BENEFITS UNDER ESI SCHEME.

Medical Benefit :

The Scheme provides full range of medical care to Insured person and
family, through a network of ESI Dispensaries & Panel clinics,
diagnostic centres and ESI Hospitals etc. Super speciality facilities are
provided to the beneficiaries through recognised advanced medical
institutions empanelled for the purpose on referral basis. The
Corporation has set up a revolving fund in most of the States to ensure smooth
flow of funds for super-speciality treatment of ESI beneficiaries.
All Insured Persons and members of their family are entitled to free, full and
comprehensive medical care under the Scheme. The package covers all aspects of
health care from primary to super speciality facilities.

Sickness Benefit :

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.
The maximum duration of Sickness Benefit is 91 days in two
consecutive benefit periods. There is a waiting period of 2 days which
is waived if the insured person is certified sick within 15 days of the
spell for which sickness benefit was last paid. The sickness benefit rate
is roughly equivalent to 50% of the average daily wages of the insured
person.

Maternity Benefit

Maternity benefit consists of periodical cash payments in case of confinement or

miscarriage or sickness arising out of pregnancy, confinement, premature birth of
child or miscarriage, to an insured woman as certified by a duly appointed medical
officer or mid wife.

Disablement Benefit

Disablement benefit is admissible for disablement caused by employment injury.

At the first instance, temporary disablement benefit is payable as long as the
temporary disability lasts. If the employment injury results in partial or
total/permanent disability, permanent disablement benefit is payable till the death
of the insured person.

Dependant Benefit

Dependants' benefit consists of periodical payments to dependants of an insured

person who dies as a result of an employment injury sustained as an employee
under the ESI Act.
There are no contributory conditions for qualifying to this benefit. Thus, if a person
dies of employment injury even on the first day of his employment, his dependants
are entitled to the benefit

Funeral Expenses

Funeral expenses are in the nature of a lump sum payment upto a

maximum of Rs. 2500/- made to defray the expenditure on the
funeral of deceased insured person. 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.
 CONTRIBUTION

Contribution is the amount payable to the Corporation by the Principal Employer

in respect of an employee and comprises the amount payable by the employee and
the employer.

t is obligatory on the part of the employer to calculate and remit ESI Contribution
comprising of employers' share 4.75% plus employees' share of 1.75% which is
payable on or before 21st of the following month, to the month to which the salary
relates. If the employee is drawing upto Rs.50/- as daily average wage, he is
exempt from the payment of his share of contribution. The employer is however to
pay employer's share of 4.75% of the salary received/receivable by the employee.

Recovery of contribution

In the first instance the Principal Employer is to pay employers' share of

contribution in respect of every employee whether employed directly or through
immediate employer. The employees' share may thereafter, be recovered by
making deduction from their wages for the wage period for which contribution is,
however is payable. No such deduction may be made from any wages other than
those relating to the period in respect in which contribution is payable.

Exemptions

Exemption Under Section 88 of the Act is granted by the "Appropriate

Government" to employees, or class of employees, who remain away from their
Hqrs. for more than 7 months in a year, and those employees who are posted in
non-implemented areas.

Exemption Under Section 90 can be granted to a factory / establishment

belonging to any local authority such as a Municipality / Corporation, etc. if
employees in any such factory/establishment are otherwise in receipt of benefits
substantially similar or superior to the benefit. provided under the Act.

Seasonal Factory

Seasonal Factory means a factory which is exclusively engaged in one or more of

the following manufacturing processes, namely, cotton ginning, cotton or jute
pressing, decortication of groundnuts, 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 and includes a factory which is
engaged for a period not exceeding seven months in a year:

 In any process of blending, packing, or repacking of tea or coffee;

 In such other manufacturing processes as the Central Government may, by
notification in the official gazette, specify.

Employees working in the following seasonal processes have been exempted by

Central/State Governments under Section 88 of the Act -

 Re-drying un-manufactured leaf tobacco,

 Salt manufacture,
 Ice manufacturing in certain States and Wool pressing with or without cotton
pressing and ginning.
 Decortications involved in groundnut/walnut processing.
BENEFITS AT A GLANCE
 Benefit
Contributory conditions
Duration
Rate

Sickness benefit
more info
Payment of contribution
for atleast 78 days in the
relevant contribution period
91 days in any two consecutive
benefit periods

Standard benefit rate (not less

than 50% of daily wages)

Extended Sickness benefit

(ESB)
more info

Continuous employment for a

period of 2 years and payment
of contribution for at least 156
days in 4 contribution periods.

up to 2 years in deserving cases

140% of the standard benefit
rate (not less than 70% of daily
wages.

Enhanced Sickness Benefit

more info
Payment for atleast 78 days in
the relevant contribution period
7 days for vasectomy and 14
days for tubectomy extendable
in case of post operative
complication etc.

Twice the standard benefit rate.

Temporary
Disablement Benefit
more info
No condition.
Till the incapacity lasts
140% of the Standard Sickness
Benefit rate (not less than 70%
of daily wages)

Permanent disablement
benefit
more info
No condition
for life
 Maternity
benefit
more info
Payment of
contribution for 70 days
in immediately preceding
two consecutive periods.
12 weeks of which not
more than six can
precede the expected
date of confinement;
6 weeks for mis-carriage
and additional one month
for sickness arising out of
confinement, premature
birth of child or
miscarriage
Double the Standard
Benefit rate (Not less
than full wages)
more info

Medical Benefit
more info
No condition. IP
and his family is
eligible from the day one
of his insurable
employement.
To start with for a period
of 3 months or till the
spell of treatment lasts
whichever is later and
thereafter based on
payment of contribution
Full medical care.
Facilities including
hospitalisation for
insured person and
family.
more info

Other Benefits

Funeral Expenses
more info
No condition . Diseased
IP should be an IP on the
date of death.
One time payment
Actual expenditure on
funeral not exceeding Rs.
2500/-

Rehabilitation
allowance
more info
No condition
For each day on which
insured person remains
admitted in Artificial limb
centre for fixation /
repair or replacement of
artificial limb.
Double the standard
sickness benefit rate but
Benefits[claims]

Every claim for a benefit payable under the Act is to be made in writing to the
appropriate Branch Office on form appropriate for the purpose of the benefit for
which the claim is made. Assistance for filling in the claim form in case of insured
persons who cannot do so themselves will be provided at the Branch Office.

Claim forms for sickness benefit, temporary disablement benefit and maternity
benefit are printed at the bottom/on the reverse of the appropriate certificates
issued by the IMO/IMP. These forms are available at each Branch Office and will
be supplied free of cost