E.S.I.
SCHEME
Employees' State Insurance (abbreviated as ESI) is a self-financing
social security and health insurance scheme for Indian workers. This
fund is managed by the Employees' State Insurance Corporation (ESIC)
according to rules and regulations stipulated there in the ESI Act 1948.
The ESI act passed in 1948 (amended in 1975, 1985 and 1989) is an
important measures of social security and health insurance in the
country. It provides for certain cash and medical benefits to industrial
employees in case of sickness, maternity and employment injury.
ESIC is an autonomous corporation by a statutory creation
under Ministry of Labour and Employment, Government of India.
Important measure of social security and insurance for workers
Provides certain Cash and Medical benefits to industrial
employees in case of Sickness, Maternity and Employment Injury.
The Act further include Maternity Benefit Act, 1961 and
Workmen’s Compensation Act 1923.
Scope -Extends to whole of India
Covers
Power-using factories employing 10 or more persons (non-
seasonal)
Non-power using factories employing 20 or more persons
(non-seasonal)
Shops
Hotels
Cinema & theatres
Road motor transport establishments
Newspaper establishments
Excludes mines, railways and defence establishments.
All employees
Manual
Clerical
Supervisory
Technical
Employees getting salary up to 21000 per month (2016)
CONTRIBUTIONS
Employer – 4.75 % of total wage bill
Employee – 1.75 % of wage
Employees getting daily wage of < 70 INR exempted
State govt – 1/8 th of expenditure on medical care
Central govt – 7/8 th of expenditure on medical care
ADMINISTRATION
ESI Corporation - Autonomous body
Chairman - Union Minister of Labour
Vice chairman – Secretary, Ministry of Labour
Members -Representatives
Central Govt.– 5 representatives
State govt.- 1 from each
Union territories – 1 from each
Employee 5 representatives
Employer organization- 5 representatives
Medical profession - 2 representatives
Parliament -3 reprepresentative
Standing committee -Constituted from members
Act as executive body for administration
Director General is a Chief executive officer
- assisted by
Insurance commissioner
Medical commissioner
Financial commissioner
Actuary
Medical benefit council – Advisory Body
Headed by DGHS Govt. of India
-Assisted by
Deputy DGHS Govt. of India
Medical commissioner
One member from each state
3 representatives of employees
3 representatives of employers
Few from medical profession – one must be
woman
For day to day administration
21 state wise regional offices
15 sub regional offices
Local offices under sub regional offices
Local benefit council
Inspection officers
Benefits
1. Medical Benefit
For Insured Person
Full Medical Care
For Family Members of Insured Person
Restricted Medical Care
-Includes only OPD services
Expanded Medical Care
-Includes full medical care excluding
hospitalization
Extended medical care
-Corporation provides immunization to
young children of insured persons
Old age Medical Care
After having completed 5 years in insurable
employment, rate of contribution is INR 120/-
per annum for self and spouse.
Other Medical Benefits
Dentures , spectacles, hearing aids
Artificial limbs
Special appliances – Hernia belts, Walking
callipers, surgical boots, spinal braces
Organization of Medical Care
Direct Pattern
Service Dispensaries
o Full time dispensary -In areas where > 1000
employees͛ family units
o Part- time Dispensaries -In areas where < 750
employees͛ family units
o Mobile Units- If the residential concentration of
employees scattered.
2. Sickness Benefit
Periodical cash payment to insured- when sickness is certified
by insurance practitioner
Maximum 91 days in a year.
At the rate of approximately 50% (earlier) of daily
wages
Now raised to 60% of daily wages (should have paid at
least 78 days in contribution period of 6 months)
Extended Sickness Benefit
o Given for certain chronic diseases (34 diseases)
o E.g. Tuberculosis, AIDS, Malignancies, CCF
o For up to 309 days
o After Insured Person has been in continuous
employment for 2 years
o Insured Person is protected from dismissal from service
during this period
3. Maternity Benefit
For confinement/miscarriage or sickness arising out of the
same -Payable in cash to insured woman
Duration -ESI Maternity Leave increased to 24 weeks
from 12 weeks.
For confinement – 12 weeks
Miscarriage – 6 weeks
Rate -At full wages
Women with following category will also be eligible for ESI
maternity benefits:
o a commissioning mother who as biological mother wishes
to have a child and
o prefers to get embryo implanted in any other woman;
o a woman who legally adopts a child of up to three months
of age;
o The insured woman having two or more than two
surviving children shall be entitled to
o receive maternity benefits during a period of twelve
weeks of which not more than six
o weeks shall precede the expected date of confinement.”
o Sickness due to confinement – extra 30 days
4.Disablement Benefit
Temporary Disablement
-At 85 % of wages till disablement lasts
Total Permanent Disablement
- Life pension at full rate
Partial Permanent Disablement
-A proportion of full rate as Life pension
5. Dependent’s Benefit
In case of death of insured person due to employment injury
- Dependents of insured person are eligible for periodical
payments
- Pension at rate of 40 % more than the Standard Benefit Rate
Payable to widow and children up to age of 18 years (in case
of daughter benefit withdrawn if she marries earlier) in a fixed
share
Cash : Dependent benefit
o Widow, legitimate or adopted child up to age of 25 years
or till daughter gets married or widow gets remarried
o At 40% more than the standard benefit rate
o Benefit enhanced from 70% to 75% wef 1/12/2007
6. Funeral expenses
Cash payment on death of an Insured person towards
expenses on his funeral
Maximum Rs 5000 (earlier)
Now, funeral benefit is Rs 10,000/- given to the eldest
surviving member
7. Rehabilitation allowance
Medical benefit after permanent disablement or
retirement
Available on monthly payment of Rs.10 by IP
Available to IP and Family members
8. Unemployment Allowance
(Under Rajiv Gandhi Shramik Kalyan Yojana)
An Insured Person who become unemployed after being
insured three or more years, due to
closure of factory, retrenchment or permanent invalidity due to
non occupational injury
Benefits
Unemployment Allowance equal to 50% of wage for a
maximum period of up to one year.
Medical care for self and family from ESI Hospitals/
Dispensaries during the period IP receives unemployment
allowance.
Vocational Training provided for upgrading skills -
Expenditure on fee/travelling allowance borne by ESIC.
Benefit to Employers
o Exemption from Workman’s Compensation Act
o Exemption from Maternity Benefit Act
o Exemption from payment of medical allowance to
workers
o Rebate on Income Tax
o Healthy workforce
DUTIES OF FMO TOWARDS ESIC
•ESI covers Occupational Diseases. There is an
Occupational Disease Centre (ODC) at ESI Gotri
General Hospital. Under the ESI Act, Occupational
Disease is an Employment injury (EI)
•Industry Doctors can refer the accident cases to these
dispensaries with ESI Numbers and details on their
letter heads
•Employment injury are to be reported to ESI
IN CASE OF AN ACCIDENT
•FMOs should refer Accident cases to nearest
Emergency Dispensary during Off hours ( 12 to 5 and
after 7 PM onwards)
•FMO can refer them to ESI Hospital directly ( in case
of serious EI) with their ESI Numbers and Form 16.
•FMO should keep records of initial findings of the
accident and first AID given in Accident Register.
WHAT RECORDS TO DEVELOP AND MAINTAIN
•List of ESI Beneficiaries.. With their Dispensary
allotted
Number, age ,sex
•File of ESI Certificates issued
•Form no 16
•First AID register ( Accident register)
•Telephone Directory of ESIS Dispensaries and
hospitals.
