Employees State Insurance Scheme (ESIS)

Employee's State Insurance Scheme (ESIS) is a multidimensional and an integrated social security system customized to offer ‘protection’ to the employees. This was introduced as per the ‘Employees State Insurance Act, 1948’. According to this Act, the ESIS will provide help in case of sickness, death due to employment, injury, maternity, temporary or permanent disablement etc.

ESIS offers complete medical care for the insured person as well as the dependents. This insurance comes into force right from the beginning of the employment. This scheme offers cash benefit in case of any uncertainty resulting in a loss of income or disablement or confinement for women. Besides, the Employee's State Insurance Scheme (ESIS) also offers variety of cash benefits in the form of pension popularly known as dependents benefit. This is offered to the family members dependent on the insured, in case of death due to accidents caused due to workplace (industries) or any injury suffered during working or someone who faced hazardous situation while on duty.

Features of Employees’ State Insurance Scheme

  • Includes medical care facilities for the insured individual as well as the dependent members of his/her family from the first day of insurable employment.
  • Includes medical coverage during certain illnesses, as specified in the document of the scheme, which includes cash benefit during medical leave. This extends up to a maximum of 70% of the employee’ wages till 91 days. In order to qualify for this benefit the insured worker is required to contribute for 78 days in a contribution period of 6 months.
  • Includes Maternity Benefit up to 26 weeks which is extendable by further one month on medical advice at the rate of full wage subject to contribution for 70 days in the preceding Two Contribution Periods, ranging to 100% of the average daily wages of employees in cash. This benefit is also applicable for miscarriages or medical termination of pregnancy of employees up to 6 weeks.
  • Benefit for dependents include financial security during illnesses and injuries while at work, financially securing your dependents during emergencies arising from sudden loss of income. In such unfortunate situations, the dependents are eligible for payments in the form of monthly instalments.
  • The unemployed are eligible for being insured for at least three years, provided they disclose details regarding their previous place of work and retrenchment or permanent invalidity. In such cases, employees can avail a monthly payment of 50% of their wage in cash for a maximum of 2 years.
  • Instances of temporary disablement of employees make them eligible for a monthly payment of 90% of their wage till the time of their recovery. Employees who are permanently disabled can avail monthly payments of 90% of their wage for their entire life.

Benefits Offered by Employees State Insurance Scheme (ESIS)

The Below Mentioned Benefits are Offered by ESIS:

  • Medical Benefits: ESIS offers complete medical care for the insured person as well as the dependent family members from the first day of insurable employment. In short, ESIS helps you by taking care of your medical needs. • Medical coverage during certain illnesses, as mentioned in the document of the Employees’ State Insurance Scheme, is offered in the form of cash. This benefit extends up to a maximum of 70% of the employee’ wages till a term of 91 days. In order to qualify for this benefit the insured worker is required to contribute for 78 days in a contribution period of 6 months.

  • Sickness Benefit: ESIS offers cash benefit at the time of medical leave up to 70% of the wages. This benefit is provided up to 91 days.

  • Maternity Benefit: up to a span of 26 weeks, which is extendable by further one month on medical advice at the rate of full wage subject to contribution for 70 days in the preceding Two Contribution Periods ranges to 100% of the average daily wages of employees in cash. This benefit is also applicable for miscarriages or medical termination of pregnancy of employees up to a maximum of 6 weeks.

  • Benefit for Dependents: In case you suffer any health hazards or injuries whilst at work, your dependents do not have to worry about the financial crisis that may arise due to the sudden loss of income. ESIS offers payments in monthly installments to your dependents.

  • Benefit for Unemployment: Incase you become unemployed after being insured for three or more years, on account of closure of factory/establishment, retrenchment or permanent invalidity, a monthly payment equal to 50% of wage in cash is offered by ESIS for a maximum of 2 years.

  • Benefit for Disablement: In case of temporary disablement, ESIS offers payment each month at the rate of 90% of wage for temporary disablement till the time the injury is healed. In case of permanent disablement, ESIS offers monthly payments at the rate of 90% of wage continuously for the entire life (whole life).

  • Offers Funeral Expenses of Rs. 10,000.

  • Other benefits include vocational and physical rehabilitation, and old age medical care.

Things to Keep in Mind

  • A new employer has to be informed of the ESI Registration Number after the insured switches from one company to another. This will make him/her eligible for utilizing the same benefits, if and when needed.
  • Pehchan Card serves as a channel towards social security. Hence, the cardholder has to prevent it damage or loss.
  • The insured and the dependent family members who are covered under the scheme have to immediately report a lost card to their Branch Office or Dispensary.
  • Recommended processes for referrals should be strictly followed.
  • In case an employee plans to relocate for professional reasons, he/she has to get the Form 105 signed by their existing employer to remain eligible for the benefits of the ESI scheme in another location.
  • The insured has to closely abide by doctors’ medications and prescribed treatments.

What is Covered in Employees’ State Insurance Scheme (ESIS)?

The Employees’ State Insurance Scheme was inforced only in two Indian cities, Delhi and Kanpur, when it was initially implemented in 1952. Since then, the scheme has spread in leaps and bounds across the country. Currently, it is accessible in more than 843 centers in 33 States and Union Territories. The ESI Act has now been adopted by more than 7.83 lakh factories and establishments and has a reach of over 2.13 crore insured individuals and families. It holds a record of over 8.28 crore beneficiaries.

According to notification by the government, according to Section 1(5) of the ESI Act, shops and restaurants or hotels that are involved in sales are covered by the Employees’ State Insurance Scheme

Infrastructure of Employees State Insurance Scheme (ESIS)

The progress in the infrastructure of ESIS is commendable since its introduction in 1952. It has been growing rapidly in order to fulfill the social security needs of the increasing population of the employees.

So far, ESIS has made available 151 hospitals and 42 hospital annexes to take care of inpatient services. It also has set-up 954 panel clinics, 1450/188 ESI dispensaries or AYUSH units.

ESIS has also set-up 5 occupational disease centers each in Mumbai, New Delhi, Chennai, Kolkata and Indore to rule out occupational diseases at the beginning of the employment who are engaged in hazardous industries.

In order to make the monthly payouts, ESIS has set-up a network of more than 628/185 branch offices/ pay offices. The functioning of this department is further inspected or managed by 62 regional/ sub-regional and divisional offices.

What is Rajiv Gandhi Shramik Kalyan Yojana?

Rajiv Gandhi Shramik Kalyan Yojana is especially designed for the unemployed. It is an allowance that was first implemented on 1st April, 2005. An insured individual who has signed up for this scheme is eligible for making the most of its benefits in case of his/her unfortunate unemployment after being insured for a minimum of three years due to specific reasons like closure of factory or business entity, retrenchment or permanent invalidity. Benefits offered under this scheme are:

  • Unemployment Allowance is equivalent to 50% of his/her individual wage for a maximum term of 2 years.
  • Medical care for the insured individual and his/her dependent family members can avail medical benefits at authorized hospitals and dispensaries
  • Expenditure towards Vocational Training organized for the unemployed for upgrading skills, along with traveling charges

When is ESIS Registration Required?

When a company employs 10 or more employees, it is mandatory for that company or any other entity to register with the ESIC. An employee who earns less than Rs.21,000 per month contributes 1.75% of his/her salary towards the ESI whereas the employer pays 4.75% towards the ESI making a total of 6.5%. The company or establishment can apply for an ESI registration within 15 days from the time the ESI Act becomes applicable to that company or establishment.

Procedure for ESIS Registration

  • Download the PDF version of Form No. 1(Employers Registration Form) and fill up the required details accurately.
  • Submit it online along with the required documents, as mentioned above.

Documents Required for ESIS Registration

  • Registration Certificate received under the Factories Act or Shops and Establishment Act
  • Articles of Association of the Company and Memorandum of Association
  • Certificate of Registration for a company/ Partnership deed for a Partnership entity
  • An exhaustive list of all employees working in an organization
  • PAN Card of the company as well as that of the employees working in the same company
  • Details regarding annual income of all the employees
  • Cancelled cheque of the Bank Account of the Company
  • Exhaustive list of the names of Directors of the Company
  • List of all the shareholders of the Company
  • Detailed account of the attendance of all the employees

Employees' State Insurance Act, 1948

Employees' State Insurance Scheme is an initiative towards offering Social Insurance to individuals, as per the provisions of the Employees' State Insurance Act. Its objective is to financially secure employed individuals and dependent members in their families, as per the Employees' State Insurance Act, 1948, from unforeseen incidents of illness, temporary and personal disablement, maternity, and death and physical injury caused while being gainfully employed. The Employees' State Insurance Scheme offers medical care to insured individuals and their dependent family members under such circumstances.

The ESI Scheme is applicable to employees of factories, shops, restaurants and hotels and other business entities like road transport, newspaper, cinemas, and educational institutions that employ at least 10 people who earn a monthly wage of a minimum of Rs. 15,000. For some states, these benefits are extended only to establishments that employ no more than 20 individuals. The ESI Corporation has decided to increase the capping on monthly wage from Rs. 15,000 to Rs. 21,000. The benefits have been extended to employees of construction sites located in areas mentioned under the ESI Scheme since 1st August, 2015.

Both the employer and employee contribute towards the Employees' State Insurance Scheme. While the employer contributes 4.75% of an employee’s wage towards the scheme, the same employee has to make a contribution of 1.75% of his/her wages. However, employees who receive less than Rs. 137 as their daily wages have been exempted from contributing towards the scheme. Only their employers are liable to make the required contributions.

Employees' State Insurance Scheme and its Application

The statutory corporate authority, named Employees’ State Insurance Corporation (ESIC), established by the Employees’ State Insurance Act 1948, is been conferred with the responsibility of ensuring smooth administration of the Scheme. The ESI scheme is a self-financed comprehensive social security initiative introduced to ensure financial security of employees insured under the scheme. It offers medical benefits to the insured and his/her dependent family members against certain specific illnesses, death due to physical injuries at the workplace, and temporary and permanent disabilities.

The ESIC is headquartered at New Delhi and has an extensive network across India. Currently, 151 hospital and 42 hospital annexes for inpatient services. Primary and out-patient medical services are provided through a network of about 1450/188 ESI dispensaries/AYUSH units, and 954 panel clinics.. Additionally, there is also a Medical Benefit Council that is established to offer their expert guidance to the ESIC regarding its administrative duties.

Public Healpline No. & Address

Cilck Here to download the PDF version of Employees' State Insurance Corporation (ESIC) Helpline No & Center Addresses.

Composition of Employees' State Insurance Scheme

  • Director General, Employees' State Insurance Scheme
  • Chairman, as appointed by the Government of India
  • Vice President, as appointed by the Government of India
  • Up to 5 individuals nominated by the Government of India
  • 1 representative for each state of India, as appointed by the Government of India
  • 1 representative for each Union Territory of India, as nominated by the Government of India
  • 10 representatives of employers, as nominated by the Government of India
  • 10 representatives of employees, as nominated by the Government of India
  • 2 representatives from the medical field, nominated by the Government of India
  • 3 MPs (Members of Parliament) – 2 from Lok Sabha and 1 from Rajya Sabha

Improvement in ESIC Hospitals

  • Electronic Health Record
  • VIBGYOR - Operation Indradhanush
  • Medical Helpline
  • Special OPD
  • Pathological & X-Ray in PPP Model
  • Quality Control on Medicine & Drugs
  • Regular Inspection of H'ble Member of ESIC to ESIC/ESIS Hospitals
  • Queue management, Behavioral Training of Doctor & Paramedical Staff, Ayush, Yoga, Special Child & Mother care hospital, May I help You etc.
  • Specialties being Created - ICU, CT, MRI, Dialysis, Cat-labs

Employees’ State Insurance Scheme Reviews

“An accident left me temporarily disabled last year. The financial benefits for the disabled offered by the ESIS helped me pay for my hospital and treatment expenses. Without this scheme, I have no idea how I would have met the huge medical expenses.” – Akhil Kumar

“The nature of my factory job leaves me to the risk of accidents. That’s how I got severely injured. I’m glad that my employer had already initiated me to the Employees’ State Insurance Scheme, which requires me as well as my employer to make a certain contribution. The accumulated contribution funded my journey to complete recovery.” – Pankaj Tripathi

“As an employer, it is my responsibility to ensure the welfare of my employees. The Employees’ State Insurance Scheme helps me do just that.”

Frequently Asked Questions On ESIS

What is the procedure for the registration of an employer?

  • Download the PDF version of Form No. 1(Employers Registration Form) and fill up the required details accurately.
  • Submit it online along with the required documents, as mentioned above.

Is it mandatory for employers to register under the Employees’ State Insurance Scheme?

Yes, it is compulsory for all employers who have registered their business establishment or factory or shop under the ESI Act.

What is the ESI Code number?

Employees’ State Insurance Code is a unique 17-digit number that is assigned to every employer who has registered their business enterprise/shop/factory under the Employees’ State Insurance Act. A unique code is also allotted to employees of business entities who are registered under this Act.

What are the records that are to be maintained for the purpose of the ESI scheme?

  • Registration Certificate received under the Factories Act, or Shops and Establishment Act
  • Articles of Association of the Company and Memorandum of Association
  • Certificate of Registration for a company/ Partnership deed for a Partnership entity
  • An exhaustive list of all employees working in an organization
  • PAN Card of the company as well as that of the employees working in the same company
  • Details regarding annual income of all the employees
  • Cancelled cheque of the Bank Account of the Company
  • Exhaustive list of the names of Directors of the Company
  • List of all the shareholders of the Company
  • Detailed account of the attendance of all the employees

What are the establishments that are covered under ESI?

According to a notification issued by the government, as per the provisions of Section 1(5) of the ESI Act, shops and restaurants or hotels that are involved in sales are covered under the Employees’ State Insurance Scheme.

How much salary is eligible for ESI?

Employees drawing a maximum monthly salary of Rs. 21,000 is eligible for Employees’ State Insurance.

What is Employee State Insurance Act?

As per the ESI Act, 1948, shops and restaurants or hotels that are involved in sales are covered by the Employees’ State Insurance Scheme. The act lays down the admisterial duties and responsibilities of the statutory corporate body, named the Employees’ State Insurance Corporation (ESIC) for the efficient management of the Employees’ State Insurance Scheme.

How does ESI scheme work?

The statutory corporate authority, named Employees’ State Insurance Corporation (ESIC), established by the Employees’ State Insurance Act 1948, is been conferred with the responsibility of ensuring smooth administration of the Scheme. The ESI scheme is a self-financed comprehensive social security initiative introduced to ensure financial security of employees insured under the scheme. It offers medical benefits to the insured and his/her dependent family members against certain specific illnesses, death due to physical injuries at the workplace, and temporary and permanent disabilities.

Can we withdraw ESI amount?

ESI makes the insured eligible for medical care free of cost at authorized hospitals and dispensaries of the scheme when a claim is raised. It does not allow the insured to withdraw any amount from the scheme.

How do I make a claim against ESIS?

To initiate a claim against Employees’ State Insurance Scheme, the insured has to download Form 15, fill up the required details accurately and then submit it at Employees’ State Insurance Corporation.

What is the age limit for ESIS coverage?

The age limit is different for every benefit offered by Employees’ State Insurance Scheme. The age specifications are as follows:

Medical care to retired Insured persons under Rule 61 - To an Insured Person who leaves the insurable employment (on attaining the age of superannuation, or retires under a VRS or takes premature retirement) after being insured for not less than five years.

Sickness Benefit - On payment of contribution for not less than 78 days in a contribution period of 6 months.

Extended Sickness Benefit – up to two years in the case of 34 malignant and long-term diseases at an enhanced rate of 80 per cent of wages..

Temporary disablement – eligible for the benefit from the day of entering into insurable employment in case of employment injury sustained during the course & out of insurable employment. Temporary Disablement Benefit at the rate of 90% of wage is payable as long as disability continues.

Dependant Benefit – Eligible for the benefits from the day of entering into insurable employment and during the insurable employment. The maximum age limit extends for whole life to the widow or until her re-marriage and up to the age of 25 years for legitimate or adopted sons. The same benefits are applicable for unmarried daughters till the age of 25 years or until her marriage, whichever is earlier. For infirm children, the benefits are offered till infirmity lasts. DB paid at the rate of 90% of wage in the form of monthly payment to the dependants of a deceased Insured person in cases where death occurs due to employment injury or occupational hazards.

Is ESI contribution refundable?

According to the provisions of Employees’ State Insurance Act, 1948, contributions towards Employees’ State Insurance Scheme are not refundable under any circumstance. The insured and his/her dependant family members are only eligible for the benefits that it offers.

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