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

      Friday, May 1st, 2015 Amritesh 2 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:-


      FEATURES AND EXTENT OF ESI SCHEME

      • 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.

      BENEFITS AND CONTRIBUTORY CONDITIONS UNDER ESI SCHEME

      APPLICABILITY
      CONTRIBUTION
      BENEFIT PERIOD
      BENEFITS
      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
      tubectomy;
      extendable in cases in
      post operative
      complication etc.
      100% of daily average
      wages
      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.
      Lifetime
      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
      Institutions.
      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
      injury.
      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
      permanent
      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
      employment.
      Maximum period of
      one year during life
      time
      50% of average
      daily wage.
      Vocational
      Rehabilitation Skill
      Development Scheme (under Rajiv Gandhi
      Shramik Kalyan
      Yojana)
      Insured Person should be in
      receipt of
      Unemployment
      Allowance under
      Rajiv Gandhi
      Shramik Kalyan
      Yojana
      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.
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      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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      2 Comments on "Employees’ State Insurance Act (ESI): Benefits and Features"

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      Rajesh Auchare
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      Hi Amritesh,
      Hope you are doing fine.
      I am making PPT on ESIC benefits and its unique feature
      to explain the employees and encourage them to avail the benefits under ESIC.

      Pls support with the presentation if have with you.

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