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Employees’ State Insurance Act (ESI): Benefits and Features

Friday, May 1st, 2015 Amritesh no responses

Employees’ State Insurance Act (ESI) is social security and welfare scheme aimed at providing medical care and other related benefits to the workers/employees working in various factories and establishments. ESI acts as a Medical Insurance cover to employees/workers and his immediate family members.
Huge Infrastructure has been built up for the same purpose. ESI Hospitals, Dispensaries, Specialist Centers and Clinics are setup throughout the country to provide medical care to the members covered under the ESI Act. Apart, from their own setup ESI Authorities have also entered into arrangements with other Institutions to provide the best medical care.
In my previous post I have covered the Salient Provision of the Act. In this post I will discuss the features and benefits under the ESI Scheme.

Provisions and Applicability of the Employees’ State Insurance Scheme (ESI). Check the link given below:-


  • More than 2.6 crore employees are covered under the ESI Act as per reports with further 50 lakh employees expected to benefit from the recent amendments.
  • More than 10 crore beneficiaries are covered under the Scheme as per reports. (Includes dependent family members)
  • Around 800 ESI centers are established across the country to provide the best medical care to the beneficiaries.
  • Financial Benefits to the dependent Children up to the age of 25 years.
  • Medical Benefit extended to dependent minor brother/sister in case of Insured Person not having his own family and his parents are not alive.
  • Continuation of Medical Benefit to Insured Person retiring under VRS Scheme or opting for Pre mature retirement.
  • Many new Medical Facilities are being setup to provide the best medical care to the Insured members.


Sickness Benefit
Contribution for atleast 78 days in the relevant contribution period.
91 days in any two consecutive periods.
70% of Daily Average Wage/Salary.
Extended Sickness Benefit
(34 Specified Long Term Diseases)
Continuous Employment for a period of 2 years and contribution for 156 days in 4 consecutive contribution periods.
2 years.
80% of Daily Average Wage/Salary.
Enhanced Sickness Benefit
(Sterilization for Family Welfare)
Contribution for atleast 78 days in the relevant contribution period.
1 Week for vasectomy
and 2 weeks for
extendable in cases in
post operative
complication etc.
100% of daily average
Temporary Disablement Benefit
He/She should be an employee on the date of Employment Injury.
Till the Time person remains incapable of discharging his/her duties.
90% of the Daily Average Wages/Salary.
Permanent Disablement Benefit
He/She should be an employee on the date of Employment Injury.
As determined by the Medical Board setup for the same.
Dependent’s Benefit
The deceased should be an employee on the date of fatal accident.
To Widow till Life or until remarriage.
To Legitimate or adopted Children  dependent on the deceased till they attain 25 years of age, or in case of daughter till she gets married, in  case of infirmity till such infirmity lasts.
To other dependents depending on the clause set for the same.
90% of the daily average Wages distributed among the dependants in prescribed ratio.
Maternity Benefit
Payment of Contribution for atleast 70 days immediately preceding one or two contribution periods.
Maximum of 12 weeks of which not more than six
weeks should precede
the expected date of delivery. 6 weeks for miscarriage and
additional 1 month for sickness arising
out of pregnancy, premature birth of
child or miscarriage.
Full Wages.
Confinement Expenses
To an Insured
Woman or an Insured Person in
respect of his wife
incase facilities for
confinement are not
available in ESI
Up to two confinements only.
Rs. 2,500/- in each case.
Funeral Expenses
He/She should be covered under ESI Act.
Expenditure should not exceed Rs 10,000/-.
Rehabilitation Allowance
Medical Benefits in case of disablement due to injury at time of employment.
Each day on
which insured person
remains admitted in
Artificial Limb-
Centre for
fixation/repair or
replacement of
artificial limb.
100% of Average Daily Wages.
Medical Benefit
Any Insured Person and his Family.
Till the illness/disease/disability lasts.
Full Medical Care and Treatment.
Medical Benefits to Retired & Disabled Insured Person and Spouse
On payment of
Rs.120/- p.a
for one year in advance by any insured, persons who retire
from insurable
employment on
attaining the age of
superannuation or
under VRS or
prematurely after
being in insurable
employment for not
less than five years,

by insured
persons who cease
to be in insurable
employment on
account of permanent disablement due to
an employment
Period for which
contribution is paid.

 Insured Persons are entitled for
full medical care for
self and spouse only,
Period for which
contribution is paid,
till attaining the age of superannuation.
Full Medical Care and Treatment.
Unemployment Allowance
An Insured Person who has lost
employment due to
closure of factory,
retrenchment or
disablement of at
least 40% arising out of non-employment
injury and the
contribution in
respect of him have
been paidfor a minimum of
three years prior to
the loss of
Maximum period of
one year during life
50% of average
daily wage.
Rehabilitation Skill
Development Scheme (under Rajiv Gandhi
Shramik Kalyan
Insured Person should be in
receipt of
Allowance under
Rajiv Gandhi
Shramik Kalyan
Short duration of 10
weeks or other longer
duration courses of
upto six months at
Advance Vocational
Training Institutions.
Entire fee charged by
the Institutions is to be
paid by the
Corporation. To and fro
Rail/Bus fare
For travelling to attend the training
programme , is reimbursed.
Conveyance Allowance to Permanent Disablement Beneficiaries (PDB)
Insured under the ESI Act and in receipt on benefit under Permanent Disablement Scheme.
Conveyance Allowance on their personal visit to Branch Office for submission of Life Certificate Annually.
Rs 100/- to be a paid for each annual visit.

Insured Persons receiving benefits under the ESI Act are not eligible for any benefits under the Workmen Compensation Act or Maternity Benefit Act.
Amritesh is an experienced professional in the field of HR, Finance and Compliance. He is currently working in the IT Industry with an US based firm. He took up Blogging as a hobby which eventually turned into passion. He primarily focuses on topics related to Personal Finance, HR, Compliance and Technology.
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