS

To insure all employees (Sec 38) -

Working in or in connection with the work of factory /

establishment.

Drawing monthly wages upto Rs. 15,000/-

Employed Directly – Sec 2(9) I

Indirectly – By or through immediate Employer

Working on Premises

Working outside but with supervision

Casual, Temporary, badli

Daily, Weekly, Fortnightly or piece-rated

Apprentices or Trainees – Other than those employed under

Apprentice Act.

Those drawing monthly wages above Rs.15,000/- are not to

be covered.

Employer to register all coverable employees online – Reg

11,12, 15.

Direct IP and family members to visit BO/Pehchan Camp to

capture Photograph and Bio-metric details for Pehchan Card.

To Generate Online Challan and pay both employee &

employers‟ contributions within 21 days after the end of the

wage period – Sec 39, 40 & Reg 31.

To maintain Register of Employees (Form-6) – Reg. 32

To arrange first aid and medical care and transport in case of

accident – Reg 69.

To maintain Accident Book – Reg 66.

To submit Accident Report (Form-12) – Reg 68

Immediately in case of serious Accidents

Within 48 hours in case of others

To maintain Register and Records/Books of Account and

make them available for Inspection to Social Security Officer or

any other officer authorised by the Corporation – Sec 44, 45.

OBLIGATION OF THE EMPLOYEES/IPs

To furnish particulars of self and family to the Employer on

joining Insurable Employment and to disclose Old Insurance

Number/Identity Card / Pehchan Card in Previous Employment.

To get self and family photographed and give Bio-metric

details at appropriate Branch Office and obtain TIC/Pehchan

Card.

Visit ESI Dispensary / Hospital in case of Sickness,

Confinement, Accident and follow the advice of concerned

Medical Officer / Specialist.

To present himself for examination by Medical Board as

advised by Branch manager Regional Office in case of

Permanent Disability arising out of employment.

To approach appropriate Branch Office for claiming Cash

Benefits.

To approach appropriate Branch Office or visit ESIC website

for any help or information regarding medical and cash benefits

available.

May verify the contributions/eligibility particulars online from

the IP Portal.

MAJOR SOCIAL SECURITY BENEFITS

MEDICAL BENEFITS – Administered through

ESI Dispensaries and ESI Hospitals

CASH BENEFITS – Administered through

Regional Offices and Branch Offices

Contribution Period Benefit Period

1st Apr to 30th Sep 1st Jan to 30th June

1st Oct to 31st Mar 1st Jul to 31st Dec

MEDICAL BENEFITS

ESI Act provides reasonable medical care in the form of medical

treatment and attendance to Insured Persons and their families

in respect of Medical, surgical and obstetric treatment under

section 56.

Domiciliary Visits

Out Patient Treatment

Specialist Consultation

Diagnostic Facilities

In-Patient Treatment

Super Specialist Services

Referral Treatment

Old Age Medical Care

Vocational Rehabilitation

Physical Rehabilitation

MEDICAL BENEFIT TO RETIRED INSURED PERSONS

UNDER RULE 60 & 61

IP who leaves the Insurable employment on his

superannuation, VRS or pre-mature retirement after being

insured for not less than 5 years is eligible to receive medical

benefits for himself and his spouse.

IP who ceased to be in an insurable employment on account

of permanent disablement due to E.I. w.e.f. 1.2.91 is also

eligible to receive medical benefits for himself and his spouse till

he attains the age of superannuation.

This benefit is provided on payment of contribution in lump

sum for one year at the rate of Rs. 10/- per month.

This benefit will also be applicable to widows of IPs who are

in receipt of Dependent Benefit on payment of contributions

under Rule 60

CASH BENEFITS AND CONTRIBUTORY CONDITIONS

AMENDMENTS IN THE ACT W.E.F. 1/6/2010

oFacilitating coverage of smaller factories employing 10 or

more persons irrespective of whether power is used in

manufacturing process or not

oEnhancing age limit of dependent son for eligibility to

dependents benefit from 18 years to 25 years

o Extending Medical Benefit to dependent minor brother /

sister in case of Insured persons not having own family and

whose parents are also not alive

o Streamlining the procedure for assessment of dues from

defaulting employers by prescribing a time limit of 5 years

for the same

o Providing an Appellate Authority within the Corporation

against assessment to avoid unnecessary litigation

oExtending medical Benefit to Insured persons retiring

under VRS scheme or taking premature retirement

oTreating Commuting Accidents as Employment Injury

oStreamlining the Procedure for grant of exemptions

oThird party participation in Commissioning and Running of

Hospitals

oOpening of Medical / Dental / Paramedical / Nursing

colleges to improve quality of medical care

oMaking an enabling provision for extending medical care

from under- utilized ESI Hospitals to other beneficiaries on

payment of user charges.

LATEST INITIATIVES

Electronic Clearance System (ECS) involving cash benefit

payments for all recipients of Permanent Disablement Benefit

(PDB) payment and Dependant Benefit (DB).

Submission of Life Certificate once in a year for PDB/DB

Beneficiary

ESIC has approved payment of conveyance allowance to

PDB beneficiary @ Rs. 100/- per visit for submission of Life

Certificate.

Confinement Expenses increased from Rs. 2,500/- to Rs.

5,000/-

No need for submission of monthly claim for PDB / DB

benefit.

Calculation of Benefit Rates has been simplified.

Minimum Dependent Benefit of Rs. 1200/- per month per

family w.e.f. 1/4/2012

Increase in PDB and DB rates to compensate for erosion in

the value due to Inflation.

Increase in commutation of PDB fm Rs. 30,000 to Rs. 60,000

Renovation of field offices with proper accommodation and

amenities to providing waiting space and working environment

for our stakeholders.

Provision of 24 X 7 Toll Free Phone to register Grievances

1800112526

IT Project Panchdeep has been launched for „Anytime

Anywhere‟ services.

Creation of an Appellate Authority within the organization for

appeal by employers.

Comprehensive Medical Care services on cashless basis

within reasonable distance.

Services provided include Primary, Secondary and tertiary

medical care.

There is no ceiling on individual medical care and the same is

provided as per need.

Special emphasis is being given on preventive and promotive

health care services through vans, health camps etc.

For provision of tertiary / Super Specialty medical care, tie-up

has been made with 800+ reputed private and government

hospitals all over the country and patients may opt for any of the

networked hospitals for treatment.

NEW AMNESTY SCHEME 2014

ESI CORPORATION has notified New Amnesty Scheme,

2014 on 28.01.2014 for withdrawal of Criminal Cases filed U/s

84, 85 and 85-A of ESI Act, 1948 till 31.12.2013

The Amnesty Scheme will also allow out of court settlement

of cases filed by the Employers U/s 75 of the Act

The Amnesty Scheme will also allow out of court settlement of

cases filed by the Employers disputing levy of damages

Full details of the Scheme is available in our Official Website

www.esic.nic.in & www.apesic.nic.in

IT ENABLED SERVICES – PROJECT PANCHDEEP

For Efficient and smooth delivery of services, the

ESI Corporation has introduced IT enabled

services in the Corporation.

BENEFITS THROUGH IT ENABLED SERVICES

Employers can register their Factories and Establishments on their own

including Sub-Units

Employers can register their employees on their own

No need to submit Return of Contributions

Accident Reports can be submitted online

Payment of Contributions can be made online

Payment position of Contributions can be viewed online

Updation of Employee/Employer data can be done by the employers

themselves

Contractor mapping facility is available

Employees can view their Entitlement for Benefits online

Employees can view the status of their claim online

Employees can view the payment position of contributions in respect of

them online

Employees are issued with 2 Magnetic Pehchan Cards – one for self

and the other for his/her family.

Employees can avail Cash benefits anywhere, anytime

Employees can avail Medical Benefits Anywhere Anytime

PEHCHAN CARDS

In order to give a distinctive “Pehchan (Identity)” to the

beneficiaries and their family members, biometric hi-tech

unique Identity cards by the name of „Pehchan Card‟ are

being issued to the I.Ps.

Pehchan Cards are issued in duplicate for use by IPs and

their family members.

The cards have inbuilt provisions of storing/ sorting

out/retrieving/portraying all data related to the IP, fed in the

system.

This will facilitate IP to be recognised and facilitated in any

of the ESIC Institutions.

BENEFITS OF PEHCHAN CARD

IP and his family can avail benefits anywhere inIndia at any time in ESIC / ESIS establishments.

Pehchan Card has life long validity. On change ofemployment / place of employment, fresh registrationis not required.

Pehchan Card will provide access to entiremedical/clinical/medicinal histories/reports and drugadministration in respect of IPs and members of theirfamily distinctively. This will help in providing betterhealth care to the beneficiaries.

PEHCHAN ENROLLMENTS

All IPs must be enrolled for Pehchan Card with dependentfamily members

In case IP‟s dependents stay away in different city/state, IPand his dependents can enroll separately for Pehchan.

IPs and their dependents can enroll at Online PehchanCamps which are in operation at all our Branch Offices.

Hybrid Pehchan Camps are also being arranged atEmployer‟s place, on the request of employer.

All employers are requested to immediately send theemployees working under them, for Pehchan Enrollment atOnline Camps or make use of Hybrid Pehchan camp facility inconsultation with ESIC Regional Office, Hyderabad.

GRIEVANCE REDRESSAL

Holding of Suvidha Samagam by Regional Directors &

Branch Managers

Meeting Beneficiaries without Appointment

Complaint / Suggestion books in Field Offices

Client Satisfaction Surveys

Facilitation Centers

Placing Instructions / Forms on web-site

PENAL PROVISIONS

Punishment for false statement

Punishment for Non-Payment of contributions

Punishment for contravention of or Non-compliance

with any of the provisions of the Act.

Payment of Interest and Damages for delayed

payment of Contributions

A FINAL WORD…A FINAL WORD…

We dedicate ourselves to

ensure ‘chinta se mukti’ to

our stakeholders.