44How does the Employees' State Insurance Scheme assist you?
The dependence of an individual on cash income is a characteristic feature of modern economy. An interruption of money income even for a small period is, therefore, a hardship; a prolonged loss of income is indeed a catastrophe. By coming forward to provide health protection and income maintenance in a series of oft-experienced contingencies like sickness, maternity, disablement and death due to employment injury, the Employees' State Insurance Scheme tends to ameliorate your economic anxiety and to be a friend in need and distress.
Why is it called a Health Insurance Scheme?
The Employees' State Insurance Scheme performs a dual role; by providing assistance in kind (medical care) it tries to restore your health and working capacity and by assistance in cash (cash benefit) it tries to sustain you when your income is interrupted. With a better and facile health protection, greater vitality, and assurance of income-maintenance in times of need, it makes you every inch a better, a healthier, secure worker and therefore, a happier man. The assistance comes to you not as an act of benevolence but in virtue of an acquired right.
Who administers the Employees' State Insurance Scheme?
The Employees' State Insurance Scheme is administered by a corporate body called the Employees' State Insurance Corporation (ESIC), which has members representing Employees, Employers, the Central Government, State Governments, Medical Profession and the Parliament. The Director General is the Chief Executive Officer of the Corporation and is also an ex-officio member of the Corporation. The other bodies at the national level are the Standing Committee (a representative body of the Corporation) and the Medical Benefit Council, a specialized body which advises the Corporation on administration of Medical Benefit. At the Regional and Local levels, the Regional Boards and Local Committees have been constituted. There is, thus, an association of interests and interest groups at all levels. ESIC is the trustee of the interests of the insured persons. It discharges its obligations and duties through a net-workof Regional Offices and Branch Offices, Hospitals and Dispensaries spread over the entire country.
Whom does the Scheme protect?
The Scheme protects all "employees" engaged on a monthly remuneration not exceeding Rs. 6500/- in a factory/ establishment to which the Act applies. Persons employed for wages on any work connected with the administration of the factory or establishment or any part, department or branch There of or purchase of raw materials, or distribution or sale of the product of a factory or establishment are also covered. Mines, Railway Running Sheds, Naval, Military and Air Force Workshops and specified seasonal factories are excluded. The scheme also provides full medical cover to the dependants of insured persons. In the event of death of an insured person due to employment injury dependants become eligible to cash benefit.
Where do Employees' State Insurance Funds come from?
The Employees' State Insurance Funds are primarily built out of employers contribution and employees contribution payable monthly as a fixed percentage of wages.
How are the employees registered under the Scheme?
Simultaneously with his/her entry into employment in a covered factory or establishment, an employee is required to fill in a Declaration Form. The employee is then allotted a Registration Number, which distinguishes and identifies the person for the purposes of the Scheme. A person is registered once and once only upon his entry in insurable employment.
What is an Identity Card?
Simultaneously with his/her entry into employment in a covered factory or establishment, an employee is required to fill in a Declaration Form. The employee is then allotted a Registration Number, which distinguishes and identifies the person for the purposes of the Scheme. A person is registered once and once only upon his entry in insurable employment.
What are the rates of contribution?
Contributions payable in respect of an employee comprise of employer's contribution and employee's contribution prescribed in Schedule I of the Act. An employee covered under the scheme has to contribute 1.75% of the wages whereas, an employer contributes 4.75% of the wages payable to an employee. The total contribution in respect of an employee thus works out to 6.50% of the wages payable.
Who is exempted from payment of contribution?
Employees earning less than Rs 40/- a day are exempted from payment of contribution. The employers share of contribution is, however, payable.
How are the Contributions collected?
The Contribution is deposited by the Employer in cash or by cheque at the designated branches of some nationalized banks. The responsibility for payment of all contributions is that of the employer with a right to deduct the Employees' share of contributions from employees' wages relating to the period in respect of which the Contribution is payable.
What are 'Contribution Periods' and 'Benefit Periods?
Workers, covered under the ESI Act, are required to pay contribution towards' the scheme on a monthly basis. A contribution period means a six-month time span from 1st April to 30th September and 1st October to 31st March. Thus, in a financial year there are two contribution periods of six months duration.
Cash benefits under the scheme are generally linked with contributions paid. The benefit period starts three months after the closure of a contribution period. The two types of periods are iIIucidated below:-
Contribution Period
Benefit period
1st April to 30th September Corresponding
1st October to 31st March
1st January to 30th June of the following year
1st October to 31st March 18th July to 31 st December
SOCIAL SECURITY BENEFITS
SICKNESS BENEFIT
What does 'Sickness Benefit' mean?
Sickness signifies a state of health necessitating medical treatment and attendance and abstention from work on medical grounds. Financial support extended-by the Corporation is such a contingency is called Sickness Benefit.
What are the Contributory Conditions?
The contribution condition required to be fulfilled for admissibility of sickness benefit during any benefit period is that contributions should have been paid in respect of an insured person in the corresponding contribution period for not less than 78 days.
How much is the Standard Benefit Rate?
The daily rate of Sickness Benefit during any benefit period is the "standard benefit rate" this rate corresponds to the average daily wage of an insured person during the corresponding contribution period and is roughly half of the daily wage rate. Benefit is paid for Sundays also. 28 wage groups have been evolved for working out the daily rate of Standard Sickness Benefit. Standard Benefit rates for 28 wage groups are shown in Annexure 'A'.
How much is the Standard Benefit Rate?
The daily rate of Sickness Benefit during any benefit period is the "standard benefit rate" this rate corresponds to the average daily wage of an insured person during the corresponding contribution period and is roughly half of the daily wage rate. Benefit is paid for Sundays also. 28 wage groups have been evolved for working out the daily rate of Standard Sickness Benefit. Standard Benefit rates for 28 wage groups are shown in Annexure 'A'.
What is the duration of Sickness Benefit?
Sickness benefit is payable' for a maximum period of 91 days in any two consecutive benefit periods. Benefit is not paid for an initial waiting period of 2 days unless the insured person is certified sick within 15days of the last spell in which Sickness Benefit was paid.
What is Extended Sickness Benefit?
Extended Sickness Benefit is a Cash Benefit paid for prolonged illness due to any of the 34 specified diseases as mentioned below.
Tuberculosis
Leprosy
Chronic Empyema
Bronchiectasis
Interstitial Lung disease
AIDS
Malignant Diseases
Diabetes Mellitus-with proliferative retinopathy/diabetic footl nephropathy.
Monoplegia
Hemiplegia
Paraplegia
Hemiparesis
Intracranial space occupying lesion
Spinal Cord Compression
Parkinson's disease
Myasthenia Gravis/Neuromuscular Dystrophies
Immature Cataract with vision 6/60 or less
Detachment of Retina
Glaucoma
Coronary Artery Diseases
Congestive Heart Failure-Left, Right
Cardiac valvular Diseases with failure/complications
Cardiomyopathies
Heat disease with surgical intervention along with complications
Chronic Obstructive Long diseases .(COPD) with congestive' heart failure (CorPulmonale),
Cirrhosis of liver with ascitis/chronic active hepatitis, ("CAH")
Dislocation of vertebra/prolapse of intervertebral disc
Non union or delayed union of fracture
PostTraumatic surgical amputation of lower extremity
Compound fracture with chronic osteomyelitis
Schizophrenia
Endogenous depression
Maniac Depressive Psychosis (MDP)
Dementia
More than 20% Burns with infection/complication
Chronic Renal Failure
Reynaud's disease/Burger's disease
In addition, extended sickness benefit may also be sanctioned by the prescribed authority, in case of any rare disease or special circumstances on the recommendation of the specified authority.
What are the contributory conditions?
Except in case of disability from administration of drugs/ injections, the insured person should have been in continuous employment for a period of 2 years and should have contributed for atleast 156 days in 4 preceding contribution periods.
How much is the benefit rate?
The daily rate of Extended Sickness Benefit is40% more than the Standard Sickness Benefit rate admissible.
How Long is the benefit available?
After exhausting Sickness Benefit payable for 91 days the ESB is payable upto a further period of 124/309 days that can be extended upto 2 years in special circumstances. Thus, together with the Sickness Benefit for 91 days, it puts a claimant on benefit for an aggregate period 400 days for all specified diseases and 2 years in chronic suitable cases on recommendation of competent authority.
What is Enhanced Sickness Benefit ?
Enhanced Sickness Benefit is cash benefit for the insured persons undergoing sterlisation operation of vasectomy/ tubectomy for family planning.
What are the contributory conditions?
Enhanced Sickness Benefit is cash benefit for the insured persons undergoing sterlisation operation of vasectomy/ tubectomy for family planning.
How much is the benefit available?
The contributory conditions are the same as for claiming sickness benefit.
How Long is the benefit available?
The benefit is available upto 7 days for vasectomy and upto 14days for tubectomy operations. This period can however be extended in cases of post operative complications or sickness arising out of these sterlisation operations. Its duration is not counted towards the total number of 91 days for which
the sickness benefit is available during any two consecutive benefit periods.
What is 'Disablement'?
Disablement is a condition resulting from employment Injury which may be :-
(a) temporary i.e. rendering an insured person incapable of work temporarily and necessitating medical
treatment; .
(b) permanent partial i.e. reducing the earning capacity of the insured person generally for every employment;
(c) permanent total Le. totally depriving the insured person of the power to do all work.
What constitutes an "Employment Injury"?
Employment injury means a personal injury caused to an employee by an accident or occupational disease arising out of and in course of his employment in a factory or establishment covered under the Employees' State Insurance Act. The law relating to Employment injury has been liberalised. Now, an accident arising in the course of employment is presumed also to have arisen out of his employment if there is no evidence to the contrary. Further, an accident brought about by willful disobedience, negligence or breach of regulations etc. or an accident happening while traveling in a transport provided by the employer or while meeting an emergency is accepted subject to certain conditions, to have arisen in the course of and out of employment. Injuries suffered while under the influence of drink sand drugs take away the right to the employee to this benefit.
Roadside accident caused while commuting between place of residence and workplace is also treated as notional extension of employment for purpose of death or disablement benefit.
What are 'Occupational Diseases'?
Occupational Diseases are such diseases as are susceptible of being traced back to their occupational origin. There are specified under Schedule III of the Employees' State Insurance Act, which enumerates the compensable Occupational Diseases and the corresponding industrial processes involving exposure to the diseases are thus recognised without any further evidence.
What are the Benefits granted?
Temporary Disablement Benefit is paid periodically in arrears as the evidence of incapacity (medical certificate) is produced. Permanent total disablement and permanent partial disablement benefits are paid in the form of pensions. Current employment for wages or engagement in any gainful activities is no bar to payment of permanent disablement benefits. An insured person suffering from an occupation disease is also entitled to full medical care.
How much is the Benefit Rate?
The daily benefit rate for permanent total disablement and temporarydisablementis40% more than the Standard Sickness Benefit rate and is roughly equivalent to about '10%of the wage rate. For permanent partial disablement, the rate of benefit is proportionate to the percentage of loss of earning capacity. The benefit is paid for Sundays also.
What is the duration of Benefit?
Temporary Disablement Benefit is paid as long as disablement lasts. There is a waiting period of 3 days (excluding the day of accident), but if in capacity exceeds this period, benefit is paid from the very first day. The permanent disablement benefit is paid for the life-time of the beneficiary.
What are the contributory conditions?
There are no qualifying conditions as to the length of employment or the number of contributions paid. Protection accrues from the very moment of entry into insurable employment.
How is Permanent Disablement assessed?
There is indeed no way of adequately compensating a permanently disabled employee and yet some method of determining whether an employment injury has resulted in permanent disablement and of assessing the extent of permanent damage caused by that employment injury has to be adopted for the purpose of determining the scale of compensation for the loss of earnings. This is done by evaluating loss of earning capacity with reference to general disability for all work. The evaluation is done by a Medical Board whose decision can be appealed against to a Medical Appeal Tribunal presided over by a judicial officer, with a further right of appeal to Employees' Insurance Court or directly to Employees' Insurance Court. Pending an appeal, payment for permanent loss of earning capacity as recommended by the Medical Board is made, subject to adjustment later. Loss of wages and expenditure on conveyance occasioned by attendance before the Medical Board are compensated by the Corporation in accordance with rates framed for the purpose.
Where the assessment of loss of earning capacity by the Medical Board is not of a final character, the beneficiary is required to appear again before the Medical Board for a review of the assessment.
Can the decisions of Medical Board or of Medical Appeal Tribunal be reviewed?
Yes. If the Medial Board or the Medical Appeal Tribunal is satisfied by fresh evidence that a. decision was given because of non-disclosure or mis-representation of a material fact, it can review its earlier decision at any time. A Medical Board can also review its earlier assessment of extent of disablement, if it is satisfied that there has been substantial and unforeseen aggravation of the results of the relevant injury and substantial injustice would be done by not reviewing it. Such review, however, cannot be made earlier than 5 years or in the case of the provisional assessment, earlier than 6 months of the date of assessment to be reviewed.
Is lumpsum Benefit allowed in place of Pension?
Yes. At the option of the beneficiary, permanent disablement pension, where the daily rate payable is not significant, can be commuted for a lumpsum payment subject to the fulfilment of the following two conditions :-
(i) that the permanent disablement has been assessed
as final, and
(ii) the daily rate of permanent disablement does not
exceed Rs 5/- and the total commuted value does not
exceed Rs 30,000/- (effective from April-D3).
Is there any provision for physical rehabilitation?
The Corporation at its cost arranges for the vocational rehabilitation of disabled insured persons provided the disability has been assessed at above 40 percent and the beneficiary is not over 45 years of age. The training is provided at vocational rehabilitation centres run by the Govt. of India etc. The fee, travelling expenses etc are borne by the Corporation.
What about vocational rehabilitation?
The Corporation at its cost arranges for the vocational rehabilitation of disabled insured persons provided the disability has been assessed at above 40 percent and the beneficiary is not over 45 years of age. The training is provided at vocational rehabilitation centres run by the Govt. of India etc. The fee, travelling expenses etc are borne by the Corporation.
What is 'Dependents' Benefit'?
Dependents Benefit is a monthly pension payable to the eligible dependents of an insured person who dies as a result of an Employment Injury or occupational disease.
Who are the Beneficiaries and how long is the Benefit available?
Dependants entitled to the benefit could be :-
(a) Widow/Widows during life or until remarriage:
(b) Legitimate or adopted son until age 18 or if legitimate son is infirm, till infirmity lasts;
(c) Legitimate or adopted unmarried daughter until age 18 or until marriage, whichever is earlier, or if infirm, till infirmity lasts and she continues to be unmarried.
In the absence of any widow or legitimate child, the benefit is payable to a parent or grandparent for life, to any other male dependant until age 18 or to an unmarried or widowed female dependant until age 18.
How much is the Benefit for each Beneficiary?
The total divisible benefit is equivalent to the temporary disablement benefit rate (roughly 70% of the wage rate). The widow/widows share 3/5th of the benefit and the legitimate or adopted son and daughter 2/5th each of the benefit. If the total benefit so divided exceeds the full rate, there is a proportionate reduction in the respective shares of the beneficiaries.
How to claim 'Dependants' Benefit'?
To establish title to Dependant' Benefit, the following documents should be submitted at the Branch Office:-
(a) Claim in the appropriate form;
(b) Evidence of death being due to employment injury;
(c) Proof of relationship to the deceased supporting eligibility of the claimant as a "dependant";
(d) Evidence of age of the claimant(s) (certified copy of official record of birth, Baptismal register, school records, original horoscope etc;
(e) Certificate of infirmity from Medical Referee or any other prescribed authority in case of legitimate infirm son or legitimate or adopted unmarried infirm daughter.
After the claim to Dependant's Benefit has been admitted, the beneficiary should submit at six-monthly intervals (with the claim for June and December),a declaration that he/she is alive and has not married/remarried, attained the prescribed agel continues to be infirm, as the case may be duly attested by the prescribed authority.
Can Dependant's Benefit be reviewed?
Yes. Dependant's Benefit once awarded can be reviewed by the Corporation at any time if it is satisfied on fresh evidence that the earlier decision was due to non-disclosure or misrepresentation of material facts. It can also be reviewed on birth, death, marriage, re-marriage and attainment of age 18, by a claimant. The benefit can be continued, increased, reduced or discontinued.
What is Maternity Benefit?
Yes. Dependant's Benefit once awarded can be reviewed by the Corporation at any time if it is satisfied on fresh evidence that the earlier decision was due to non-disclosure or misrepresentation of material facts. It can also be reviewed on birth, death, marriage, re-marriage and attainment of age 18, by a claimant. The benefit can be continued, increased, reduced or discontinued.
What are the contributory conditions?
The contribution condition is the same as for Sickness Benefit.
How much is the Benefit?
The daily benefit rate is double the Sickness Benefit rate and is thus roughly equivalent to the full wages. Benefit is paid for Sundays also.
What is the duration of the Benefit?
The Benefit is paid as follows:-
(a) For confinement:-
For a total period or 12 weeks beginning not more than 6 weeks before the expected date of child birth.
If the insuredwoman dies during confinement or within 6 weeks thereafter, leaving behind the living child, the benefit continues to be payable for the whole of the period. But if the child also die during that period, the benefit will be paid upto and including the day of death of the child.
(b) For Miscarriage:-
For a period of 6 weeks following the date of miscarriage.
(c) For Sickness arising out of pregnancy, confinement, premature birth of child or miscarriage:- For an additional period of upto four week.
In all the cases, the benefit is paid only if the insured woman does not work for remuneration during the period for which benefit is claimed. There is no waiting period.
How to claim Maternity Benefit?
Where an insured woman wishes to claim Maternity Benefit after confinement or for miscarriage, she should obtain from the Insurance Medical Officer/insurance Medical Practitioner, a certificate of confinement or miscarriage and submit it to her Branch Office personally or by post along with a claim for Maternity Benefit. The claim form also contains a declaration of abstention from work.
If Benefit is desired before confinement, a Notice and Certificate of Pregnancy and a Certificate of Expected Confinement obtained from the Insurance medical Officer/ Insurance Medical Practitioner are also required to be submitted.
For claiming Benefit in the event of death of an insured woman leaving behind a child, her nominee and if there is no such nominee, her legal representative should submit personally or by post to the Branch Office of the deceased insured woman, claim for the Benefit together with a certificate of death of the insured woman.
An insured woman claiming Maternity Benefit for Sickness arising out of pregnancy, confinement, premature birth of child or miscarriage should submit her claim in the manner as for sickness benefit.
Where a claim to Maternity Benefit is not submitted Along with prescribed certificates referred to above, the Corporation has the discretion to accept other evidence in lieu thereof.
What is Medical Bonus?
Medical Bonus is lump sum payment made to an insured woman or the wife of an insured person in case she does not avail medical facility from an ESI hospital at the time of delivery of a child. This bonus of Rs. 250/- has been increased to Rs. 1000/- from 1st April 2003.
What does Medical Benefit consist of?
Medical Benefit means medical care of insured persons and their families, wherever covered for medical benefit.
Where are 'out-patient' services provided?
Out-door medical care is provided at State Insurance Dispensaries or Mobile Dispensaries manned by full-time doctors ('Service' system) or at the private clinics of Insurance Medical Practitioners ('Panel" system). The scope of medical services also includes simple ante-natal and post-natal care for women, family welfare planning services and immunization against the common infectious diseases. The Scheme provides at the sole cost of the Corporation, artificial limbs to insured persons who lose their limbs due to employment injury or in certain circumstances otherwise also, dentures, spectacles arid hearing-aids where the loss of teeth, impairment of eye-sight or hearing respectively is due to employment injury.
How and where are 'In - patient' Services Provided?
ESIC has a network of 141 hospitals country wide. Majority of these hospitals are administered by the State Govts. In - patient and diagnostic services in basic specialties are available
at these hospitals. State schemes have also tie-up arrangements with a number of Medical colleges. major state hospitals, as well as, private hospitals for advanced treatment for malignant diseases and complicated surgical interventions.
What about Preventive health care services?
ESI Scheme provides preventive health care services through the network of its dispensaries and hospitals. These include immunization against some killer diseases, pulse polio vaccination and family welfare services etc. The scheme also participates in all major national preventive health service campaigns.
How long Is Medical Benefit available?
Insured worker and the members of his family are eligible for medical care from the very first day of the worker coming under ESI Scheme. The medical care includes primary medical care, diagnostic services, specialist consultations and indoor medical care. Whenever the patient is not able to travel by himself/herself, ambulance services are also provided. The I.P. or his family members are not required to pay for any of the services.
A worker who is covered under the Scheme for the first time is eligible for medical care for a period of three months. If he/she continues in insurable employment for three months or more the medical care is available to him/her till the start of the first benefit period. If he/she contributes atleast for 78 days in a contribution period the eligibility is there upto the end of the corresponding benefit period.
A worker is also eligible for extended sickness benefit when he/she is suffering from anyone of the long term 34 diseases listed in the Act. This is admissible after the worker has been under ESI coverage for atleast 2 years during which he/she should have contributed atleast for 156 days. When these conditions are satisfied medical benefit is admissible for a maximum period of 730 days for the I.p. and his/her family.
What are Funeral expenses?
This component consists of a lump sum payment toward the expenditure on the funeral of the deceased insured person.
What is the amount payable?
The lump sum amount of this benefit is equal to the actual expenditure, not exceeding Rs. 2500/- towards the funeral of the deceased insured person.
Are there any Contribution Conditions?
No contribution condition is required for this Benefit. The only condition for admissibility of this Benefit is that the deceased person should have been an insured person at the time of his death. The Funeral expenses are thus payable in respect of an insured person in receipt of Permanent Disablement Benefit even if he may not be employed at the time of his death in a factory or establishment covered under the ESI Act.
To whom are the Funeral expenses payable?
The expenses are payable to the eldest surviving member of the family of the deceased insured person. If the insured person did not have a family or if he was not living with his family at the time of his death, the benefit is payable to the person who actually incurs the expenditure on the funeral of the deceased insured person.
How to claim the Funeral expenses?
To claim the expenses, the claimant should submit his/ her claim personally or by post to the Branch Office of the deceased insured person within three months, together with the following documents:-
(a) Death certificate as proof of death of the insured person issued by the Insurance Medical Officer/ Insurance Medical Practitioner or such other Medical Officer of a hospital or other institution who attended the insured person at the time of death or examined the body aft~r the death; (Death certificate issued by cremation/burial ground or by Municipal authorities or certified copy of village etc. death records may also be accepted as evidence of death);
(b) a declaration of the claimant, either
(i) that he is the eldest surviving member of the family of the deceased insured person and incurred expenditure on the funeral of the deceased. or
(ii) in case the claimant is other than the eldest. surviving member of the family, that the deceased insured person did not have a family or was not living with his family at the time of his death and that the claimant actually incurred expenditure on the funeral of the deceased insured person. The declaration should be countersigned by a competent authority
CRK
From India, Vijayawada
The Contractor who is lending the services of his employees to the principal employer is not to be counted either for coverage of the factory/establishment or for his own coverage. Proprietor, partners and the contractors are not to be covered. Thus, at both the places, the contractor is not covered.
From India, Hyderabad
From India, Hyderabad
Thank you Mr. CRKM for the detailed information on benefits admissible under the ESI Scheme as available in the ESI "Employee Guide" (2003 edition). I am giving below the details of the medical benefit admissible to the retired employees and permanently disabled persons, and also the "Un-employment allowance" admissible to the insured person in case of retrenchment/closure of the factory.I am also giving an up date wherever required ,to the information furnished by you.
What is the medical benefit admissible to an insured person after leaving his insurable employment?
An insured person who leaves the insurable employment on attaining 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 medical benefit for himself and his spouse subject to production of proof thereof, and payment of a nominal contribution of rupees one hundred and twenty 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 received the medical benefit on payment of the contribution @ 120/p.a. for 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 he not sustained such permanent disablement.
2. What is unemployment allowance?
The ESI Scheme has introduced a scheme of unemployment allowance to the IPs who have been rendered unemployed involuntarily due to closure of the factory / establishment , retrenchment or permanent invalidity arising out of non-employment injury w.e.f. 1-4-2005. Affected IPs and their families will also be entitled to medical care from ESI Dispensaries / hospitals during periods of unemployment allowance.
Unemployment which arises due to following reasons shall be covered under the Scheme:-
Retrenchment as defined in the Industrial Disputes Act, 1947
Closure of the factory / establishment as defined in the Industrial Disputes Act, 1947.
Permanent invalidity not less than 50% arising out of non-employment injury. (The invalidity should be duly certified by a Medical Board constituted by the Central or State Government)
The applicant should have been an Insured Person under the ESI Act on the date of loss of insurable employment on account of retrenchment, closure of the factory / establishment or permanent invalidity arising out of non-employment injury.
Contribution in respect of him/ her should have been paid/ payable for a minimum period of three years (with effect from 11.09.2009 - previously five years) prior to the loss of employment. The duration of a year in this context, would mean a period of 156 days or more. An IP who has lost employment and in respect of whom the contribution was paid/ payable for 156 days or more in any two consecutive contribution periods in this reckoning will be deemed as having worked for one full year. Similarly, those who have paid contribution for 78 days more in a contribution period will be deemed as having served for a half year.
The period of service of an I.P .need not be continuous with one employer. The I.P. shall be entitled to this allowance irrespective of the fact whether part of his/her service as employer in the same or in any other region.
The I.P. need not satisfy any qualifying conditions afresh for claiming unemployment allowance for any subsequent spells provided to him/her but he/she should be an IP on the subsequent dates of unemployment. The unemployment allowance in the subsequent spells shall be at the same rate as has already been decided /paid.
As specified in section 65 of the Act, an IP shall not be entitled to any other cash benefit and the unemployment Allowance simultaneously for the same period. However, he/she may opt for either of the two, i.e., cash benefit or unemployment allowance . The term ‘cash benefit’ excludes periodical payments of PDB under ESI Act and Regulations.
As specified under Section 61 of the ESI Act , an IP who is in receipt of unemployment allowance shall not be entitled to receive any similar benefit admissible under the provisions of any other enactment.
There will be one month waiting period after the retrenchment.
Unemployment allowance shall not be admissible in the following circumstances:
During lock out; Lay off/temporary closure of factory /estt.;Strike resorted to by the employees ;and Voluntary abandonment of employment/premature retirement.
The rate of unemployment allowance in respect of a person who becomes unemployed shall be calculated on the basis of average daily wage during the last four completed contribution periods, immediately preceding the date of unemployment.
The daily rate of unemployment allowance shall be the Standard Benefit Rate as specified in the Table of Standard Benefit under Rule 54 of ESI (Central)Rules 1950 corresponding to the average daily wage so arrived.
Duration of allowance:
The maximum duration , for which an IP shall be eligible to draw the unemployment allowance during his/her entire life time, would be six months. However, the unemployment allowance shall not be admissible for a period less than one month at a time.
In case the beneficiary gets gainful employment subsequently , he/she can avail the balance allowance in case the contingency so arises but he/she should again be IP to be eligible for unemployment allowance for subsequent spells.
The IP eligible for unemployment allowance under the Scheme shall also be entitled to medical care for himself/herself and his/her family from the ESI Dispensaries/ESI hospitals/ IMPs Clinics for a period corresponding to contribution Period before unemployment, whichever is later.
In the event of death of the IP on any date prior to the expiry of 6 months period of unemployment allowance , the family of the deceased IP shall continue to be entitled to medical care for the remaining period as the case would have been, had the IP remained alive.
Medical care under this scheme shall, however, be restricted to only for the first spell of unemployment.
The claim for unemployment Allowance shall be submitted by the claimant at any time but not later than six months from the date of retrenchment/ unemployment to the appropriate Branch Office in the Form (UA-1) supported by the documentary evidence (in Form UA-2) proving his/her retrenchment / unemployment/invalidity.
This certificate is to be issued by Inspector of Factories, Asst/Deputy Commissioner, Labour, Workmen Compensation Commissioner or any other authority specified in this regard. Certificate of invalidity will be issued by the medical board constituted by the Central /State Govt.
Mode of Payment of allowance
The allowance is payable by Account Payee Cheque only
Payment in the event of death of IP
The amount of unemployment allowance upto and including date of death of IP, is payable to his/her nominee / legal heir.
Updates for the other information:
1. The Scheme protects all "employees" engaged on a monthly remuneration not exceeding Rs. 15,000/- (w.e.from 1-5-2010) - in a factory/ establishment to which the Act applies.
2. The rates of contribution are prescribed under Rule 51 of ESI (Central) Rules, 1950. The first Schedule to the Act has been repealed from 1-2-91 vide ESI (Amendment) Act, 1989 and the Central Rules from 50 to 62 have brought in to force from 1-2-91.
3. Employees earning average wages not exceeding Rs. 70/- a day are exempted from payment of contribution. The employers share of contribution is, however, payable.
4. Benefit period for the contribution period from 1st October to 31st March is 1st July to 31st December.
5. The daily rate of Sickness Benefit during any benefit period is twenty percent more than the “standard benefit rate" during the corresponding contribution period.
6. There are 99 wage groups in the Standard benefit rate table in Rule 54.
7. The daily rate of disablement benefit is50% more than the Standard Sickness Benefit rate and is roughly equivalent to about '75%of the wage rate.
8. Dependants entitled to the dependant benefit are (from 1st June, 2010)
(a) Widow/Widows during life or until remarriage:
(b) Widowed mother for life;
(c) Legitimate or adopted son until he attains the age of 25 years;
(d) Legitimate or adopted unmarried daughter until her marriage;
(e) If wholly dependent on the earnings of the insured person at the time of his death, a legitimate or adopted son or daughter who has attained the age of twenty five years and is infirm;
In the absence of any widow or legitimate child, the benefit is payable to a parent or grandparent for life, to any other male dependant until age 18 or to an unmarried or widowed female dependant until age 18.
9. Maternity benefit is periodical payments to an insured woman for specified period of abstention from work, due to confinement, miscarriage or sickness arising out of pregnancy, pr-mature birth of child or miscarriage or confinement.
10. An insured woman shall be qualified to claim maternity benefits for a confinement occurring or expected to occur in a benefit period, if the contributions in respect of her were payable for not less than seventy days in the immediately preceding two consecutive contribution periods.The dail rate of Maternity benefit is double the 'Standard benefit rate' during the corresponding benefit period.
11. Medical bonus ( now termed as “confinement expenses”) to an insured woman and an insured person in respect of his wife shall be paid a sum of rupees two thousand five hundred per case on account of confinement expenses PROVIDED that the confinement occurs at a place where necessary medical facilities under the Employees' State Insurance Scheme are not available.
12. Funeral expenses consists of the lump sum amount equal to the actual expenditure, not exceeding Rs. 5000/-towards the funeral of the deceased insured person.
From India, Hyderabad
What is the medical benefit admissible to an insured person after leaving his insurable employment?
An insured person who leaves the insurable employment on attaining 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 medical benefit for himself and his spouse subject to production of proof thereof, and payment of a nominal contribution of rupees one hundred and twenty 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 received the medical benefit on payment of the contribution @ 120/p.a. for 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 he not sustained such permanent disablement.
2. What is unemployment allowance?
The ESI Scheme has introduced a scheme of unemployment allowance to the IPs who have been rendered unemployed involuntarily due to closure of the factory / establishment , retrenchment or permanent invalidity arising out of non-employment injury w.e.f. 1-4-2005. Affected IPs and their families will also be entitled to medical care from ESI Dispensaries / hospitals during periods of unemployment allowance.
Unemployment which arises due to following reasons shall be covered under the Scheme:-
Retrenchment as defined in the Industrial Disputes Act, 1947
Closure of the factory / establishment as defined in the Industrial Disputes Act, 1947.
Permanent invalidity not less than 50% arising out of non-employment injury. (The invalidity should be duly certified by a Medical Board constituted by the Central or State Government)
The applicant should have been an Insured Person under the ESI Act on the date of loss of insurable employment on account of retrenchment, closure of the factory / establishment or permanent invalidity arising out of non-employment injury.
Contribution in respect of him/ her should have been paid/ payable for a minimum period of three years (with effect from 11.09.2009 - previously five years) prior to the loss of employment. The duration of a year in this context, would mean a period of 156 days or more. An IP who has lost employment and in respect of whom the contribution was paid/ payable for 156 days or more in any two consecutive contribution periods in this reckoning will be deemed as having worked for one full year. Similarly, those who have paid contribution for 78 days more in a contribution period will be deemed as having served for a half year.
The period of service of an I.P .need not be continuous with one employer. The I.P. shall be entitled to this allowance irrespective of the fact whether part of his/her service as employer in the same or in any other region.
The I.P. need not satisfy any qualifying conditions afresh for claiming unemployment allowance for any subsequent spells provided to him/her but he/she should be an IP on the subsequent dates of unemployment. The unemployment allowance in the subsequent spells shall be at the same rate as has already been decided /paid.
As specified in section 65 of the Act, an IP shall not be entitled to any other cash benefit and the unemployment Allowance simultaneously for the same period. However, he/she may opt for either of the two, i.e., cash benefit or unemployment allowance . The term ‘cash benefit’ excludes periodical payments of PDB under ESI Act and Regulations.
As specified under Section 61 of the ESI Act , an IP who is in receipt of unemployment allowance shall not be entitled to receive any similar benefit admissible under the provisions of any other enactment.
There will be one month waiting period after the retrenchment.
Unemployment allowance shall not be admissible in the following circumstances:
During lock out; Lay off/temporary closure of factory /estt.;Strike resorted to by the employees ;and Voluntary abandonment of employment/premature retirement.
The rate of unemployment allowance in respect of a person who becomes unemployed shall be calculated on the basis of average daily wage during the last four completed contribution periods, immediately preceding the date of unemployment.
The daily rate of unemployment allowance shall be the Standard Benefit Rate as specified in the Table of Standard Benefit under Rule 54 of ESI (Central)Rules 1950 corresponding to the average daily wage so arrived.
Duration of allowance:
The maximum duration , for which an IP shall be eligible to draw the unemployment allowance during his/her entire life time, would be six months. However, the unemployment allowance shall not be admissible for a period less than one month at a time.
In case the beneficiary gets gainful employment subsequently , he/she can avail the balance allowance in case the contingency so arises but he/she should again be IP to be eligible for unemployment allowance for subsequent spells.
The IP eligible for unemployment allowance under the Scheme shall also be entitled to medical care for himself/herself and his/her family from the ESI Dispensaries/ESI hospitals/ IMPs Clinics for a period corresponding to contribution Period before unemployment, whichever is later.
In the event of death of the IP on any date prior to the expiry of 6 months period of unemployment allowance , the family of the deceased IP shall continue to be entitled to medical care for the remaining period as the case would have been, had the IP remained alive.
Medical care under this scheme shall, however, be restricted to only for the first spell of unemployment.
The claim for unemployment Allowance shall be submitted by the claimant at any time but not later than six months from the date of retrenchment/ unemployment to the appropriate Branch Office in the Form (UA-1) supported by the documentary evidence (in Form UA-2) proving his/her retrenchment / unemployment/invalidity.
This certificate is to be issued by Inspector of Factories, Asst/Deputy Commissioner, Labour, Workmen Compensation Commissioner or any other authority specified in this regard. Certificate of invalidity will be issued by the medical board constituted by the Central /State Govt.
Mode of Payment of allowance
The allowance is payable by Account Payee Cheque only
Payment in the event of death of IP
The amount of unemployment allowance upto and including date of death of IP, is payable to his/her nominee / legal heir.
Updates for the other information:
1. The Scheme protects all "employees" engaged on a monthly remuneration not exceeding Rs. 15,000/- (w.e.from 1-5-2010) - in a factory/ establishment to which the Act applies.
2. The rates of contribution are prescribed under Rule 51 of ESI (Central) Rules, 1950. The first Schedule to the Act has been repealed from 1-2-91 vide ESI (Amendment) Act, 1989 and the Central Rules from 50 to 62 have brought in to force from 1-2-91.
3. Employees earning average wages not exceeding Rs. 70/- a day are exempted from payment of contribution. The employers share of contribution is, however, payable.
4. Benefit period for the contribution period from 1st October to 31st March is 1st July to 31st December.
5. The daily rate of Sickness Benefit during any benefit period is twenty percent more than the “standard benefit rate" during the corresponding contribution period.
6. There are 99 wage groups in the Standard benefit rate table in Rule 54.
7. The daily rate of disablement benefit is50% more than the Standard Sickness Benefit rate and is roughly equivalent to about '75%of the wage rate.
8. Dependants entitled to the dependant benefit are (from 1st June, 2010)
(a) Widow/Widows during life or until remarriage:
(b) Widowed mother for life;
(c) Legitimate or adopted son until he attains the age of 25 years;
(d) Legitimate or adopted unmarried daughter until her marriage;
(e) If wholly dependent on the earnings of the insured person at the time of his death, a legitimate or adopted son or daughter who has attained the age of twenty five years and is infirm;
In the absence of any widow or legitimate child, the benefit is payable to a parent or grandparent for life, to any other male dependant until age 18 or to an unmarried or widowed female dependant until age 18.
9. Maternity benefit is periodical payments to an insured woman for specified period of abstention from work, due to confinement, miscarriage or sickness arising out of pregnancy, pr-mature birth of child or miscarriage or confinement.
10. An insured woman shall be qualified to claim maternity benefits for a confinement occurring or expected to occur in a benefit period, if the contributions in respect of her were payable for not less than seventy days in the immediately preceding two consecutive contribution periods.The dail rate of Maternity benefit is double the 'Standard benefit rate' during the corresponding benefit period.
11. Medical bonus ( now termed as “confinement expenses”) to an insured woman and an insured person in respect of his wife shall be paid a sum of rupees two thousand five hundred per case on account of confinement expenses PROVIDED that the confinement occurs at a place where necessary medical facilities under the Employees' State Insurance Scheme are not available.
12. Funeral expenses consists of the lump sum amount equal to the actual expenditure, not exceeding Rs. 5000/-towards the funeral of the deceased insured person.
From India, Hyderabad
Dear KVRM,
With due respect, i would like to add that due to typographical mistake there might been one mistake in the Unemployment allowance particulars:
Now the I.P., who is entitled for the "Unemployment allowance" is entitled for maximum period of "12 months, i.e. 360 days" instead of "6 months".
And the eligible criteria for is changed from continuous insurable employment for 5 years is reduced to 3 years.......
with regards.....
From India, Hyderabad
With due respect, i would like to add that due to typographical mistake there might been one mistake in the Unemployment allowance particulars:
Now the I.P., who is entitled for the "Unemployment allowance" is entitled for maximum period of "12 months, i.e. 360 days" instead of "6 months".
And the eligible criteria for is changed from continuous insurable employment for 5 years is reduced to 3 years.......
with regards.....
From India, Hyderabad
Dear VSP, Thank you for your timely correction. Now, the unemployment allowance is payable for a maximum period of twelve months either in one spell or in different spells of not less than one month's duration.I have already mentioned that the eligibility criteria has been reduced from 5 years to 3 years continuous insurable employment with effect from 11-9-2009. One more change is the time limit for submission of claim for un-employment allowance has been extended upto nine months with effect from 1st July,.2010.
From India, Hyderabad
From India, Hyderabad
Dear All
I have referred many sites to know in detail about ESI but i haven't found one information, Can anyone tell the person who has covered under ESI he/she has to get treatment only in ESI or can he/she avail the general treatment like fever,back pain etc even in private hospital.
Regards
Prasad
From India, Bangalore
I have referred many sites to know in detail about ESI but i haven't found one information, Can anyone tell the person who has covered under ESI he/she has to get treatment only in ESI or can he/she avail the general treatment like fever,back pain etc even in private hospital.
Regards
Prasad
From India, Bangalore
ESIC is a waste of money for both employee and employer. Have you ever wondered why companies go in for an additional Mediclaim Policy inspite of having an ESIC??????????..........Instead of talking big about ESIC there should have been GOOD FACILITIES AVAILABLE BEFORE MAKING IT A STATUTORY DEDUCTION...........Why don't some of our Political Superstars and Bureaucrats avail of this facility on those pathetic hospital if it is really really so good?????????..........Making a scheme look good in paper is a child's play.....implementing a really change is what real Men do AND WHAT REAL MEN WANT.................RGRDS
From India, Mumbai
From India, Mumbai
One of our employee was pregnant, she didn't inform ESI for the pregnancy and now she gave birth to a child in a private hospital. I have two queries :
Is there any process to claim hospital expenses of delivery
Is company is liable to pay his 3 months salary (paid leave benefit) or not - if he didn't got any paid leave benefit from ESI.
Please help.
Thanks
Rajiv Verma
From India, Delhi
Is there any process to claim hospital expenses of delivery
Is company is liable to pay his 3 months salary (paid leave benefit) or not - if he didn't got any paid leave benefit from ESI.
Please help.
Thanks
Rajiv Verma
From India, Delhi
Computerization in ESI
NOW, in a phased manner computerization in ESI is being introduced and in some States the preparation of monthly challan on line has become mandatory. While entering the details of wages for generation of monthly challan, if any mistake is happened in entering the wages that cannot be amended and the system is not allowing to amend the amount of wages which was wrongly entered by oversight or by the mistake of the data entry operator. If a provision is made for amendment in the wages also as like in the case of employees registeration which provides provision for update ip details. Plz through a light on this aspect
sanagapalli VR
From India, Hyderabad
NOW, in a phased manner computerization in ESI is being introduced and in some States the preparation of monthly challan on line has become mandatory. While entering the details of wages for generation of monthly challan, if any mistake is happened in entering the wages that cannot be amended and the system is not allowing to amend the amount of wages which was wrongly entered by oversight or by the mistake of the data entry operator. If a provision is made for amendment in the wages also as like in the case of employees registeration which provides provision for update ip details. Plz through a light on this aspect
sanagapalli VR
From India, Hyderabad
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ESI Amendment Act 2010-Gazette Notification-01 -06-10.pdf
FORMS under the ESI Act.doc