EMPLOYEES’ STATE INSURANCE

CORPORATION (ESIC)

-AN OVERVIEW
ESI ACT, 1948

 The Employees’ State Insurance Act - Promulgated by the Parliament in

the year 1948.

 The Scheme introduced in Delhi and Kanpur on 24th February, 1952.

 First major legislation on Social Security in independent India to
provide certain benefits to the employees in the organized sector in
case of :
(i) Sickness,
(ii) Maternity and
(iii) Employment injury

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APPLICABILITY OF THE ESI ACT

Non-seasonal factories located in

geographical areas notified for
implementation of the Scheme and
employing 10 or more persons.
Sec 1(4) & 2(12)

Motor Road Transport, Preview Theatres

including Cinemas, Newspaper Establishments,
Shops and private medical nursing homes and
educational institutions located in implemented Sec 1(5)
areas.
EMPLOYING TEN/TWENTY
*Note: The threshold limit in respect of shops and other
OR MORE COVERABLE
establishments has been brought down to 10 by 25 State
PERSONS
Governments and other states are in the process of doing so.

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EXCLUSIONS

 Employees drawing wages exceeding Rs 21000 p.m.

 Factories employing less than 10 persons,
 Shop & Establishments not notified u/s 1(5) of the ESI Act or employing
less than 10 persons,
 Factories exempted by GOI u/s 87 of the ESI Act,
 Factories/Shops/Estt. exempted by State Govt u/s 90 of the ESI Act,1948,
 Seasonal factories,
 Mines covered under the mines Act,
 Railways Running Sheds,
 Unorganized sector e.g. vendors.
 ESIC ORGANISATION

 Employees’ State Insurance Corporation- Apex decision making Body

Chairman : LEM
Member Secretary: DG, ESIC
Multi stakeholder Body

 Standing Committee- To administer affairs of the Corporation

Chairman: LS
Member Secretary: DG ESIC
Members elected by the Corporation

 Medical Benefit Council- advises corporation on Medical Benefits.

Chairman : D G ESIC
Co-Chairman : D G of Health Services
Member : Medical Commissioner, States, Employers, Employees, Medical Profession.
ESIC SUB-COMMITTEES
Corporation/Standing Committee empowered to constitute & delegate to
Sub-Committee(s) or Officers under Reg. 3(1).

I. General Purposes Medical Care Sub-Committee-

II. Budget and Accounts Sub-Committee

III. Sub-Committee of ESI Corporation on AYUSH

IV. Sub-Committee to look into the progress of Medical Education Projects

V. Sub-Committee Organizational Restructuring of the ESIC

VI. Sub-Committee for Comprehensive Review of Medical Care Services

VII. Construction Sub-Committee

REGIONAL BOARDS & LOCAL COMMITTEES
 Regional Boards: Chairman ESIC appoints for each state in consultation with
state concerned
 –Shall perform administrative and/or executive function entrusted/delegated by Corporation or
Standing Committee ; to recommend changes in act/rules/required from time to time.
i. Chairman,
ii. Vice-Chairman,
iii. Members- Employer, Employees, Central/State Govt. Nominee
iv. Member Secretary: Regional Director
 Local Committees: Chairman Regional Board appoints for each specified area in
consultation with Regional Board concerned
 - to discuss local problems in regard to the ESI Scheme
i. Chairman
ii. State Govt Nominee
iii. Members- Employer, Employees, Central/State Govt. Nominee
iv. Member Secretary: Branch Manager/ Branch Officer.
COVERAGE OF ESI SCHEME

Details 2012-13 2013-14 2014-15 2015-16

States/UT 30 30 31 33
covered
Implemented 810 815 830 833
Centers
Factories/Estts. 666 666 723 784
(in ‘000)
Employees 16.5 17.4 19.5 18.9
(in millons)
Insured Persons 18.6 19.5 20.3 21.4
(in millions)
Beneficiaries 72.1 75.6 78.9 82.9
(in millions)
ESIC- FIELD INFRASTRUCTURE

 The ESIC headquarters : New Delhi,

 Regional Offices : 23

 Sub-Regional Offices : 37

 Divisional Office : 01

 Branch Offices/pay offices : 627/185

 No of Implemented centers : 833 in 393 Districts

MAJOR BENEFITS
UNDER ESI SCHEME
SICKNESS BENEFIT
Sickness Benefit : Payment of contribution for 78 days in corresponding
contribution period of six months.

Upto 91 days in two consecutive benefit periods at 70% of

the average daily wages for 91 days in a year.

Enhanced Same as above

Sickness Benefit : 14 days for Tubectomy & 7 days for vasectomy, extendable
on medical advice. Rate of payment is 100% of the average
daily wages.

Extended : For 34 specified long term diseases. Continuous insurable

Sickness Benefit employment for two years with 156 days contribution in four
consecutive contribution period.

124 days which may be extended upto two years on medical

advice during a period of two years in insurable employment.
Rate : 80% of the average daily wages approx.
DISABLEMENT BENEFIT
Temporary : From Day one of entering insurable employment &
Disablement Benefit irrespective of having paid any
contribution for disablement due to employment injury.

As long as temporary disablement lasts.

Rate : about 90% of the average daily wages approx.

Permanent
Disablement Benefit: Same as above.

For whole life.

Rate : about 90% of the average daily wages depending
upon loss of earning capacity.
DEPENDANTS’ BENEFIT
 From day one of entering insurable
employment & irrespective of having paid any
contribution in case of death due to
employment injury

 For life to the widow or until her re-marriage.

To dependant children till the age of 25 years.

 To dependant parents for life

 Rate: About 90 % of the average daily wages

approx. shareable in fixed proportion
MATERNITY BENEFIT

 Payment of contribution of 70 days in two

preceding contribution periods (one year).

 Up to 26 weeks in case of normal delivery.

Up to 6 weeks in case of miscarriage.
Extendable by 4 weeks on medical advice.

 Rate: Almost 100 % of the average daily

wages
MEDICAL BENEFIT
 Full Medical Facilities for self family from day
one of entering insurable employment

 Full Medical care till disease or disablement

lasts. No ceiling on expenditure

 Retired Insured Person who have been in

insurable employment for at least five years
before retirement on superannuation or under
VRS or premature retirement and Disabled
Insured Persons are entitled for full medical care
for self & spouse only on payment of Rs.120.00
as annual contribution.
Super specialty Treatment
 Expenditure of Super Specialty treatment (including
diagnostic) is totally borne by E.S.I. Corporation.

 The scope of services to be covered under Super

Specialty treatment are as under-
 Cardiology and Cardiothoracic vascular surgery
 Neurology and neuro surgery
 Pediatric surgery
 Oncology and Onco-surgery
 Urology and Uro-surgery
 Gastro-enterology and endocrine surgery
 Burns and Plastic Surgery
This will include all the required investigations.
In addition-
 CT Scan
 MRI
 PET Scan
 Echo-Cardiography
 Scanning of other body parts
 Specialized bio-chemical and
immunological investigations
 Any other investigations costing more
than Rs.3,000 Per Test
 Tie-up arrangements in Orissa with reputed
Hospitals made for cashless / hassle-free
treatment to I.Ps.
 Super Specialty Treatment – eligibility criteria:
 IP must be in insurable employment for 2
years.
 Out of 2 years / 4 contribution periods,
he should contribute for 156 days.
 Out of 4, IP should be eligible for SB
payment for at least 2 contribution
periods.
CONFINEMENT BENEFIT
 Any Insured Woman or an Insured
Person in respect of his wife in case
Expenses for confinement occurs at a
place where necessary medical
facilities under ESI Scheme are not
available.
 Up to two confinements only
 Rate: Rs.5000.00 per case
FUNERAL EXPENSES
 From day one of entering insurable
employment

 For defraying expenses on the funeral

of an Insured Person

 Rate: Actual Expenses subject to a

maximum of Rs.10000/-
VOCATIONAL TRAINING

 In case of physical disablement due

to employment injury.

 As long as vocational training lasts.

 Rate: Actual fee charged of Rs.123/-

a day whichever is higher.
PHYSICAL REHABILITATION

 In case of physical disablement due

to employment injury.

 As long as a person is admitted in an

artificial limb centre.

 Rate: 100% of the average daily

wages.
UNEMPLOYMENT ALLOWANCE
 In case of involuntarily loss of
employment due to closure of factory,
retrenchment or permanent invalidity
due to non-employment injury and the
contribution in respect of him have been
paid/payable for a minimum of three
years prior to the loss of employment.
 Maximum twelve months during life
time.
 Rate: 50% of the average daily wages.
SKILL UPGRADATION TRAINING
UNDER RGSKY

 In case of involuntarily loss of

employment due to closure of factory,
retrenchment or permanent invalidity
due to non-employment injury and the
contribution in respect of him have been
paid/payable for a minimum of three
years prior to the loss of employment.

 For a short duration-maximum up to 6

months.
 SPREE
 Whether your factory / establishment is functioning in
implemented areas?
 Whether you have 10 or more persons working in your
factory / establishment?
IF YES
 Whether you have covered your Unit under ESI Act, 1948?
 Whether you have registered all the coverable employees working in
your Unit under the ESI Act, 1948?
IF NOT
AVAIL ONE TIME OPPORTUNITY PROVIDED BY E.S.I. CORPORATION
UNDER THE
“Scheme for Promoting Registration of Employers &
Employees”
(SPREE)
NOW EXTENDED UP TO 30TH JUNE, 2017
 Features / Benefits of SPREE
 Employers registering during the period will:

 Be covered from the date of registration or as

declared by them.
 Not to pay contribution for back period.
 Not to pay any penalty (Damages).
 Not to pay any interest.
 Not liable to be prosecuted in the court of law.

 The newly registered employees shall be

treated as covered from the date of their
registration.
 PROCEDURE FOR ONLINE
REGISTRATION
 Open www.esic.in in Mozilla Firefox 3.8 & above / IE 7.0 &
above and click on “click here to login”. Then click on “I
understand the risk” – “Add Exception” – “Get certificate” –
“Confirm Security Exception”. A new window will open and
now click on “sign up” button.

 In the new window fill up: Company Name, Principal

Employer Name. State (select, Odisha), Region (selection,
RO, Bhubaneswar), E Mail (User Name), Phone No.-submit.
After submission check your E-mail for password. Now,
again go the www.esic.in and log in – put user ID (E-mail)
& Password and click on submit button.

 Pay initial advance contribution online payment mode. (for

contractors & security agencies)
 BENEFITS TO THE EMPLOYERS
 Employers are absolved of all their liabilities of providing
medical facilities to employees and their dependants in
kind or in the form of fixed cash allowance,
reimbursement of actual expenses, lump sum grant or
opting for any other medical insurance policy of limited
scope, unless it is a contractual obligation of the
employer as the responsibility of paying cash benefits
shifts to the Corporation in respect of insured
employees.

 Employers are exempted from the applicability of

Maternity Benefit Act, Workmen’s Compensation Act, in
respect of employees covered under the ESI Scheme.
 BENEFITS TO THE EMPLOYERS

 Any sum paid by way of contribution under the ESI Act is

deducted in computing income under the Income Tax
Act.

 Employers employing persons with disabilities drawing

monthly wages upto Rs.25,000/- are exempted from
paying employer’s share of contribution upto of 3 years.
 ROLE OF EMPLOYERS
 Get your factory / establishment registered within 15
days after the ESI Act becomes applicable.

 Employers are advised to apply for coverage only

through the ESIC web portal – ‘www.esic.in’.

 In case of Labour / Manpower supplying agencies,

challan of advance contribution should be generated by
the employers through the ESIC web portal, deposited in
the bank for issuance of 17 digit Employer’s Code
number.

 Pay ESI contribution within 21 days of the following

month, in which the wages fall due.
 ROLE OF EMPLOYERS
 The employee Insurance Number is valid for the
lifetime of an employee and throughout the
country. He need not register himself again if he
changes location or employment.

 Employers must ensure that the employee does

not have any previous Insurance Number before
registering him as a new Insured Person.

 The employers themselves have been authorized

to upload personal particulars of employees,
including family members of such employees.
Hence, change of name cannot be executed.
 ROLE OF EMPLOYERS
 Employers should upload / update their particulars
viz. e-mail ID, Mobile Number & PIN Code of the area
to the ESIC web portal ‘www.esic.in’.

 Submit an ‘Accident Report’ to the Branch Office (BO)

/ ESI Dispensary concerned immediately in respect of
accidents that could result in death or disablement of
the employee within 24 hours of its occurrence. Minor
accidents which do not cause absence from work need
not be reported.

 Grant leave to insured employees on the basis of

sickness certificates issued by any authorised ESI
doctor.
 ROLE OF EMPLOYERS
 Intimate the date of closure or shifting (temporary or
permanent) of the factory / establishment to the
RO/SRO/BO within seven days of its closure or
shifting.

 Promptly report any change in the business activity,

ownership of the concern or its management.

 Ascertain the liability towards ESI dues, while taking

over the ownership of any factory establishment by
purchase, gift, lease or licence or in any other manner
whatsoever as new owner is liable to discharge the
past liabilities, if any.
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