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Replied to "ESI" in Compensation and Benefits!!
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Welcome to ESIC

Employees’ State Insurance Scheme of India, is a multidimensional social security system tailored to provide socio-economic protection to worker population and their dependants covered under the scheme. Besides full medical care for self and dependants, that is admissible from day one of insurable employment, the insured persons are also entitled to a variety of cash benefits in times of physical distress due to sickness, temporary or permanent disablement etc. resulting in loss of earning capacity, the confinement in respect of insured women, dependants of insured persons who die in industrial accidents or because of employment injury or occupational hazard are entitled to a monthly pension called the dependants benefit.

Medical Benefit
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:-
This consists of hospitalization facilities and includes specialist services, drugs and dressings and diets as required for in-patients.
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.
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.
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. So far, 828976 sterilization operation viz. 176197 vasectomies and 652779 tubectomies have been performed upto 31.3.1999. 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.
Insured persons and members of their families are provided artificial limbs, hearing aids, and artificial appliances like spinal supports, cervical collars, walking calipers, crutches, wheel chairs and cardiac pace makers as a part of medical care under the Scheme.

Sickness Benefits

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 roughly 60% 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.

(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.

Maternity Benefits

Maternity Benefit is payable to an Insured Woman in the following cases subject to contributory conditions:-

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 double the Standard Benefit Rate, or roughly equal to the average daily wage.

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Sr Manager
Hyderabad, AP


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