EMPLOYEE STATE

INSURANCE
CORPORATION
Applicability of Scheme:

The Scheme is applicable to only those areas where the Scheme is

extended / made applicable by the State Government by notification.
The Scheme applies to all factories, shops and establishments located
in the implemented areas, where ten or more persons are employed.

Thus, the Scheme is applicable to all factories, shops, hotels,

restaurants, cinema theatres, offices, medical institutions,
educational institutions, etc. subject that:

i) The employer is located in an area to which the Scheme is extended

by the State Government, and
ii) Ten or more persons are employed
Applicability of Scheme (Continued..):

The Scheme is not applicable to :

a) Seasonal factories exclusively engaged in one or more of the

following manufacturing processes, viz., cotton ginning, cotton or jute
pressing, decortication of ground-nuts, the manufacture of coffee,
indigo, lac, rubber, sugar (including gur) or tea or any manufacturing
process which is incidental to or connected with any of the aforesaid
processes

b) Mines, subject to the operation of the Mines Act.

Employees State Insurance Scheme of India An introduction :

It is a comprehensive Social Security Scheme designed to accomplish the task of

socially protecting the 'employees' in the organized sector against the events of
sickness, maternity, disablement and death due to employment injury and to provide
medical care to the insured employees and their families.

The scheme provides full medical care to the employee registered under the scheme
during the period of his incapacity for restoration of his health and working capacity.
It provides financial assistance to compensate the loss of his/ her wages during the
period of his abstention from work due to sickness, maternity and employment
injury. The scheme provides medical care to his/her family members also.
Administration of Scheme:

The comprehensive and multi-pronged social security program is administered by an

apex corporate body called the Employees' State Insurance Corporation. It
comprises members representing vital interest groups, including, employees,
employers, the Central and State Government, representatives of Parliament and
medical profession. The Corporation is headed by the Union Minister of Labor, as its
Chairman, whereas the Director General, appointed by the Central Government
functions as its Chief Executive Officer. The broad based corporate body is, primarily,
responsible for coordinated policy planning and decision making for growth,
development and efficacy of the scheme. A Standing Committee, constituted from
amongst the members of the Corporation, acts as an Executive Body. The
Medical Benefit Council, constituted by the Central Government, is yet another
Statutory Body that advises the Corporation on matters related to effective delivery
of medical services to the Beneficiary Population.
Administration of Scheme:

The Corporation, with its Central Headquarters at New Delhi, operates through a
network of 62 Regional, Sub- Regional and Divisional Offices located in various
States. The administration of Medical Benefit is taken care of by the respective State
Government except in case of Delhi and Noida/Greater Noida area in Uttar Pradesh
where the Corporation administers medical facilities directly. The Corporation has
taken over the administration of 36 ESI Hospitals in various States for developing
them as ESIC Model Hospitals.
WAGES Defined
Wages means all remuneration paid or payable in cash to an employee, if
the terms of the contract of employment, express or implied, were
fulfilled and includes any payment to an employee in respect of any
period of authorized leave, lock out, strike which is not illegal or layoff and
other additional remuneration, if any, paid at intervals not exceeding two
months, but does not include :-
a). Any contribution paid by the employer to any pension fund or
Provident fund, or under this act;
b). Any traveling allowance or the value of any traveling concession;
c). Any sum paid to the person employed to defray special expenses
entailed on him by the nature of his employment ; or
d). Any gratuity payable on discharge.
WAGES Defined

The above definition has three parts

1. All remuneration paid or payable in cash to an employee
following from the term of employment (including
agreement) express or implied. The periodicity of payment is
not relevant in this case.
2. Any additional remuneration even if not flowing from any
agreement or settlement but paid at intervals not exceeding
two months.
3. The exceptions as provided in Clause (a) to (d) above. Any
remuneration paid or payable under para 1 and 2 is wages
and chargeable to contribution whereas any amount paid
towards items mentioned in clause (a) to (d) are not wages
and therefore no contribution is chargeable on the amount.
Benefits for Employers under ESIC:

The various benefits that the employers reap out of the Scheme are:

a) No expenditure to be incurred towards administration of medical care to the

employees / their dependents.

b) No requirement for medical insurance policy as all medical facilities, including

Super specialty treatment is extended to the beneficiaries, without any ceiling
on expenses.

c) Employers are exempted from the provisions of / liabilities under:

i) Maternity Benefit Act
ii) Employees Compensation Act
Benefits for Employees under ESI Scheme :

The benefits available under the Scheme to the employees can be categorised
under two broad heads, viz., cash benefits and non-cash benefit, viz., medical care.
Cash Benefits:
1. Sickness benefit for employees during the period of sickness
2. Maternity benefit for employees during the period of confinement
3. Disablement benefit:
a) Temporary disablement benefit: for employees arising out of employment injury
b) Permanent disablement benefit: for employees arising out of employment injury
4. Dependents' benefit for dependents of employees; in case of death of
employee due to
employment injury
Benefits for Employees under ESI Scheme (Continued):

5. Other benefits:

a) Funeral Expenses to a person who performs the last rites of the deceased
employee
b) Rehabilitation allowance for employee who is disabled due to employment
injury
c) Vocational rehabilitation - for employee who is disabled due to employment
injury
d) Medical Bonus for insured woman / wife of employee during confinement
Besides the above, other benefits being provided to the beneficiaries are
Confinement Expenses, Physical Rehabilitation, Unemployment Allowance (RGSKY)
and Skill Up gradation Training under RGSKY.
Medical Benefits An Overview

In ESIC, comprehensive medical care ranging from OPD, medical attendance,

treatment, drugs, specialist consultation, hospitalization of insured persons (IPs)
and their family members to superspeciality treatment, are provided under the
Scheme. Medical Benefit is available to the Insured Person (IP) and his family
members from the day one enters the insurable employment.

What makes this Scheme unique, is that, medical care is provided to ESI
Beneficiaries as per need. There is no ceiling on expenditure on individual
medical care. Besides this, Medical Care as available in ESI
Dispensaries/Hospitals is also provided to retired and permanently disabled
insured persons and their spouses on payment of a token annual premium of
`120/-.
How is the Scheme financed ?

ESI Scheme, like most of the Social Security Schemes the world over, is a self financing
health insurance scheme. Contributions are raised from covered employees and their
employers as a fixed percentage of wages. As of now, covered employees contribute 1.75%
of the wages, whereas, the employers contribute 4.75% of the wages, payable to their
employees. Employees earning upto Rs.137/- a day are exempted from payment of their
share of contribution.

The State Governments, as per provisions of the Act, contribute 1/8th of the expenditure
of medical benefit within a per capita ceiling of Rs. 1500/- per Insured Person per annum.
Any additional expenditure incurred by the State Governments, over and above the ceiling
and not falling within the shareable pool, is borne by the State Governments concerned.
Contribution & 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 Benefit Period

1st April to 30th September 1st January to 30th June
of the following year
1st October to 31st March 1st July to 31st Dec.
Benefits to Employees

ESI Scheme Major Social Security Benefits in Cash and

Kind include

1. Medical Benefit for self & Family

2. Sickness Benefit for self
3. Maternity Benefit - for self
4. Disablement Benefit
a). Temporary Disablement Benefit for self
b). Permanent Disablement Benefit for self
5. Dependents Benefit for dependents in case of death
due to employment injury
The section 46 of the Act envisages following six social security benefits :-

(a) Medical Benefit

(b) Sickness Benefit(SB)
(c) Maternity Benefit (MB)
(d) Disablement Benefit
(e) Dependent's Benefit(DB)
(f) Other Benefits

(a) 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 Rs.120/-
TYPE OF MEDICAL BENEFITS PROVIDED
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

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. Apart from the curative
services provided through hospitals and dispensaries, the Corporation also provides the
following facilities including family welfare services.
IMMUNIZATION
The Corporation has embarked upon a massive programme of immunization of young
children of insured persons. Under this programme, preventive inoculation and vaccines
are given against diseases like diphtheria, pertusis, polio, tetanus, measles, mumps,
rubella, tuberculosis etc.

FAMILY WELFARE SERVICES

Along with the immunization programme, the Corporation has been undertaking
provision of family Welfare Services to the beneficiaries of the Scheme. The Corporation
has organized these services in 180 centres besides reserving 330 beds in hospitals for
undertaking tubectomy operations. The ESI Corporation has also extended additional cash
incentive to insured persons to promote acceptance of sterilization method by providing
sickness cash benefit equal to full wage for a period of 7 days for vasectomy and 14 days
for tubectomy. The period for which cash benefit is admissible is extended beyond the
above limits in the event of any complications after Family Planning operations.

SUPPLY OF SPECIAL AIDS

Insured persons and members of their families are provided artificial limbs, hearing aids,
1. Systems 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 and where the State Government has
recognised the qualifications in such system, treatment facilities may be provided under the
ISM & H as well. The various ISM &H systems of treatment in vogue are:, Ayurvedic, Unani,
Sidha, Yoga therapy and Homeopathy.

Certificates required for the purpose of Cash Benefits in respect of persons treated by ISM
&H should be issued by IMO /IMP having recognised qualifications in such system and duly
appointed by the State Government. The issue of certificates under ISM &H is possible only
where dispensaries in systems other than allopathic medicine are functioning independently
with IPs and their family units attached to them and not functioning merely as referral units.
In places where ISM &H units function only as referral centres, certificates will have to be
issued by the Allopathic dispensary to which the IP is attached.
2. Scale of Medical Benefits:

The scale of Medical Benefit under section 57 of Act to be provided to the IPs and
members of their families is to be prescribed by State Government in consultation with
the Corporation under Section 58(1 & 3) of Act under State Medical Benefit Rules. An IP
and/or a member of his family does not have the right to claim Medical Services over
and above those which have been so prescribed. The beneficiaries are entitled to
reasonable medical, surgical and obstetric treatment.
2. Scale of Medical Benefits (Continued..):

To Insured Persons:- IPs are entitled to avail treatment in ESI

Dispensary/Hospital/Diagnostic Centre and recognized institutions, to which he is
attached such as:- Outpatient treatment
Domiciliary treatment by visits at their residences.
Specialists Consultation.
In-patient treatment(Hospitalization)
Free supply of drugs dressings and artificial limbs, aids and appliances.
Imaging and laboratory services.
Integrated family welfare, immunization and MCH Program and other national health
program etc.
Ambulance service or re-imbursement of conveyance charges for going to hospitals,
diagnostic centers etc.
Medical Certification and
Special provisions.
2. Scale of Medical Benefits (Continued..):

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:- "FULL" Medical Care i.e., all facilities as for IPs including
hospitalization.

"EXPANDED" Medical Care i.e., all facilities as for IPs except hospitalization. A small
number of IPs in the States of Gujarat and Bihar fall under this category.
The Corporation aims at providing uniform scale of Medical Care to the Family members
in all implemented areas as the rates of the contribution paid by the employees and the
employers are the same throughout the country.
3. Benefits to Retired IPs

Medical Benefit to Retired Insured Persons and Permanent Disabled Insured Persons:-

On payment of Rs.10/- P.M. in lump sum for one year in advance, Medical Benefit can be
provided (under Section 56 of the Act) to: An Insured Person and his or her spouse who
leaves insurable employment on attaining the age of superannuation after being insured
for not less than five years, till the period for which contribution is paid.
An Insured Person and his/her spouse who ceases to be in insurable employment on
account of permanent disablement due to employment injury shall be entitled to
medical benefit.
4. Administration of Medical Benefit in a State

The administration of Medical Benefit under the ESI Scheme is the statutory
responsibility of the State Government except in the Union Territory of Delhi where the
ESIC has taken over direct responsibility to administer the same with effect from
1.4.1962.

The Corporation has also taken the responsibility of directly administering the existing
Occupational Disease Centers at Delhi. Mumbai, Calcutta, Chennai and Nagda as well as
the Scheme in the Industrial pocket of Uttar Pradesh i.e., Noida and Greater Noida.
5. Domiciliary Treatment

An Insured Person and his family members are entitled to free medical attendance by
IMO/IMP at their residence when the condition of the patient is such that he/she cannot
reasonably be expected to attend the dispensary/clinic.

Conveyance allowance for Domiciliary visit For the domiciliary visit, the IMO's are paid
conveyance allowance. The quantum of this allowance is decided by the State
Government in consultation with the Corporation.
The IMPs are not paid any domiciliary conveyance allowance. In their case, it is included
in the capitation fee upto a distance of 5 km. between the Clinic of IMP and IP's
residence.

The IMOs/IMPs are required to maintain record of domiciliary visits in a register month-
wise. The columns in this register are given under the Chapter "Sickness Absenteeism
and Recording"
6. Specialists Consultation

The standard of Medical Care under the E.S.I. Scheme provides for specialist consultation
to IP in all cases and to members of their families in areas with "Expanded" and "Full"
Medical Care. Arrangements for specialist consultation may be provided at
Specialist/Diagnostic Centers, E.S.I. Hospitals or at such other institutions by appointing
Specialists/Super Specialists on full time/part-time basis where suitable arrangements
exist. Such consultation is provided in the following specialties:-

General Medicine, General Surgery, Pulmonary Medicine (Tuberculosis and Chest

Diseases), Obstetrics and Gynecology, Pathology, Pediatrics, Eye, Ear, Nose and Throat
Diseases, Skin and STD, Radiology, Orthopedics Rehabilitation Services (Physiotherapy
and Occupational Therapy), Dental, Psychiatry, Critical Care Services, Cardiology,
Neurology, Urology and Nephrology, Gastroenterology, Endocrinology, Oncology, Burns
and Plastic Surgery, Cardio Thoracic Surgery, Neurosurgery, Occupational Medicine,
Laboratory Services, Blood Transfusion Services, Hematological Services, Anesthesiology
7. Inpatient Treatment:

Under the E.S.I. Scheme, IPs in all areas and their family members in areas with "Full"
medical care facility are entitled to hospitalization.

In-patient treatment is provided at hospitals constructed by E.S.I.C or by reservation of

beds in the hospitals owned by the State Government, local Fund Organization or Private
Bodies or by constructing annexes to such institutions. The E.S.I. Scheme pays for these
beds on the basis of occupied bed days. The Corporation has framed standard plans for
construction of different sizes of hospitals/annexes mainly with a view to achieving
uniformity and standardization all over the country.

The Corporation has also laid down norms for equipment and staff for hospitals of
different bed strengths.
7. Inpatient Treatment (Continued.):

Drugs and Dressings

All drugs and dressings (including vaccines and sera) that may be considered necessary
and generally in accordance with the E.S.I.C drug formulary are supplied free of charge.
There are two parts in E.S.I.C Drug Formulary, 1998 as follows:-

Part-I:- List of medicines for emergency kit for dispensary

Hospital

Part II:-List of medicines to be supplied by dispensaries in Service Areas or by approved

chemists or depots on prescription in panel areas.
8. Imaging Services

Imaging Services and Laboratory Investigations

Imaging and investigations including CT Scan, MRI, Echocardiography and laboratory

facilities are provided free of cost to IPs and their families at state level specialty
hospitals or other institutions having tie up with E.S.I. Scheme
9. Artificial Limbs & Aids and Appliances:
Insured Persons and their family members are provided following artificial limbs, aids
and appliances as part of medical care under the E.S.I. Scheme.:- Artificial limbs
Hearing Aids
Spectacles (Frame costing not more than Rs.100/- and replacement of frames not to be
made earlier than 5 years) (To insured persons only)
Artificial Dentures, teeth (To insured persons only)
Artificial Eye (To insured persons only)
Wigs (replacement not earlier than 5 years) to female beneficiaries only
Cardiac pacemaker
Wheel Chair/tricycle
Spinal supports (jackets, braces etc.)
Cervical collars
Walking callipers, surgical boots etc.
Crutches
Hip prosthesis, total hip
Intra ocular lens (IOL)
10. Special Provisions:

Benefits received by Insured Person- Not assigned or attachable Sec 60

Bar on benefits under other enactments Sec 61

No reduction of wages during sickness Sec 72

No termination/Dismissal/Discharge/ Reduction during sickness Sec 73

Medical Board- Medical appeal tribunal employees' Insurance Court Sec 54-A

Appeal can be filed within 3 months but this period can be extended
11. Reimbursement:

Under Regulation 69, every employer has to arrange for First-aid Medical care and
transport of accident cases till the injured IP is seen by the IMO/IMP and such employer
is entitled to reimbursement of expenses incurred in this regard upto the maximum of
scale prescribed from time to time. However, reimbursement is not permissible, if the
employer is required to provide such medical aid free of charge under any other
enactment.

The cost of provision of such emergency treatment would be reimbursed to the

employer by the Director/AMO (ESI Scheme) of the respective State and, therefore, all
claims duly supported by relevant receipts and vouchers should be sent to him for
verification and payment.
11. Reimbursement (Continued..):

Regulation-96 A reads as follows:- Claims for reimbursement of expenses incurred in

respect of medical treatment of IP and his family may be accepted in circumstances and
subject to such conditions as the Corporation may by general or special order specify.

The following conditions have been laid down under this Regulation :- Full authority is
vested with the State Government concerned to reimburse expenditure in respect of
medical treatment of IP and his family.

It may be left to the discretion of the State Government to decide the Authority within
their machinery who will approve the expenditure in question; and
Time limit for submission of the claims for reimbursement is one year

The State Government has to keep in view the following points while considering the
cases of reimbursement of expenditure on Medical Care: Whether such facilities for
which reimbursement is recommended are not available with the State.
Whether the hospital where the IP was sent or proposed to be sent was/is the nearest
(b) Sickness Benefit(SB) :

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. Prescribed certificates are;
Forms 8,9,10,11 & ESIC-Med.13. Sickness benefit is 70% of the average daily wages and
is payable for 91 days during 2 consecutive benefit periods.

Qualifying Conditions
(i) To become eligible to Sickness Benefit, an IP should have paid contribution for not less
than 78 days during the corresponding contribution period.

(ii) A person who has entered into insurable employment for the first time has to wait for
nearly 9 months before becoming eligible to sickness benefit, because his corresponding
benefit period starts only after that interval.
Qualifying Conditions (Continued..)

(iii) Sickness Benefit is not payable for the first two days of a spell of sickness except in
case of a spell commencing within 15 days of closure of earlier spell for which sickness
benefit was last paid. This period of 2 days is called "waiting period". This provision
should be clearly understood by IMOs/IMPs as actual experience shows that such of IPs
who want to avail medical leave on flimsy grounds generally come for First
Certificate/First & Final Certificate within 15 days of earlier spell, usually on unpaid
holidays and/or on each weekly off etc, to avoid loss of benefit for 2 days due to fresh
waiting period.

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 per cent of wages.

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.
(c) 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.

Maternity Benefit is payable to an Insured Woman in the following cases:

Confinement-payable for a period of 12 weeks (84 days) on production of Form 21 and 23.
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 on production of Form 24 (B).
Maternity benefit rate is 100% of average daily wages.
Benefits to Employees
In addition, the Scheme also provides some other need
based benefits to insured workers. These are:
i). Funeral Expenses to a person who
performs the last rites of IP
ii). Rehabilitation allowances for self
iii). Vocational Rehabilitation - for self
iv). Old age Medicare for self and spouse
v). Medical Bonus for insured women and
IPs wife
Medical Benefit
Insured worker and members of his family are eligible for
medical care from the very first day of the worker coming
under ESI Scheme.
A worker who is covered under the scheme for first time is
eligible for medical care for the period of three months. If
he/she contributes at least for 78 days in a contribution period
the eligibility is there up to the end of the corresponding
benefit period.
A worker is also eligible for extended sickness benefit when
he/she is suffering from any one of the long term 34 diseases
listed in the Act. This is admissible after the worker has been
under ESI these conditions are satisfied medical benefit is
admissible for a maximum period of 730 days for the IP and
his/ her family.
Sickness Benefit

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

Sickness Benefit represents periodical payments

made to an Insured Person for the period of certified
sickness after completing 9 Months in insurable
employment.
Benefits to Employees

To qualify for this benefit, contributions should have

been payable for atleast 78 days in the relevant
contribution period.
The Maximum duration for availing sickness Benefit is
91 days in two consecutive benefit periods
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.
Extended Sickness Benefit

Extended Sickness Benefit is a Cash Benefit paid for

prolonged illness (Tuberculosis / Leprosy, Mental and
Malignant diseases) due to any of the 34 Specified
diseases

The IP 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
Extended Sickness Benefit

The daily rate of Extended Sickness Benefit is 40%

more than the standard Sickness Benefit rate
admissible

After exhausting sickness Benefit Payable for 91 days

the Extended Sickness Benefit is payable upto further
period of 124 / 309 days that can be extended upto 2
years in special circumstances
Enhanced Sickness Benefit

Is Cash Benefit for IP undergoing sterilisation

operation of vasectomy / tuberctomy for family
planning.
The contributory conditions are the dame as for
claiming sickness benefits
The daily rate of this benefit is double the standard
benefit rate. Say, not less than the daily wage.
The benefit rate of this benefit is double the standard
benefit rate. Say, not less than the daily wage.
The benefit is available upto 7 days for vasectomy and
upto 14 days for tubectomy operations.
 Maternity Benefit

Maternity Benefit is cash payable to an Insured women for the

specified period of abstention from work for confinement or mis-
carriage or for sickness arising out of pregnancy, confinement
premature birth of child or miscarriage confinement connotes
labour after 26 weeks of pregnancy whether the result issue is alive or
dead,

Miscarriage means expulsion of the contents of a pregnant uterus

at any period prior to or during 26th week of pregnancy.
Maternity Benefit

Criminal abortion or miscarriage does not, however,

entitle to benefit.
The contribution condition is the same as for Sickness
Benefit.
The daily benefit rate is double the sickness Benefit
rate and is thus roughly equivalent to the full wages.
Benefits is paid for Sundays also.
Maternity Benefit

The Benefit is paid as follows (Duration)

a). For Confinement
For a total period 12 Weeks beginning not more than
6 weeks before the expected date of child birth, if the
insured women dies during confinement or with in 6
weeks thereafter, leaving behind the living child, the
benefit continues to be payable for the whole of the
period. But the child also die during that period, the
benefit will be paid upto and including the day of the
death of the child.
Maternity Benefit

b). For Miscarriage

For the 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 or upto four weeks.
In all the cases, the benefit is paid only if the insured
women does not work for remuneration during the
period for which benefit is claimed. There is no
waiting period.
Maternity Benefit

Medical Bonus
Medical Bonus is lump sum payment made to an
Insured woman or the wife of an insures 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
Disablement Benefit
a). Temporary disablement benefit :

In case of temporary disability arising out of an

employment injury or occupational disease.,
Disablement benefit is admissible to insured person for
the entire period so certified by an Insurance Medical
officer / Practitioner for which IP does not work for
wages.
The benefit is not subject to any contributory condition
and is payable at a rate which is not less than 70% of
daily average wages.
However, not payable if the incapacity lasts for less than
3 days excluding the date of accident.
Permanent disablement benefit

In case an employment injury or occupational disease

results in permanent, partial or total loss of earning
capacity,
Periodical payments are made to the IP for life at a rate
depending on the actual loss of earning capacity as
may be determined and certified by a duly-constituted
Medical Board.
The rates of Disablement Benefits are determined in
accordance with the provisions of Rule 57 of ESI
(Central) Rules, 1991.
In order to product erosion in real value of the
periodical payments of Permanent Disablement
benefits, against rise in the cost of living index,
periodical increases are granted, based on actuarial
calculation
Permanent disablement benefit

Commutation of periodical payments into lump sum

(one time payment) is permissible where the
permanent disablement stands assessed as final and
daily rate of benefit does not exceed Rs. 1.50. per day.

Commutation of Permanent Disablement Benefit into

lump sum payment is also allowed in case the total
commuted value does not exceed Rs.10000/- (The
ceiling is now being raised to Rs.30000/-).
Dependants 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
Beneficiaries and Duration of benefit
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
dependent until age 18 or to an unmarried or widowed female
dependent until age 18.
Dependants Benefit
How much

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.
The amount of pension paid to the dependents of a deceased
insured person is reviewed vis--vis the cost of living index and
increases are granted from time to time to compensate for
erosion in its real value.
Other Benefit
(i). Funeral Expenses

Funeral Expenses are in the nature of lump

sum payment up to a maximum of Rs. 10000/-
made to defray the expenditure on the funeral
of deceased IP. The amount is paid either to
the eldest surviving member of the family or, in
his absence, to the person who actually incurs
the expenditure on the funeral.
Other Benefit

Rehabilitation Allowance
The corporation, vide its Resolution dated 22.12.1979,
resolved to grant rehabilitation Allowance to the IPs,
for each day, on which they remain admitted in an
Artificial limb centre. On the rates, which generally
confirm to double the Standard Sickness Benefit rate.
The above benefit was introduced with effect from
1.1.1980
Levy of Interest & Damages
Under Section 39(5)(a) of the ESI act, read with Regulation 31(A) of
the ESI (General) Regulations 1950, the employer is liable to pay
simple interest at the rate of 15 percent per annum in respect of
each day of default or delay in payment contributions. In addition,
under the Provision of Regulation 31-C of ESI (General) Regulations,
1950, read with sec.85(B)(i) of the ESI Act, the Corporation is
empowered to recover damage as under:
Period of delay in Rate of Damages
payment of Contribution on the amount due
i). Up to less than 2 months 5%
ii). 2 months and above but less than 4 months 10%
iii).4 months and above but less than 6 months 15%
iv). 6 months and above 25%
Interest and damages can also recovered as arrears of land revenue
Section 45(c) to Section 45(I) by the Recovery Officer of ESI
Corporation.
Obligation of the Employers
1). Get your Factory / establishment registered with in 15 days
after the Act becomes applicable. Submit Form 01 online for
this purpose. Obtain Employers code No. for use in all ESIC
Forms / documents and correspondence with the offices of the
ESI Corporation.

2). Fill up Declaration Forms in respect of all coverable

employees and submit the same to the Regional Office/ Local
Office of the corporation well before the Appointed Day and
obtain insurance Numbers from the concerned Local Office/
Regional Office, In respect of newly appointed employees, fill
up the declaration form soon after appointment of such
employees and submit the same to the Local Office Concerned.
Obligation of the Employers
3). Pending receipt of identity cards/ identity
certificates you may issue certificate of employment
in Form 86 to the covered employee(s) enabling them
to avail cash/medical Benefits
4). Pay ESI contribution (Employee's Share @4.75% and
the Employers share @ 1.75% of the wages) with in
21 days of the month following, in which the wages
fall due.
Obligation of the Employers

5).Maintain an Accident Book as prescribed under the

Factory Act / ESI Act.
6).Submit an Accident Report to the Local Office / ESI
Dispensary concerned immediately in respect of
accidents that could result in death or disablement
and within 24 hours of its occurrence otherwise.
Minor accidents which do not cause absence from
work need not be reported
7).Grant leave to insured employees on the basis of
sickness certificates issued by any authorised ESI
doctor.
Obligation of the Employers

Maintain the following records/ registers properly for the purpose

of inspection
1. Attendance Registers / Muster Rolls (in respect of all
employees including those employed through contractors)
2. Wage register
3. Cash Book / Bank Book
4. Account Books including Ledgers and Vouchers, Balance
Sheet.
5. Employees Register
6. Accident Book
7. Returns of Contribution
8. Return of Declaration Forms
9. Copies of Challans
10. Inspection Book
Obligation of the Employers
9. Submit return of contribution within 42 days of the
expiry of contribution period.
10. Intimate the date of closure of shifting (Temporary
or Permanent) of the Factory / Establishment to the
Regional office / Local Office within seven days of its
closure or shifting
11. Promptly report change in business activity,
ownership of the concern or its management.
12. Ascertain the liability towards ESI dues, while
taking over the ownership of any
factory/establishment by purchase, gift, lease or
license or in any other manner whatsoever as new
owner is liable to discharge the past liabilities if any