ESI

Coverage of an employee :

The Scheme covers the employees who draw a monthly wage of less than INR 21000 per month and are employed by an establishment which employs 10 or more persons. The following flowchart gives a correct picture of the coverage.

Contribution rates:

The contribution rate under the scheme is 6.5% of the wages with the employer’s share of contribution being 4.75% and the employee’s share being 1.75%. The given table would make it clear-

Types of benefits:

Under the scheme, there are following benefits to the eligible employees-

• Medical Benefit : Full medical care is provided to an Insured person and his family members from the day he enters insurable employment. There is no ceiling on expenditure on the treatment of an Insured Person or his family member. Medical care is also provided to retired and permanently disabled insured persons and their spouses on payment of a token annual premium of INR 120/- .

1. System of Treatment
2. Scale of Medical Benefit
3. Benefits to Retired IPs
4. Administration of Medical Benefit in a State
5. Domiciliary treatment
6. Specialist consultation
7. In-Patient treatment
8. Imaging Services
9. Artificial Limbs & Aids
10. Special Provisions
11. Reimbursement
     

• Sickness Benefit(SB) : Sickness Benefit in the form of cash compensation at the rate of 70% of wages is payable to insured workers during the periods of certified sickness for a maximum of 91 days in a year. In order to qualify for sickness, benefit the insured worker is required to contribute for 78 days in a contribution period of 6 months.

1. Extended Sickness Benefit(ESB) : SB extendable up to two years in the case of 34 malignant and long-term diseases at an enhanced rate of 80% of wages.
    
2. Enhanced Sickness Benefit : Enhanced Sickness Benefit equal to full wage is payable to insured persons undergoing sterilization for 7 days/14 days for male and female workers respectively.

• Maternity Benefit (MB) : Maternity Benefit for confinement/pregnancy is payable for twenty-six (26) weeks, which is extendable by further one month on medical advice at the rate of full wage subject to contribution for 70 days in the preceding two contribution periods.

• Disablement Benefit

1. Temporary disablement benefit (TDB) : From day one of entering insurable employment & irrespective of having paid any contribution in case of employment injury. Temporary Disablement Benefit at the rate of 90% of wage is payable so long as disability continues.
2. Permanent disablement benefit (PDB) : The benefit is paid at the rate of 90% of wage in the form of monthly payment depending upon the extent of loss of earning capacity as certified by a Medical Board

• Dependants Benefit(DB) : DB paid at the rate of 90% of wage in the form of monthly payment to the dependants of a deceased Insured person in cases where death occurs due to employment injury or occupational hazards.

• Other Benefits

Funeral Expenses : An amount of INR 15,000/- is payable to the dependents or to the person who performs last rites from day one of entering insurable employment.
Confinement Expenses : An Insured Women or an I.P.in respect of his wife in case confinement occurs at a place where necessary medical facilities under ESI Scheme are not available. In addition, the scheme also provides some other need-based benefits to insured workers.

Vocational Rehabilitation :To permanently disabled Insured Person for undergoing VR Training at VRS.

Physical Rehabilitation: In case of physical disablement due to employment injury.

Old Age Medical Care: For Insured Person retiring on attaining the age of superannuation or under VRS/ERS and person having to leave service due to permanent disability insured person & spouse on payment of Rs. 120/- per annum.

Rajiv Gandhi Shramik Kalyan Yojana:

This scheme of Unemployment allowance was introduced w.e.f. 01-04-2005. An Insured Person who become unemployed after being insured three or more years, due to closure of factory/establishment, retrenchment or permanent invalidity are entitled to :-

• Unemployment Allowance equal to 50% of wage for a maximum period of up to Two Years.
• 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.

Atal Beemit Vyakti Kalyan Yojana :

This scheme is a welfare measure for employees covered under Section 2(9) of ESI Act, 1948, in the form of cash compensation up to 90 days, once in a lifetime, to be claimed after three months in  one or more spells for being rendered unemployed, provided the employee should have completed two years of insurable employment and has contributed not less than seventy eight (78) days in each of the four consecutive contribution periods immediately preceding to the claim of the relief. The relief shall not exceed twenty five percent (25%) of the average earning per day.

The Scheme was introduced w.e.f. 01-07-2018.  The scheme is implemented on pilot basis for a period of two years initially.

Incentive to employers in the Private Sector for providing regular employment to the persons with disability:

• Minimum wage limit for Physically Disabled Persons for availing ESIC Benefits is INR 25,000/-.
• Employers’ contribution is paid by the Central Government for 3 years.

Quantum of Benefits:

• • Sickness Benefit: cash is paid at a standard rate which is not less than 50% of the wages.
  • Extended Sickness Benefit: Cash benefit which is equal to about 70% of the daily wages.
  • Enhanced Sickness Benefit: Cash benefit which is double the standard sickness benefit rate, that is, equal to full wages.

• Maternity Benefit: Cash benefit is equal to full wages or double the Standard Sickness Benefit rate

• Disablement Benefit: 

Temporary disablement benefit is paid in cash at 70% of the wages is payable till temporary disablement lasts. And in case of permanent disablement, the cash benefit is payable for life which is worked out on the basis of loss of earning capacity determined by a medical board.

• Dependents’ Benefit: cash benefit of  about 70% of the wages shareable among dependents in a fixed ratio.

• Funeral expenses: INR 2500/-

• Confinement Allowances: INR 1000/- is paid to an insured woman or in respect of the wife of an insured person in case she does not avail medical facilities of the scheme for child delivery.