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Social Security-A Corporate View

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ESI- Highlights

1

.

Super specialty treatment2. Unlimited Dialysis

3 Special treatment to Eye & Bone

4. Disabled employee coverage

5. Benefits Anytime & Anywhere.

6. Lower premium Higher benefits

1

. IT Roll out Employer support

2. Services of 24x7 Toll Free Helplineand facilitation center.

3. Reporting framework

Benefits Technology

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Focus to Improvements

Maximizing Private Hospitals for all ailments

Online

Pehchan

Card

Employee Self Service

-

ESS in ESIC

Maximizing Cashless Hospitalization

One stop process of Claim reimbursement

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ESI Optimize & Attract

PvtHospitals

Nearest hospitals

networking

One Click approval forPrivate hospitals

Value added pre-authorization cashless

treatment

ESI

Expand ESI counters in

Private Hospitals

Increase Women medicalpractitioners

Increase awareness of ESIprocedures

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In recent years, India, like several other developing countries, has established different types of

social security scheme. The ESIS is one among such scheme. Its main objectives is to provide

medical benefits for citizens whos earnings fall under certain limit of income.

Feedback recording.gains

IP 1 : I took my wife for antenatal care and for delivery to ESI hospital, Ayanavaram, Chennai. The treatment was very good

IP 2: I took my mother for asthma treatment to the ESI hospital Vellore. She was feeling better than when she was treated in a

private hospital

IP 3: Fifteen days back I went to the ESI clinic with an ear ache. Medical services were good. I suffer from this complaint frequently.

And I visit ESI regularly for treatment. I am satisfied with their service.

Scenario

These factors affect diverse groups of individuals differently and play distinctive roles in the decision to seek medical care

(mostly taken by the individual) and in the decision regarding the subsequent number of visits to ESI dispensaries or

private facilities.

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Feedback recordingfocus to improve

IP 1:

The conditions in the dispensaries are appalling. We have to ultimately go to a government hospital or arrange money for

private treatment. What then, is the use of the ESI

IP 2:

The timing does not suit our working hours. We find it difficult to take leave or permission to go to the clinic in the morning

hours. Finally we end up going to private doctors

IP 3 :

In the out-patients clinic there are not enough places; with many patients the place is not very comfortable. Receiving the OP

card itself takes a long time. The sanitation conditions in these facilities are also not very good

IP 4:

Not enough diagnostics facilities are available in these clinics. Where diagnostic facilities are available most of the doctors are

men and female beneficiaries registered under this scheme are reluctant to approach them for diagnosis. They prefer getting

treatment from private nursing homes or private clinics, several times out-of-pocket expenditure incurred for treatment and

reimbursement at times takes several weeks

Scenario

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IP

Medical Officersexamine the patient

IP is issued withreference letter and

routed to Pvt Networkhospital

Medical Facility

unavailable

ESI Current & Proposed Flow

IP is treated in ESIhospital

Approaches the Network(empanelled) Hospital andproduce the referenceletter at reception

Based on the caplimit(eligibilitycertificate) the Hospitalintimates ESiC

Medical Facility availableApproaches ESI Hospital

Case is received atESIC & payment isprocessed

ESIC should sendInstant SMS on

every stage of theCashless cycle.Helpline facility

should be availablefor updates on the

case

Register online in ESICweb portal

Officers check the systemand approves

System calculates theeligibility and mail istriggered to the officer

Case is received at PVtHospital & treatment isinitiated

Existing processProposed process

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Provident Fund

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EPF - gains

Savings plan & Safety of returns

Loan options

Tax treatment

Interest earned

Withdrawal facility

Dependant eligibility for deceased

Pensionable Service Benefit

Data accuracy

Social security in home location

Lower taxability impact

One stop shop for SS benefits

Totalisation of period of contribution inthe host country for determining theeligibility for social security benefits.

Provident Fund International worker

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EPF - Focus to Improve

BenefitsAdministration

Provident Fund post retirementview

Repatriating contribution on grosssalary

> 36 months Interest Loss

Plan should permit to changeinvestment selections corporateview

Loans /pensions schemeeligibility tenure optimizationwith changing market

Robust online status tracking

system

Improving on current SLAs,seasonal fluctuations

Business Enablers

Support Portfolio management

Inter regional transfer of funds

Robust Integrated System

Decentralized PAN India

Record Maintenance

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Forms

RPFC, Chennaimoves Form torelevant sectionwithin or relevantRPFC of otherregion

Relevant RPFC(RegionalProvident Fund

Commissioner) movesrequired

documents(Cheque &Annexure k) for EPF

transfer

PF Current & Proposed Flow

Receipt of cheque and itsrealization is handled RPFCChennai (Group 30)

Group 30 at RPFCreflects the transferredamount to associatesPF a/c

Submitted @ RPFC

On transference of

the amount RPFCconfirms about the PFtransfer completion.

RPFC, Chennai movesForm to relevant sectionwithin or relevant RPFCof other region

The minimum period ofPF transfer to takeeffect is around 6months if it is withinTamilnadu and arounda year for transferacross interstate RPFCoffices.

3 days-60 days

15-30 days

90 days

30- 60 days

Processed only

at year end

Processed onlyat year end

Confirms only duringannual statement release

Relevant RPFC(RegionalProvident Fund

Commissioner) movesrequired -Annexure k for

EPF transfer

30 45 days

Receipt of Annexure K,NEFT Transfer is made toemployees current PF a/c

On transference ofthe amount RPFCshould send instantSMS about the PFtransfer , closurestatus

The minimum period ofPF transfer to take effectis 2 months if it iswithin Tamilnadu andaround 3 months fortransfer across interstateRPFC offices.and Closure 2 months.

Existing processProposed process

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Thank You