Panchdeep Insurance Revenue 2.0

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Confidential Copyright 2009 Wipro Ltd

ESIC

Pragati (Insurance)

Revenue

December 12, 2013 1


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Introduction- Revenue

Revenue mainly comprises of

Monthly Contribution & Live List

Action on Defaulters

Inspection & Survey

Pre-Implemention Survey & Implementation

Other processes which are also captured are

BIFR

Write Off Process

Winding-up process

Specific interface with other modules are mentioned in the respective

processes. However, HRMS would be a common interface across Insurance

Module.


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Introduction

Employers have to remit the contributions on a monthly basis to ESIC. This

includes 1.75 % of Employeesand 4.75% of Employersshare adding up to 6.5 %

of the monthly wage of the Employee.

The Employer upon accessing Form 6 online, selects the month for which payment

is being made. Upon doing so, the details of the Employees are furnished (based

on Form 3). Thereafter the Employer has to only fill up the wage details of eachEmployee. This form may also be used in lieu of CCP.

Contribution details are calculated based on the number of days worked and total

wages paid.

Upon submission of the details in Form 6, a challan may be generated for the

total/partial amount of contribution. On submission of the challan, a unique challan

number is generated. A facility to print the challan is also provided. Using this procedure monthly contributions can be tracked on a monthly basis and

the process of submission of RC shall not be required after IT roll-out.

On the basis of the Contributions received, Live List will be generated


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Entry Triggers

Employer is registered with ESIC

Submission of Form 6

Monthly contribution becomes due


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Workflow

Employee details are

populated

Employer Logs in

the portal

Selects the month for which

contribution payable

Employer fills details of no. of days

worked & wages

Total Contribution

amt determinedChallan generated


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The Process

Employer Login

Logs in using the User

Id and Password

Monthly Contribution

Form 6 format is available online

Offline filing of Monthly Contribution details is also

possible (e-formswhich can be downloaded, filled offline

& then uploaded )

OR upload of contribution data using CSV format

Generate the challan based on Form 6

Deposit the challan with the BankGenerate Live List

Employer selectsthe month

Employer

Live List

Checks if IP is

Eligible for Medical

Benefit

HIS

Challan Updation

Updates challan deposited date.Updates corresponding Challanwith Challan credited date andamount.Receipt Voucher will be generatedand considered in books of account.

Receives

Challan & Bank

statement

F&A

Reconciliation and Realization



Exit Triggers

Inspection of the Employers defaulting on payment of contribution as well as

those paying on time is scheduled.



When the Employer is exempted, he is not required to remit Monthly

Contribution

IPs making contributions under rule 60 & 61

Medical benefits are provided to insured person who ceases to be in an

insurable employment on account of permanent disablement on payment ofRs.120 per annum.

Medical benefits to retired insured person on payment of Rs.120 per

annum.

Exception Process



Process related Reports

Live List

List of ESB/TDB Cases

List of IPs under Rule 60/61



Screens



Interface

This module will have interface with

F&A

When the challan is submitted, a unique challan number will be generated.

This number will be used while remittance.

In case of cheque bounce, F&A will intimate the details of the bounced cheque

for Actionon defaulter/ Recovery.

HIS

All the IPs eligible for Medical Benefit will be provided through the LiveList.

While availing the Medical Benefit, HIS will be able to check eligibility for Cash

Benefit.

In case of Super Speciality benefit, eligibility criteria can be checked.

Portal

Employer should be able to login using Internet

Access to Form 6 & Challan should be available for the Employer.



MIS Reports

Following MIS Reports can be generated

Monthly Contribution received

Region-wise contribution received

No. of Defaulters



Every month the defaulting Employers are identified. Employer who fails to make

complete contribution for the month before 21stof next month is treated as defaulter.

If an Employer makes payment for defaulted period, then the employer is removed from

the Defaulter list. Interest and Damages will be charged to the employer as per the

case.

Employers will be marked to Initial Defaulter list if Employer defaults up to 3 months. 1st

, 2ndand 3rddefault notice letters are sent to the employer for 1, 2, 3 months default

respectively.

If Employer continues to default and has defaulted for 4 months, then Employer will bemarked as Main Defaulter. Once Employer is identified as Main Defaulter following

actions are undertaken simultaneously:

C-18 ad hoc or C-18 Actual is issued (C-18 Adhoc is issued if Monthly Contribution Details are not

available for defaulting periods else C-18 Actual is issued)

The Employer is marked for Inspection.

SCN against the employer is sent to JD(I/c)/RD for approval.

If C-18 Adhoc is issued Employer is called for Personal Hearing(PH)

Revenue Branch if receives the Inspection report(IR) then issue C-18 Actual if IR is conclusive.

Employer will be issued C-18 Actual/Speaking Order/Exparte Order as per outcome of PH.

Recovery certificates are created if Employer defaults to clear dues within 15 days of

issue of C-18 Actual, Speaking Order or Exparte order.

Employer Defaults in Self-certificate submission, then employer is marked for

inspection.

Introduction



Entry Triggers

Monthly contribution is not paid/partially paid

Self Certificate is not submitted on time


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Simultaneously

Personal Hearing

Workflow

Main Defaulter List

Inspection Show CauseNotice

C-18Adhoc/Actual

Employer defaults monthly

Contribution payment

Initial Defaulter list

C-18 (Adhoc)

Only for C-18Adhoc

C-18 ActualSpeaking

OrderEx-parte

Order

Default Notices

DefaultedMore than 3 months

Employer defaults Self-

Certification

Sanction Memoto Legal Dept

if no validexplanation from

employer

Recovery Certificates

if payment not done within 5 days of issue

If Employer didntco-operate during

Inspection

As per InspectionReport findings


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The Process

Inspection

Inspection Report is available for the Inspector to

submit Report

Intimation to Inspection Division sent

Employer

Recovery

Recovery Certificates are available to the Recovery

Officer in-charge for the area

Intimation to Recovery Officer

Employer

Revenue Branch

Officer

Inspector

Recovery Officer

Revenue Branch

Generation of Default letter (notices) /C-18 Adhoc/C-18

Actual/Speaking Order/Exparte Order/C-18(i)/D-18 ,Recovery Certificates

User to edit and save the notice/letter in the system.

Above notices/letters are also sent via email if Employer

email-ID is available in the system.

Recovery Certificates are sent to Recovery off icer for

further action.

Initiate action as per Inspection Report.

Issues Default Notice LetterIssues C-18 Adhoc

Issues C-18 Actual

Issues Speaking Order

Issues Ex-parte Order

Issues C-18(i)

Issues D-18

Issues C-19, C-19(i), D-19 (Recovery Certificates)

Employer defaults in Monthly

contribution

Employer defaults self-certification


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Exit Triggers

Employer remits the arrears of Contribution and Interest and Damages and

employer is removed from Defaulters list.

Sanction Memo is issued against the Employer and sent to the Legal Branch

for Legal Proceedings against the employer OR Sanction Memo is dropped

against the Employer.

Recovery Certificates are issued against the employer


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C-18 Adhoc Report

C-18 Actual Report

Speaking Order/Exparte Order Report

C-18(i) and D-18 Report

Initial Defaulters Report

Main Defaulters Report

SCN issued Report

Sanction Memo Report


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Interface

This module will have interface with

Legal

Upon issue of a Sanction Order, the same will be sent to Legal Branch for Legal

proceedings

F&A

Payments towards arrears


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Screens


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Screens (contd)


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Inspection ensures proper compliance of the provisions given in the ESI Act. The

inspection of factories and establishments is one of the most important activity inESIC and is carried out by Insurance Inspectors.

When an investigation of a Unit takes place after the successful registration of the

Unit under ESIC, it is called Inspection.

When an investigation is conducted to determine if the Unit is coverable under ESIC,it is termed Survey.

Short Inspections are inspections conducted to determine the contribution details and

to check if all the Employees eligible under ESIC are covered

Test Inspections are inspections conducted on an already Inspected Unit and servesas a quality check on Inspections. It is usually done by Test Inspecting Officers

appointed by the RD or JD I/C.

Introduction


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Entry Triggers

Survey is conducted upon a 3rd party reference or by an Inspectors own

initiative

The reasons for Inspection are:New Employer registrations

Closure of Units

Non-payment of Contribution

Random checks on complying Employers

Employers identified in Periodical Survey RegisterExamination of complaints received


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Workflow

Inspection conducted by Inspector

Inspection

Observation Note

Inspection Report

Scrutiny of Inspection Report by DA

of Revenue Branch

Action taken based on IR


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Report Scrutiny

Same Report Screen is available for the DA to

Scrutinize the IR

If the DA finds discrepancy in report requests

clarification from II.

If the DA approves the report and discrepancies found

with Employer necessary action is taken.

Verifying and validating the Report

The Process

Insurance Inspector

Sends intimation to the Employers about

the date of Inspection

Prepares list of

Inspections to be

conducted

Inspection of Unit

Insurance Inspector conducts the inspection

Prepares Inspection Observation Note and submits to

employer

Submits re-captures Observation Note and Inspection

Report online

If Inspection could not be performed on specified date,revises date /issues Annexure A, B or C

Employer provides

documents needed

for Inspection(manual)

Inspector

Dealing Assistant

Employer


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Exit Triggers

After approval of Survey Report, Employer code is generated and requested

to submit Form 01 online if found coverable

Upon update of FDC, C-18 ad hoc may be issued to recover contributions

as per the revised dates

C-18 actual is issued and rest of the action on defaulters is initiated


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Inspections conducted by Insurance Inspector

Pending at the beginning of the month

Added during the month

Dealt during the month

Pending at the end of the month

Inspection reports received & dealt by DA

Pending at the beginning of the month

Added during the month

Dealt during the month

Pending at the end of the month


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Inspection & Survey - Interface

Legal

Upon issue of a Sanction Order, the same will be sent to Legal Branch


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Inspection & Survey - Screens


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Inspection & Survey - Screens


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Pre Implementation survey is the survey done to assess an area for implementationof the ESI scheme.

Based on the initial information gathered, a survey is conducted to gather the details

of the coverable Employers, Employees and the nature of Industries in a particular

center.

The Head Quarters office, P&D branch prepares and circulates the phased program

annually on the basis of proposals received from the RD/State Government.

Based on the survey report medical arrangements and arrangements for banking,

cash disbursement and registration are finalized.

Once approval from Ministry of Labour is received and draft notification is published

in the Gazette, Employer Registration is initiated from the date of Implementation

Introduction


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Entry Triggers

Regional Office gathers information of areas where there is a concentration

of industries.

Decision to conduct pre-implementation survey (PIS) is made on the basis of

information gathered by the Regional Office.


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Workflow

Registrationof Employers

begin

Areas identified as

not covered

PIS conducted; proposal requested for from

identified State Governments

Annual phase program is prepared; State Govt..

Requested to make arrangements for medical facilities

Draft Notification & Confirmation of facilities received

at HQ; Cost estimate requested from Actuarial

Approved by IC and

forwarded to Ministry

of Labour

Notification in

Gazette


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Actuarial

Details of the basis of the financial implication arrived

by the Actuarial Branch and sent to Head of Planning &

Development

Analyses the viability

The Process

Regional Office

Identifies Area for Survey

and assigns tasks to Insurance

Inspector

Interacts with State Government to

get proposal for medical

arrangement

Makes arrangement for cash,

banking & registration. Prepares

Draft Notification

P&D branch Head Quarters

Compile Annual Phased Program for Implementation

Requests State Governments to send proposals for

Medical arrangements

Request for Cost Implications from Actuarial Dept.

Forward recommendations to IC for approval along with

Draft Notification and details of arrangement made

Coordinates with State Govt. Regional

Offices & Actuarial Dept to consolidate

arrangements for Implementation

Regional OfficeCoordn .branch Officer

P&D Head Quarters Officers

Actuarial Officers

Insurance Commissioner

Approves an area for

Implementation

Forwards to Ministry of Labour for

Govt. approval and publication in

gazette

Insurance Commissioner


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Exit Triggers

Employer & Employee registration


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Notification Register

Pre-Implementation Survey Report


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Interface

Actuarial

Financial Implication is calculated for Proposed Implementation


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MIS Reports

Following MIS Reports are generated

Target Vs Actual Implementation

Pre-Implementation Survey &


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Pre Implementation Survey &

Implementation- Screens


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Thank You

Panchdeep Insurance Revenue 2.0

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Transcript of Panchdeep Insurance Revenue 2.0