A Corporate View by Cognizant - C-Quel

Social Security
-A Corporate View
©2011, Cognizant
ESI- Highlights
1. Super specialty treatment
1 . IT Roll out – Employer support
2. Unlimited Dialysis
3 Special treatment to Eye & Bone
4. Disabled employee coverage
5. Benefits “ Anytime & Anywhere”.
6. Lower premium – Higher benefits
| ©2010, Cognizant
2. Services of 24x7 Toll Free Helpline
and facilitation center.
3. Reporting framework
Focus to Improvements
Maximizing Private Hospitals for all ailments
Online Pehchan Card
Employee Self Service - ESS in ESIC
Maximizing Cashless Hospitalization
One stop process of Claim reimbursement
| ©2010, Cognizant
“Nearest “hospitals
Expand ESI counters in
Private Hospitals
One Click approval for
Private hospitals
Increase Women medical
Value added preauthorization cashless
| ©2010, Cognizant
Pvt Hospitals
ESI “Optimize & Attract”
Increase awareness of ESI
Feedback recording….gains
In recent years, India, like several other developing countries, has established different types of
social security scheme. The ESIS is one among such scheme. Its main objectives is to provide
medical benefit’s for citizens who’s earnings fall under certain limit of income.
IP 1 : I took my wife for antenatal care and for delivery to ESI hospital, Ayanavaram, Chennai. The treatment was very good
IP 2: I took my mother for asthma treatment to the ESI hospital Vellore. She was feeling better than when she was treated in a
private hospital
IP 3: Fifteen days back I went to the ESI clinic with an ear ache. Medical services were good. I suffer from this complaint frequently.
And I visit ESI regularly for treatment. I am satisfied with their service.
These factors affect diverse groups of individuals differently and play distinctive roles in the decision to seek medical care
(mostly taken by the individual) and in the decision regarding the subsequent number of visits to ESI dispensaries or
private facilities.
| ©2010, Cognizant
Feedback recording…focus to improve
IP 1:
The conditions in the dispensaries are appalling. We have to ultimately go to a government hospital or arrange money for
private treatment. What then, is the use of the ESI
IP 2:
The timing does not suit our working hours. We find it difficult to take leave or permission to go to the clinic in the morning
hours. Finally we end up going to private doctors
IP 3 :
In the out-patient’s clinic there are not enough places; with many patients the place is not very comfortable. Receiving the OP
card itself takes a long time. The sanitation conditions in these facilities are also not very good
IP 4 :
Not enough diagnostics facilities are available in these clinics. Where diagnostic facilities are available most of the doctors are
men and female beneficiaries registered under this scheme are reluctant to approach them for diagnosis. They prefer getting
treatment from private nursing homes or private clinics, several times out-of-pocket expenditure incurred for treatment and
reimbursement at times takes several weeks
| ©2010, Cognizant
ESI – Current & Proposed Flow
Medical Facility available
Approaches ESI Hospital
Medical Officers
examine the patient
IP is treated in ESI
Medical Facility
Register online in ESIC
web portal
System calculates the
eligibility and mail is
triggered to the officer
Officers check the system
and approves
IP is issued with
reference letter and
routed to Pvt Network
Case is received at PVt
Hospital & treatment is
Proposed process
| ©2010, Cognizant
Approaches the Network
(empanelled) Hospital and
produce the reference
letter at reception
ESIC should send
Instant SMS on
every stage of the
Cashless cycle.
Helpline facility
should be available
for updates on the
Based on the cap
certificate) the Hospital
intimates ESiC
Case is received at
ESIC & payment is
Existing process
Provident Fund
©2011, Cognizant
EPF - gains
Provident Fund
Savings plan & Safety of returns
International worker
Social security in home location
Loan options
Tax treatment
Lower taxability impact
Interest earned
Withdrawal facility
One stop shop for SS benefits
Dependant eligibility for deceased
Pensionable Service Benefit
Data accuracy
| ©2010, Cognizant
Totalisation of period of contribution in
the host country for determining the
eligibility for social security benefits.
EPF - Focus to Improve
Robust online status tracking
Improving on current SLAs,
seasonal fluctuations
Business Enablers
Support Portfolio management
Provident Fund “post retirement”
Repatriating contribution on gross
> 36 months Interest Loss
Inter regional transfer of funds
Robust Integrated System
Decentralized PAN India
Record Maintenance
| ©2010, Cognizant
Plan should permit to change
investment selections – corporate
Loans /pensions scheme –
eligibility tenure optimization
with changing market
PF – Current & Proposed Flow
Submitted @ RPFC
RPFC, Chennai
moves Form to
relevant section
within or relevant
RPFC of other
3 days-60 days
30- 60 days
RPFC, Chennai moves
Form to relevant section
within or relevant RPFC
of other region
90 days
Receipt of cheque and its
realization is handled RPFC
Chennai (Group 30)
15-30 days
Relevant RPFC(Regional
Provident Fund
Commissioner) moves
required -Annexure k for
EPF transfer
Processed only
at year end
Group 30 at RPFC
reflects the transferred
amount to associate’s
PF a/c
30 – 45 days
Receipt of Annexure K,
NEFT Transfer is made to
employee’s current PF a/c
On transference of
the amount RPFC
should send instant
SMS about the PF
transfer , closure
| ©2010, Cognizant
Relevant RPFC(Regional
Provident Fund
Commissioner) moves
documents(Cheque &
Annexure k) for EPF
Processed only
at year end
The minimum period of
PF transfer to take effect
is 2 months if it is
within Tamilnadu and
around 3 months for
transfer across interstate
RPFC offices.
and Closure 2 months.
Proposed process
The minimum period of
PF transfer to take
effect is around 6
months if it is within
Tamilnadu and around
a year for transfer
across interstate RPFC
Existing process
On transference of
the amount RPFC
confirms about the PF
transfer completion.
Confirms only during
annual statement release
Thank You
©2011, Cognizant
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