ESI ACT, 1948- Implications, Benefits and Procedure
APPLICATION OF THE ACT
It is applicable to non-seasonal power using factories employing 10 or more persons and non-power using factories employing 20 or more persons.The Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatre, road motor transport undertakings and newspaper establishment employing 20 or more persons.The existing wage-limit for coverage under the Act, is Rs.7500/- per month (with effect from 1.4.2004).
CONTRIBUTION
The employee’s contribution rate (w.e.f. 1.1.97) is 1.75% of the wages and that of employer’s is 4.75% of the wages paid/payable in respect of the employees in every wage period.
CONTRIBUTION PERIOD AND BENEFIT PERIOD
There are two contribution periods each of six months duration and two corresponding benefit periods also of six months duration as under.
Contribution period
1st April to 30th Sept.
1st Oct. to 31st March
Corresponding Cash Benefit period
1st January of the following year to 30th June.
1st July to 31st December of the year following
BENEFITS UNDER ESI SCHEME
MEDICAL BENEFITS
The Employees’ State Insurance Scheme provides full medical care in the form of medical attendance, treatment, drugs and injections, specialist consultation and hospitalization to insured persons and also to members of their families where the facility for Specialist consultation, hospitalization has been extended to the families.
For the families, this benefit has been divided into two categories as under:-
FULL MEDICAL CARE
EXPANDED MEDICAL CARE
MEDICAL BENEFITS (EXPLAINATION)!!!
FULL MEDICAL CARE
This consists of hospitalization facilities and includes specialist services, drugs and dressings and diets as required for in-patients.
EXPANDED MEDICAL CARE
This consists of consultation with the specialists and supply of special medicines and drugs as may be prescribed by them in addition to the out-patient care. This also includes facilities for special laboratory tests and X-Ray examinations.
MEDICAL BENEFITS (EXPLAINATION)!!!
System of treatment:
Generally, the allopathic system of medicine is used for providing Medical Benefit. However, where a substantial number of workers demand treatment by Indian system of medicine and Homoeopathy (ISM & H) other than Allopathy. The various ISM &H systems of treatment in vogue are:, Ayurvedic, Unani, Sidha, Yoga therapy and Homeopathy
MEDICAL BENEFITS – Scale of Medical Benefit!!!
To Insured Persons:- IPs are entitled to avail treatment in ESI dispensary/Hospital/Diagnostic Centre and recognised institutions, to which he is attached such as:-
Outpatient treatment
Domiciliary treatment by visits at their residences.
Specialists Consultation.
In-patient treatment(Hospitalisation)
Free supply of drugs dressings and artificial limbs, aids and appliances.
Imaging and laboratory services.
Integrated family welfare, immunisation and MCH Programme and other national health programme etc.
Ambulance service or re-imbursement of conveyance charges for going to hospitals, diagnostic centres etc.
Medical Certification and
Special provisions.
MEDICAL BENEFITS (EXPLAINATION)!!!
To Family Members of Insured Persons:- While in all implemented areas, IPs are entitled to medical care as detailed above, members of a family of an IP are entitled to one or other of the following scales of Medical Benefits:-
i."FULL" Medical Care i.e., all facilities as for IPs including hospitalisation.
ii."EXPANDED" Medical Care i.e., all facilities as for IPs except hospitalisation. A small number of IPs in the States of Gujarat and Bihar fall under this category.
SICKNESS BENEFITS!!!
SICKNESS BENEFITS EXPLAINED!!!
Sickness Benefit represents periodical cash payments made to an IP during the period of certified sickness occurring in a benefit period when IP requires medical treatment and attendance with abstention from work on medical grounds.
Sickness benefit is roughly 50% of the average daily wages and is payable for 91 days during 2 consecutive benefit periods.
TYPES OF SICKNESS BENEFITS!!!
EXTENDED SICKNESS BENEFITS (ESB)
ENHANCED SICKNESS BENEFIT
EXTENDED SICKNESS BENEFITS
An IP suffering from certain long term diseases is entitled to ESB, only after exhausting Sickness Benefit to which he may be eligible. A common list of these long term diseases for which ESB is payable is as follows
Infectious Diseases
Neoplasms
Endocrine,
Nutritional and Metabolic Disorders,
Disorders of Nervous System,
Disease of Eye,
Diseases of Cardiovascular System,
Chest Diseases,
Diseases of the Digestive System,
Orthopaedic Diseases,
Psychoses, and
Others (More than 20% burns with infection/complication, Chronic Renal Failure, and Reynaud’s disease/Burger’s disease)
Enhanced Sickness Benefits (w.e.f 1.8.1976 )
Insured Persons eligible to ordinary sickness benefit are paid enhanced sickness benefit at double the rate of sickness benefit i.e., about full average daily wage for undergoing sterilization operations for family welfare. Duration of enhanced Sickness Benefits is
Up to 7 days in the case of Vasectomy and
Up to 14 days in the case of the Tubectomy
from the date of operation or from the date of admission in the hospital as the case may be. The period is extendable in case of post operative complications.
MATERNITY BENEFIT (MB)!!!
Maternity Benefit (Explained)!!!
Maternity Benefit is payable to an Insured Woman in the following cases subject to contributory conditions:-Confinement-payable for a period of 12 weeks (84 days)
Miscarriage or Medical Termination of Pregnancy (MTP)-payable for 6 weeks (42 days) from the date following miscarriage-on the basis of Form 20 and 23.Sickness arising out of Pregnancy, Confinement, Premature birth-payable for a period not exceeding one month-on the basis of Forms 8, 10 and 9.In the event of the death of the Insured Woman during confinement leaving behind a child, Maternity Benefit is payable to her nominee .
Maternity benefit rate is double the Standard Benefit Rate, or roughly equal to the average daily wage
DISABILITY BENEFITS
DISABILITY BENEFITS (EXPLAINED)!!!
Temporary Disability Benefit
Duration of TDBThere is no prescribed limit for the duration of TDB. This is payable as long as temporary disablement lasts and significant improvement by treatment is possible. If a Temporary Disablement spell lasts for less than 3 days (excluding day of accident), IP will be paid sickness benefit, if otherwise eligible. A special point for IMOs/IMPs is that some IPs may resist taking a Final Certificate especially before 3 days for fear of loss of TDB.
PERMANENT DISABILITY BENEFIT
PDB is payable to an IP who suffers permanent residual disablement and results in loss of earning capacity.
The duration of PDB may be for the period given by Medical Board, if assessment is provisional or for entire life if assessment is final.PDB Rate: The PDB rate is calculated as percentage of loss of earning capacity as assessed by the Medical Board/MAT/EI Court in relation to TDB. List of injuries deemed to result in permanent total disablement. The maximum rate of PDB can be equal to the rate of TDB.
DEPENDANT’S BENEFIT
DEPENDANT’S BENEFIT (Explained)!!!
The dependants’ benefit is payable to the dependants in cases where an IP dies as result of EI.
The minimum rate of DB is Rs.14/- per day and these rates of the DB are increased from time to time. (The latest enhancement is with effect from 01.08.2002)
FUNERAL BENEFIT
Funeral expenses not exceeding Rs. 2500/- is payable towards expenditure on the funeral of a deceased IP.
ESI RELATED FORMS!!!
FORM 0- EMPLOYERS’ REGISTRATION FORMFORM 1- DECLARATION FORMFORM 1 A- FAMILY DECLARATION FORMFORM 1 B-CHANGES IN FAMILY DECLARATION FORMFORM 3- RETURN OF DECLARATION FORMSFORM 6- RETURN OF CONTRUBUTIONSFORM 12- SICKNESS OF TEMPORARY BENEFITSFORM 12 A- MATERNITY BENEFIT FOR SICKNESSFORM 13 – SICKNESS OR TEMPORARY DISABLEMENT OR MATERNITY BENEFIT FOR SICKNESS
FORM 13 A- MATERNITY BENEFIT FOR SICKNESS
FORM 14- SICKNESS OR TEMPORARY DISABLEMENT OR MATERNITY BENEFIT FOR SICKNESS
FORM 14 A- MATERNITY BENEFIT FOR SICKNESS
FORM 16- ACCIDENT REPORT FROM EMPLOYER
FORM 17-DEPENDANT’S OR FUNERAL BENEFIT (DEATH CERTIFICATE)
FORM 18- DEPENDANT’S BENEFIT (CLAIM FORM)
FORM 18 A- DEPENDANT’S BENEFIT (CLAIM FOR PERIODICAL PAYMENTS)
FORM 19- MATERNITY BENEFIT (NOTICE OF PREGNANCY)
FORM 20- MATERNITY BENEFIT (CERTIFICATE OF PREGNANCY)
FORM 21- MATERNITY BENEFIT (CERTIFICATE OF EXPECTED CONFINEMENT)
FORM 22- CLAIM FOR MATERNITY BENEFIT
FORM 23- MATERNITY BENEFIT (CERTIFICATE OF CONFINEMENT OR MISCARRIAGE)
FORM 24- MATERNITY BENEFIT (NOTICE OF WORK)
FORM 25- CLAIM FOR PERMANENT DIABLEMENT BENEFIT
FORM 26- CERTIFICATE FOR PERMANENT DISABLEMENT BENEFIT
FORM 27- DECLARATION AND CERTIFICATE FOR DEPENDANT’S BENEFIT
From India, Nizamabad
14APPLICATION OF THE ACT
It is applicable to non-seasonal power using factories employing 10 or more persons and non-power using factories employing 20 or more persons.The Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatre, road motor transport undertakings and newspaper establishment employing 20 or more persons.The existing wage-limit for coverage under the Act, is Rs.7500/- per month (with effect from 1.4.2004).
CONTRIBUTION
The employee’s contribution rate (w.e.f. 1.1.97) is 1.75% of the wages and that of employer’s is 4.75% of the wages paid/payable in respect of the employees in every wage period.
CONTRIBUTION PERIOD AND BENEFIT PERIOD
There are two contribution periods each of six months duration and two corresponding benefit periods also of six months duration as under.
Contribution period
1st April to 30th Sept.
1st Oct. to 31st March
Corresponding Cash Benefit period
1st January of the following year to 30th June.
1st July to 31st December of the year following
BENEFITS UNDER ESI SCHEME
MEDICAL BENEFITS
The Employees’ State Insurance Scheme provides full medical care in the form of medical attendance, treatment, drugs and injections, specialist consultation and hospitalization to insured persons and also to members of their families where the facility for Specialist consultation, hospitalization has been extended to the families.
For the families, this benefit has been divided into two categories as under:-
FULL MEDICAL CARE
EXPANDED MEDICAL CARE
MEDICAL BENEFITS (EXPLAINATION)!!!
FULL MEDICAL CARE
This consists of hospitalization facilities and includes specialist services, drugs and dressings and diets as required for in-patients.
EXPANDED MEDICAL CARE
This consists of consultation with the specialists and supply of special medicines and drugs as may be prescribed by them in addition to the out-patient care. This also includes facilities for special laboratory tests and X-Ray examinations.
MEDICAL BENEFITS (EXPLAINATION)!!!
System of treatment:
Generally, the allopathic system of medicine is used for providing Medical Benefit. However, where a substantial number of workers demand treatment by Indian system of medicine and Homoeopathy (ISM & H) other than Allopathy. The various ISM &H systems of treatment in vogue are:, Ayurvedic, Unani, Sidha, Yoga therapy and Homeopathy
MEDICAL BENEFITS – Scale of Medical Benefit!!!
To Insured Persons:- IPs are entitled to avail treatment in ESI dispensary/Hospital/Diagnostic Centre and recognised institutions, to which he is attached such as:-
Outpatient treatment
Domiciliary treatment by visits at their residences.
Specialists Consultation.
In-patient treatment(Hospitalisation)
Free supply of drugs dressings and artificial limbs, aids and appliances.
Imaging and laboratory services.
Integrated family welfare, immunisation and MCH Programme and other national health programme etc.
Ambulance service or re-imbursement of conveyance charges for going to hospitals, diagnostic centres etc.
Medical Certification and
Special provisions.
MEDICAL BENEFITS (EXPLAINATION)!!!
To Family Members of Insured Persons:- While in all implemented areas, IPs are entitled to medical care as detailed above, members of a family of an IP are entitled to one or other of the following scales of Medical Benefits:-
i."FULL" Medical Care i.e., all facilities as for IPs including hospitalisation.
ii."EXPANDED" Medical Care i.e., all facilities as for IPs except hospitalisation. A small number of IPs in the States of Gujarat and Bihar fall under this category.
SICKNESS BENEFITS!!!
SICKNESS BENEFITS EXPLAINED!!!
Sickness Benefit represents periodical cash payments made to an IP during the period of certified sickness occurring in a benefit period when IP requires medical treatment and attendance with abstention from work on medical grounds.
Sickness benefit is roughly 50% of the average daily wages and is payable for 91 days during 2 consecutive benefit periods.
TYPES OF SICKNESS BENEFITS!!!
EXTENDED SICKNESS BENEFITS (ESB)
ENHANCED SICKNESS BENEFIT
EXTENDED SICKNESS BENEFITS
An IP suffering from certain long term diseases is entitled to ESB, only after exhausting Sickness Benefit to which he may be eligible. A common list of these long term diseases for which ESB is payable is as follows
Infectious Diseases
Neoplasms
Endocrine,
Nutritional and Metabolic Disorders,
Disorders of Nervous System,
Disease of Eye,
Diseases of Cardiovascular System,
Chest Diseases,
Diseases of the Digestive System,
Orthopaedic Diseases,
Psychoses, and
Others (More than 20% burns with infection/complication, Chronic Renal Failure, and Reynaud’s disease/Burger’s disease)
Enhanced Sickness Benefits (w.e.f 1.8.1976 )
Insured Persons eligible to ordinary sickness benefit are paid enhanced sickness benefit at double the rate of sickness benefit i.e., about full average daily wage for undergoing sterilization operations for family welfare. Duration of enhanced Sickness Benefits is
Up to 7 days in the case of Vasectomy and
Up to 14 days in the case of the Tubectomy
from the date of operation or from the date of admission in the hospital as the case may be. The period is extendable in case of post operative complications.
MATERNITY BENEFIT (MB)!!!
Maternity Benefit (Explained)!!!
Maternity Benefit is payable to an Insured Woman in the following cases subject to contributory conditions:-Confinement-payable for a period of 12 weeks (84 days)
Miscarriage or Medical Termination of Pregnancy (MTP)-payable for 6 weeks (42 days) from the date following miscarriage-on the basis of Form 20 and 23.Sickness arising out of Pregnancy, Confinement, Premature birth-payable for a period not exceeding one month-on the basis of Forms 8, 10 and 9.In the event of the death of the Insured Woman during confinement leaving behind a child, Maternity Benefit is payable to her nominee .
Maternity benefit rate is double the Standard Benefit Rate, or roughly equal to the average daily wage
DISABILITY BENEFITS
DISABILITY BENEFITS (EXPLAINED)!!!
Temporary Disability Benefit
Duration of TDBThere is no prescribed limit for the duration of TDB. This is payable as long as temporary disablement lasts and significant improvement by treatment is possible. If a Temporary Disablement spell lasts for less than 3 days (excluding day of accident), IP will be paid sickness benefit, if otherwise eligible. A special point for IMOs/IMPs is that some IPs may resist taking a Final Certificate especially before 3 days for fear of loss of TDB.
PERMANENT DISABILITY BENEFIT
PDB is payable to an IP who suffers permanent residual disablement and results in loss of earning capacity.
The duration of PDB may be for the period given by Medical Board, if assessment is provisional or for entire life if assessment is final.PDB Rate: The PDB rate is calculated as percentage of loss of earning capacity as assessed by the Medical Board/MAT/EI Court in relation to TDB. List of injuries deemed to result in permanent total disablement. The maximum rate of PDB can be equal to the rate of TDB.
DEPENDANT’S BENEFIT
DEPENDANT’S BENEFIT (Explained)!!!
The dependants’ benefit is payable to the dependants in cases where an IP dies as result of EI.
The minimum rate of DB is Rs.14/- per day and these rates of the DB are increased from time to time. (The latest enhancement is with effect from 01.08.2002)
FUNERAL BENEFIT
Funeral expenses not exceeding Rs. 2500/- is payable towards expenditure on the funeral of a deceased IP.
ESI RELATED FORMS!!!
FORM 0- EMPLOYERS’ REGISTRATION FORMFORM 1- DECLARATION FORMFORM 1 A- FAMILY DECLARATION FORMFORM 1 B-CHANGES IN FAMILY DECLARATION FORMFORM 3- RETURN OF DECLARATION FORMSFORM 6- RETURN OF CONTRUBUTIONSFORM 12- SICKNESS OF TEMPORARY BENEFITSFORM 12 A- MATERNITY BENEFIT FOR SICKNESSFORM 13 – SICKNESS OR TEMPORARY DISABLEMENT OR MATERNITY BENEFIT FOR SICKNESS
FORM 13 A- MATERNITY BENEFIT FOR SICKNESS
FORM 14- SICKNESS OR TEMPORARY DISABLEMENT OR MATERNITY BENEFIT FOR SICKNESS
FORM 14 A- MATERNITY BENEFIT FOR SICKNESS
FORM 16- ACCIDENT REPORT FROM EMPLOYER
FORM 17-DEPENDANT’S OR FUNERAL BENEFIT (DEATH CERTIFICATE)
FORM 18- DEPENDANT’S BENEFIT (CLAIM FORM)
FORM 18 A- DEPENDANT’S BENEFIT (CLAIM FOR PERIODICAL PAYMENTS)
FORM 19- MATERNITY BENEFIT (NOTICE OF PREGNANCY)
FORM 20- MATERNITY BENEFIT (CERTIFICATE OF PREGNANCY)
FORM 21- MATERNITY BENEFIT (CERTIFICATE OF EXPECTED CONFINEMENT)
FORM 22- CLAIM FOR MATERNITY BENEFIT
FORM 23- MATERNITY BENEFIT (CERTIFICATE OF CONFINEMENT OR MISCARRIAGE)
FORM 24- MATERNITY BENEFIT (NOTICE OF WORK)
FORM 25- CLAIM FOR PERMANENT DIABLEMENT BENEFIT
FORM 26- CERTIFICATE FOR PERMANENT DISABLEMENT BENEFIT
FORM 27- DECLARATION AND CERTIFICATE FOR DEPENDANT’S BENEFIT
From India, Nizamabad
I would like to know the latest amendements made to this act with regards to eligibility criteria. I would also like to know the ESI dispenseries/Clinics in Ranga Raddy District of Andhra Pradesh
From India, Hyderabad
From India, Hyderabad
The wage limit is revised, now it is Rs.10,000/ (per month). There is no age limit I suppose. The eligible criteria is based on their salary.
From India, Madras
From India, Madras
Dear Seniors, Pl. clarify, Whether ESIC contribution to be paid for the person crossed the limit ie.Rs.10,000/- is drawing reduced salary due to loss of pay in the subsequent month? Regards, Sankar
From India, Madras
From India, Madras
I want to know that whenther the benefits provided by ESI Act.1948 are adequate?Also suggest improvements.Could any one please answer this question.I need it urgently. Thanks Regards AK
From India, Bhubaneswar
From India, Bhubaneswar
@john, vasu n mazhari
the upper age for dependents is FIXED at 18yrs.
@eagisankar
What was the cause of reduces payment?
Generally, if the employee is getting anything in compensation more than 10,000 (if intervals of LESS than 2 months) or he/she is getting ex-gratia bonus (even if intervals of MORE than 2 months), he wont be covered under this act. However he will continue to enjoy the insurance (other than accidents) for the corresponding benefit period of 6 months block.
Cheers,
Devashish.
From United States, Schaumburg
the upper age for dependents is FIXED at 18yrs.
@eagisankar
What was the cause of reduces payment?
Generally, if the employee is getting anything in compensation more than 10,000 (if intervals of LESS than 2 months) or he/she is getting ex-gratia bonus (even if intervals of MORE than 2 months), he wont be covered under this act. However he will continue to enjoy the insurance (other than accidents) for the corresponding benefit period of 6 months block.
Cheers,
Devashish.
From United States, Schaumburg
"The employee’s contribution rate (w.e.f. 1.1.97) is 1.75% of the wages and that of employer’s is 4.75% of the wages paid/payable in respect of the employees in every wage period."
Dear Mr. KK,
Thank you so much for the information. Could you plz define the "wage" that you mentioned above, whether it is gross salary or CTC or total earnings of the particular month.
Thanking you once again.
From India, Visakhapatnam
Dear Mr. KK,
Thank you so much for the information. Could you plz define the "wage" that you mentioned above, whether it is gross salary or CTC or total earnings of the particular month.
Thanking you once again.
From India, Visakhapatnam
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