KNOW YOUR ESI SCHEME
The Employees’ State Insurance Scheme is an integrated measure of Social Insurance embodied in the Employees’ State Insurance Act and it is designed to accomplish the task of protecting ‘employees’ as defined in the Employees’ State Insurance Act, 1948 against the impact of incidences of sickness, maternity, disablement and death due to employment injury and to provide medical care to insured persons and their families. The ESI Scheme applies to factories and other establishments viz. Road Transport, Hotels, Restaurants, Cinemas, Newspaper, Shops, and Educational/Medical Institutions wherein 10 or more persons are employed. However, in some States threshold limit for coverage of establishments is still 20. Employees of the aforesaid categories of factories and establishments, drawing wages up to Rs 15,000/- a month, are entitled to social security cover under the ESI Act. The ESI Scheme is financed by contributions from employers and employees. The rate of contribution by the employer is 4.75% of the wages payable to employees. The employees’ contribution is at the rate of 1.75% of the wages payable to an employee. Employees, earning less than Rs 100/- a day as daily wages, are exempted from payment of their share of contribution.
REGISTRATION, CONTRIBUTIONS AND ALLIED PROVISIONS
The employer, once allotted the ESIC registration number for their factory/establishment through ESIC web portal www.esic.in, can log in through the employer page on the web portal and register their employees, as soon as they are employed by them. In the case of first employment (the employee has not worked anywhere before joining the employer), the employer has to register the employee under the ESI Scheme by submitting the details of the employee, their family members, their place of residence and that of their family members, the dispensary at which they want to avail medical treatment, etc. Once the registration process is completed, the employee will be allotted an insurance number, which is unique and will be valid throughout the life of the employee, even if the employee changes jobs. In case, the employee is already having an insurance number, the employer has to enter that number and proceed with updating the details of the employee, as the insurance number is unique for each employee and is valid throughout the life of the employee, irrespective of his changing jobs.
The entire Online Process of ESIC may further be seen at the ESIC website, ‘www.esic.in‘ under the following heads:-
i) Employee Registration
ii) Register New IP or Already Registered
iii)Creation of Declaration Form (DF) by filling in all the relevant details of IP
iv) Submission of Declaration Form
v) Generation of IP Number
PEHCHAN CARD
On registration, every insured person (IP) is provided with a ‘Temporary Identification Certificate’ (TIC) which is valid ordinarily for a period of 3 months. Within this period, the IP along with his TIC, and their family photo, both duly attested by their employer, has to approach the nearest/any of the Branch Office, wherein the IP’s photograph would be taken and the fingerprints of the IP and their family members would be scanned. On completion of the procedure, the Pehchan Card would be delivered to the IP in about 2 weeks’ time. These two sets of Pehchan Card ensure fast and convenient delivery of the services and help the IP and their family members to avail medical facilities at the designated ESI dispensary and hospital. In emergency situations, the IP can visit any of the ESI dispensaries/hospitals. The Pehchan Card has the insurance number, name of the IP and the photograph of the IP/family members printed on it.
If you lose your Pehchan Card before it has run its normal life, a duplicate card is issued on payment of `25/- at the Branch Office concerned.
BENEFITS UNDER ESI SCHEME
1. Sickness Benefit
2. Disablement Benefit
3. Dependants’ Benefit
4. Maternity Benefit
5. Medical Benefit
Other benefits being provided to the beneficiaries are Confinement Expenses, Funeral Expenses, Vocational Rehabilitation, Physical Rehabilitation, Unemployment Allowance and Skill Upgradation Training.
ELIGIBILITY CONDITIONS, DURATION & SCALE OF BENEFITS
SICKNESS BENEFITS
(a) Sickness Benefit
Eligibility: Payment of contribution for 78 days in the corresponding Contribution Period.
Duration & scale of benefits: Up to 91 days in two consecutive Benefit Periods.
Rate: 70% of the average daily wages.
(b) Enhanced Sickness Benefit (For Vasectomy/Tubectomy)
Eligibility: Payment of contribution for 78 days in the corresponding Contribution Period.
Duration & scale of benefits: 14 days for Tubectomy & 7 days for Vasectomy, extendable on medical advice.
Rate: 100% of the average daily wages.
(c) Extended Sickness Benefit
Eligibility: For 34 specified long term diseases, continuous insurable employment for two years with minimum of 156 days’ contribution in four consecutive Contribution Periods.
Duration & scale of benefits: 124 days during a period of two years. This may be extended upto two years on medical advice.
Rate: 80% of the average daily wages.
DISABLEMENT BENEFIT
(a) Temporary Disablement Benefit
Eligibility: From day one of entering insurable employment for disablement due to employment injury.
Duration & scale of benefits: As long as temporary disablement lasts.
Rate: 90% of the average daily wages approx.
(b) Permanent Disablement Benefit
Eligibility: From day one of entering insurable employment for disablement due to employment injury.
Duration & scale of benefits: For whole life.
Rate: For permanent total disablement – 90% of the average daily wages. For permanent partial disablement – Proportionate to the loss of earning capacity as determined by the medical board.
DEPENDANTS’ BENEFIT
Eligibility: From day one of entering insurable employment in case of death due to employment injury.
Duration & scale of benefits: For life to the widow or until her re-marriage. To dependant children till the age of 25 years. To dependant parents etc. subject to conditions.
Rate: 90% of the average daily wages shareable in fixed proportion among all dependants.
Maternity Benefit
Eligibility: Payment of contribution of 70 days in two preceding Contribution Periods.
Duration & scale of benefits: Up to 12 weeks in case of confinement. Up to 6 weeks in case of miscarriage. Extendable by 1 Month on medical advice in case of Sickness arising out of Pregnancy, Confinement, or Miscarriage.
Rate: 100% of the average daily wages.
Medical Benefit
Eligibility: ‘Reasonable medical care’ for self and family from day one of entering insurable employment.
Duration & scale of benefits: Reasonable medical care till he/she remains in insurable employment. Medical Benefit under the ESI Scheme has now been extended to the widow/spouses of deceased/ retired/ superannuated Insured Persons as well as to the widow/spouses of Insured Persons who ceases to be in insurable employment on account of Permanent Disablement and also to widows of Insured Persons who are in receipt of Dependants’ Benefit.
OTHER BENEFITS
(a) Confinement Expenses
Eligibility: An Insured Woman or an I.P. in respect of his wife is eligible if confinement occurs at a place where necessary medical facilities under ESI Scheme are not available.
Duration & scale of benefits: Up to two confinements only.
Rate: Rs 5000/- per case.
(b) Funeral Expenses
Eligibility: From day one of entering insurable employment.
Duration & scale of benefits: For defraying expenses on the funeral of an Insured Person.
Rate: Actual expenses subject to a maximum of Rs 10000/-.
(c) Vocational Training
Eligibility: In case of physical disablement due to employment injury.
Duration & scale of benefits: As long as vocational training lasts.
Rate: Actual fee charged or Rs123/- a day, whichever is higher.
(d) Physical Rehabilitation
Eligibility: In case of physical disablement due to employment injury.
Duration & scale of benefits: As long as a person is admitted to an artificial limb centre.
Rate: 100% of the average daily wages.
(e) Unemployment Allowance – Rajiv Gandhi Shramik Kalyan Yojana (RGSKY)
Eligibility: In case of involuntary loss of employment due to closure of factory, retrenchment or permanent invalidity due to non-employment injury and the contribution in respect of him has been paid/payable for a minimum of three years prior to the loss of employment.
Duration & scale of benefits: Maximum twelve months during lifetime.
Rate: 50% of the average daily wages.
(f) Skill Up-gradation Training under RGSKY
Eligibility: In case of involuntary loss of employment due to closure of factory, retrenchment or permanent invalidity due to non-employment injury and the contribution in respect of him has been paid/ payable for a minimum of three years prior to the loss of employment.
Duration & scale of benefits: For a duration of a maximum of 6 months.
SUPER-SPECIALITY TREATMENT
The eligibility for super-speciality treatment is 3 months (with contribution paid for at least 39 days) of insurable employment for the insured person (for self) and 6 months (with contribution paid for at least 78 days) of insurable employment by the insured person for their family members. And The eligibility of the patients for Super-Speciality Treatment shall be determined from the date of registration of IP on the IP portal. Such tertiary care (super[1]speciality treatment) is provided through in-house super speciality facilities available in some ESI Hospitals or ESI-PGIMSRs or through large no. of advanced empanelled medical institutions on a referral basis through more than 1000 + tie-up hospitals all across India.
BENEFIT AFTER RETIREMENT
An insured person who leaves the insurable employment on the attainment of the age of superannuation or retires under a voluntary Retirement Scheme or takes premature retirement, after being an insured person for not less than 5 years, shall be eligible to receive the medical benefit for himself and his spouse subject to production of proof thereof, and payment of a nominal contribution of Rs 120/- (rupees one hundred and twenty only) for one year. In case, the insured person expires, his spouse is entitled to the medical benefit for the remaining period for which the contribution was made, and she can continue to receive the medical benefit on payment of the contribution of Rs 120/- (rupees one hundred and twenty only) per annum for a further period. This medical benefit is also admissible to an insured person who ceases to be in employment on account of permanent disablement caused due to employment injury for himself and his spouse on payment of similar contribution till the date on which he would have vacated the employment on attaining the age of superannuation, had not sustained such permanent disablement.
