BENEFITS UNDER THE SCHEME
S.THIAGARAJAN
12-08-2011
• Under the ESI Scheme Benefits are available
both to the employers and employees
BENEFIT TO THE EMPLOYERS
 Employers are absolved of all liability, of providing medical care to
employees.
 employers are exempted from the applicability of the:
 Maternity Benefit Act, 1961 &
 Workmen Compensation Act, 1923
Employers have a well secured workforce, an
essential ingredient for better productivity
BENEFITS TO EMPLOYERS
• By employing physically challenged employees employers need not
pay employers share of 4.75% contribution for three years from the
date of commencement of the contribution period.
• Wage limit for the coverage of the physically challenged employee
is Rs.25000
• Under Rule 51-A of ESI Rules person with disability under the
persons with Disabilities(Equal opportunities Protection of Rights
and Full Participation)Act, 1995(1 of 1996), and under the National
Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental
Retardation and Multiple Disabilities Act, 1999(44 of 1999)
respectively, shall be twenty five thousand rupees a month .
• This facility is available only to the new entrant and not to the
existing physically challenged employee
BENEFITS TO EMPLOYEES
• There are two types of Benefits
• Cash Benefit
• Medical Benefit
SO MUCH TO GAIN FOR SO LESS
PREMIUM
• MEDICAL BENEFIT(There is
no cap for the Medical Benefit)
• CASH BENEFIT (SICKNESS
AND DISABLEMENT)
• DEPENDANT BENEFIT
• MATERNITY BENEFIT(Cash
Benefit is based on Average
Daily wages)
4.75% EMPLOYERS
CONTRIBUTION
• UNEMPLOYMENT
ALLOWANCE
• VOCATIONAL
REHABILATION
• FUNERAL EXPENSES
• OLD AGE HEALTH
CARE.
1.75%EMPLOYEES
CONTRIBUTION
CASH BENEFIT
(1) SICKNESS BENEFIT
normal
extended
enhanced
(2) DISABLEMENT BENEFIT (employment
injury)……temporary & permanent
SICKNESS BENEFIT
Contributory
condition
DURATION
RATE
Payment for78
days in relevant
contribution
period
91 days in any
two consecutive
period
About 70% of
Average daily
Wages
EXTENDED SICKNESS BENEFIT
for 34 specified long term diseases
Contributory
period
Duration
Rate
Continuous
employment for a
period of two years
and contribution for
156 days in four
consecutive
contribution period
two years
80% of the Average
daily Wages
ENHANCED SICKNESS BENEFIT
For undergoing sterilization operation for family
planning
Contributory
period
Duration
Rate
Payment for at least
78 days in the
relevant contribution
period
7 days for
Equal to Average
vasectomy and14
daily wages
days for tubectomy ;
extendable in case
of POC
DISABLEMENT BENEFIT
(employment injury or occupational diseases)
BENEFIT
Contributor-y
condition
TDB
(incapacity
should be > 3
days Exc DOI
He should be
Till the
employed on the incapacity lasts
date of injury, no
relation to
contribution.
PDB (partial or same
total)
Duration
For life
Rate
90% of the
Average Daily
Wages
Determine by the
medical board,
depends upon
loss of earning
capacity.
Commutation of
PDB is not > Rs
30,000
DEPENDANTS BENEFIT
Contributory
condition
To whom
entitled/Duration
Deceased should be
1.To widow/s for life or
employee on the date of until remarriage(3/5 DBR)
fatal accident.
2.To widowed mother
during life(2/5 DBR)
3.To legitimate or
adopted son and legitimate
or adopted daughter till
the age of 25 yrs(2/5)
4.To parents 3/10
.Distribution does not
exceed the full rate of
DBR
Rate
90% of Average Daily
Wages to be divided
among the dependents in
the prescribed ratio)
The amount of DBR is
reviewed vis-à-vis the cost
of living index and
increases are granted from
time to time to compensate
for erosion in its real value.
MATERNITY BENEFIT
Contributory condition
Duration
Rate
Payment of contribution
for 70 days in
immediately preceding
two consecutive
contribution periods.
12 weeks of which not
more than six can precede
the expected date of
confinement;
6weeks for miscarriage
and additional one month
for sickness arising out of
pregnancy confinement,
premature birth of child
or miscarriage
Double the Standard
Benefit Rate(approx full
wages)
Maternity benefit
continues to be payable
even in the event of death
of an insured woman
during delivery or
immediately following
date of delivery for leaving
child whole of period and
in case child also dies
,during the said period
until the death of child
FUNERAL BENEFIT
• HE SHOULD BE AN INSURED PERSON ON
DATE OF DEATH.
• ACTUAL EXPENDITURE ON FUNERAL NOT
EXCEEDING Rs 10000/• AMOUNT IS PAID TO ELDEST SURVIVING
MEMBER OF THE FAMILY OR IN HIS
ABSENCE TO THE PERSON WHO ACTUALLY
INCURS THE EXPENDITURE ON THE
FUNERAL.
REHABILATIONAL ALLOWANCE
Contributory
condition
Entitlement to
medical benefit or
if disabled due to
employment
injury
Duration
Rate
For each day on Double the SBR
which insured
(full wage)
person remains
admitted in
artificial limbcentre for
fixation/repair or
replacement of
artificial limb.
MEDICAL BENEFIT
Contributory
condition
Duration
Insured person
Till the disability
and his family is / disease lasts
eligible from the
date of entry of
I.P. into insurable
employment
Benefit
Full curative and
preventive
medical care for
I.P. and his/her
dependants
Including super
specialty
treatment
SUPERSPECIALITY CONDITIONS
• IN CASE OF INSURED PERSONS 39 DAYS OF
CONTRIBUTION AND 3 MONTHS
CONTINUOUS SERVICE
• IN CASE OF FAMILY MEMBERS 78 DAYS OF
CONTRIBUTION AND ENTILTED FOR SB
• NO CONTRIBUTORY CONDITIONS IN CASE OF
ANY TYPE OF INJURY
• FACILITY AVAILABLE BASED ON IMOS
REFERENCE
CONFINEMENT EXPENSES
Contributory
condition
Duration
Rate
To an insured
Up to two
Rs 2500/- per
woman or an I.P. confinement only case.
in respect of his
confinement are
not available in
esi insitution
Unemployment Allowance named as Rajiv
Gandhi Shramik Kalyan Yojana
a) Unemployment Allowance named as Rajiv Gandhi
Shramik Kalyan Yojana, is payable to those workers
facing involuntary unemployment due to closure of
factory/establishment; retrenchment or permanent
invalidity arising out of non-employment injury. The
daily rate of Unemployment Allowance is at par with
the sickness benefit rate . This allowance is payable
for a maximum period of 1 year either in one spell or
in different spells of not less than one month’s
duration.
•Contributory conditions for
unemployment allowance
•He should be an IP
•He should have contributed
for at least three years
Medical benefit to retired/disabled insured
person and his/ her spouse
Contributory condition
Duration
Benefit
Rs On payment of 120/- in
lump sum for one year in
advance
(1)Retired I.P being
insured for not less than
five years.
(2)By insured person who
cease to be in insurable
employment on account of
disablement due to an
employment injury
Period for
Full medical
contribution is benefit for that
paid
period.
VOCATIONAL REHABILATIONAL
ALLOWANNCE
Contributory
condition
Not more than
45 years of age
and disability
not less 40% due
to employment
injury
Duration
All the days of
training in
vocational
rehabiliational
centre
Rate
Rs 145/- per day
or the amount
charged by
vocational
rehabitational
centre
whichever is
higher
OBLIGATION OF EMPLOYERS
Maintain register of employees in form – 6 (reg.32)
Ensure maintenance of separate register of employees by contractor
and settle contractor’s bills only on production of this register to esic. (
sec-41 (1-a)
Deposit both employee’s and employer’s contribution as per specified
rates within 21 days of the following month. {reg. 31}
Insure all employees by by generating Ins no. through online
Facilitate proper inspection of records/registers and the premises by
visiting officers of ESIC as and when so required. { u/s 45}
Report promptly about the accident so as to enable esic to provide
benefit in time
Not to make any false declaration or mis-representation of facts,
concerning the applicability of the act, or, admissibility of benefits to
employees –regular, hired or contractual.
Report promptly the date of closure of a factory/establishment to the esic
branch office/regional office, preferably within seven days of such closure
and clear esi liabilities.
Report any change in business activity, address, ownership or the
management to esic authorities forthwith.
Ascertain the liability towards esi dues, while taking over the ownership of
a factory/establishment through purchase, gift, lease, license or otherwise
as the new owner is liable to discharge past liabilities. (sec. 93-a)
•Furnish any additional information called for sec. 44 (2) and reg. 109
•Help and assist employees to avail their legitimate esi benefits.
•Maintain sanitary standard in and around the workplace and employees
housing colony so as to minimize the risk of exposure to occupational
hazardous and diseases.
•The employer shall render all necessary assistance which the corporation
may require in connection with the registration of his factory or
establishment and the registration of his employees and especially for
photographing such employees and their families for issue of bio metric
cards affixing the photographs to the identity cards. (reg.16)
•Indicate insurance number of Insured Person in chronological order in the
return of contribution and his own code number in all correspondence.
IMPORTANT INFORMATION FOR THE
EMPLOYERS
1. Employer should get factory/establishment registered online, immediately
on applicability of ESI Act to his unit.
2. Employer should get his employee including the employee employed through
the contractors registered online and T.I.C. generated immediately after
taking him in insurable employment.
3. The employer should direct and pursue his employees to get photographed
for Pehchan Card.
4. The employer should not re-register a new employee, if
he/she was already registered with E.S.I. Corporation
while working with another employer.
5. The employer should immediately inform the RO/SRO
about the permanent closure or transfer of
factory/establishment within 21 days of such
closure/transfer.
PROCEDURE FOR AVAILING BENEFIT
•Insured Person has to submit leave certificate along with his claim to the Branch
Office.
•Branch Office after verifying the eligibility settle the claim either by cash or
through ECS System.
•It is proposed to introduce online settlement of claim shortly.
•In that case Insured Person need not visit the Branch Office.
•To avail Super Specialty Benefit IP need not spend any amount and cashless
treatment will be provided to the Insured Person and his family.
•With the introduction of Pehachan Card and computerization the Insured Person
and his family can take treatment at his choice.
•Two Pehachan cards will be issued. One for the Insured Person and other for the
family.
VAZGAVALAMUDAN
Thank You
12-08-2011