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Website:http://www.esic.nic.in/ for General Information(s)

What is ESIC Scheme:

The ESI Act 1948, encompasses certain health related eventualities that the workers are generally

exposed to; such as sickness, maternity, temporary or permanent disablement, Occupational disease or

death due to employment injury, resulting in loss of wages or earning capacity-total or partial. Social

security provision made in the Act to counterbalance or negate the resulting physical or financial distressin such contingencies, are thus, aimed at upholding human dignity in times of crises through protection

from deprivation, destitution and social degradation while enabling the society the retention and continuity

of a socially useful and productive manpower.

Benefits of ESIC scheme:

The section 46 of the Act envisages following six social security benefits :-

(a) Medical Benefit : Full medical care is provided to an Insured person and his family members from the

day he enters insurable employment. There is no ceiling on expenditure on the treatment of an Insured

Person or his family member. Medical care is also provided to retired and permanently disabled insuredpersons and their spouses on payment of a token annual premium of Rs.120/- .

(b) Sickness Benefit(SB) : Sickness Benefit in the form of cash compensation at the rate of 70 per cent

of wages is payable to insured workers during the periods of certified sickness for a maximum of 91 days

in a year. In order to qualify for sickness benefit the insured worker is required to contribute for 78 days in

a contribution period of 6 months.

1. Extended Sicknes s Benefi t(ESB) :SB extendable upto two years in the case of 34 malignant

and long-term diseases at an enhanced rate of 80 per cent of wages.

2. Enhanced Sickness Benef i t :Enhanced Sickness Benefit equal to full wage is payable to

insured persons undergoing sterilization for 7 days/14 days for male and female workers respectively.

(c) Maternity Benefit(MB) : Maternity Benefit for confinement/pregnancy is payable for three months,

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 year.

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(d) Disablement Benefit:

1. Temporary d isablement benefi t (TDB) :From day one of entering insurable employment &

irrespective of having paid any contribution in case of employment injury. Temporary Disablement Benefit

at the rate of 90% of wage is payable so long as disability continues.

2. Permanent disablem ent benefi t (PDB) :The benefit is paid at the rate of 90% of wage in the

form of monthly payment depending upon the extent of loss of earning capacity as certified by a Medical

Board

(e) Dependants Benefit(DB) : 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.

(f) Other Benefits :

- Funeral Expenses :An amount of Rs.10,000/- is payable to the dependents or to the person who

performs last rites from day one of entering insurable employment.

- Conf inement Expenses :An Insured Women or an I.P.in respect of his wife in case confinement

occurs at a place where necessary medical facilities under ESI Scheme are not available.

In addition, the scheme also provides some other need based benefits to insured workers.

- Vocational Rehabilitation :To permanently disabled Insured Person for undergoing VR Training at

VRS.

- Physical Rehabilitation : In case of physical disablement due to employment injury.

- Old Age Medical Care: For Insured Person retiring on attaining the age of superannuation or under

VRS/ERS and person having to leave service due to permanent disability insured person & spouse on

payment of Rs. 120/- per annum.

- Rajiv Gandhi Shramik Kalyan Yojana - This scheme of Unemployment allowance was introduced

w.e.f. 01-04-2005. An Insured Person who become unemployed after being insured three or more years,

due to closure of factory/establishment, retrenchment or permanent invalidity are entitled to :-

Unemployment Allowance equal to 50% of wage for a maximum period of upto one year.

Medical care for self and family from ESI Hospitals/Dispensaries during the period IP receives

unemployment allowance.

Vocational Training provided for upgrading skills - Expenditure on fee/travelling allowance borne

by ESIC.

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Scale of treatment:

The beneficiaries are entitled to reasonable medical, surgical and obstetric treatment.

a. To Insured Persons:- IPs are entitled to avail treatment in ESI Dispensary/Hospital/Diagnostic Centreand recognised institutions, to which he is attached such as:-

Outpatient treatment

Domiciliary treatment by visits at their residences.

Specialists Consultation.

In-patient treatment(Hospitalisation)

Free supply of drugs dressings and artificial limbs, aids and appliances.

Imaging and laboratory services.

Integrated family welfare, immunisation and MCH Programme and other national health

programme etc.

Ambulance service or re-imbursement of conveyance charges for going to hospitals, diagnosticcentres etc.

Medical Certification and

Special provisions.

B. To Family Members of Insured Persons:- While in all implemented areas, IPs are entitled to medical

care as detailed above, members of a family of an IP are entitled to one or other of the following scales

of Medical Benefits:-

i. "FULL" Medical Care i.e., all facilities as for IPs including hospitalisation.

ii. EXPANDED" Medical Care i.e., all facilities as for IPs except hospitalisation

ESIC card:

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FAQs:

What is an identity card?

On registration under the scheme, the employee is termed as insured person. He is provided with a

temporary identification certificate which is valid for a period of 3 months, but may be extended, if

necessary till a permanent family photo identity card with family particulars is issued. The identity

card serves as a means of identification both for availing medical benefit at the dispensary/hospital

and availing cash benefits at the ESI branch Office. The identity card should be signed/thumb

impression affixed by the insured person. Any changes in his residence/dispensary/employment are

carried out by the Branch Office Manager in the identity card.

What is Medical Benefit?

Medical benefit means the medical attendanceand treatment to the insured persons covered

under the Act and their families as and whenneeded. This is the only benefit provided in kind

through the State Governments (except inDelhi), and uniform to all as per their requirement without

linking it to their wages and contributions.

What are the benefits admissible to an employee?

1. Full Medical care as and when needed.

2. Cash benefit to compensate his/her loss of wages during his abstention from work due to sickness

including prolonged sickness, maternity and disablement.

3. Provision of Artificial limbs, spectacle, hearing aids, cervical collar, wheel chair etc. as a part of

medical treatment as and when needed.

4. Un-employment allowance during the period of closer of the Factory/estt, retrenchment or

permanent invalidity arising out of non-employment injury for a period of six months at 50% of hiswages. Medical benefit is also admissible during this period for self and family.

5. Vocational rehabilitation training is provided to improve his skills to find out alternate employment.

What is Sickness Benefit ?

If an insured person requires medical treatment and attendance and needs abstention from work on

medical grounds, Sickness benefit is paid for the period of abstention duly certified by the Authorised

Medical Officer, for a period not exceeding 91 days in two consecutive befit periods (say one year) @

60% of his wages, subject to payment of contribution for not less than 78 days in the corresponding

contribution periods.

What is disablement?

Disablement is a condition resulting from employment injury, which may render the insured person

temporarily incapable of doing his work and necessitating medical treatment(temporary disablement).It

may reduce his earning capacity (permanent partial disability)or it may totally deprive the insured

person from the capacity of doing any work(permanent total disability).

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What is Employment injury?

It is a personal injury to an employee caused by an accident or occupational disease arising out of and in

the course of his insurable employment within or outside territorial limits of India.

What is Occupational Disease?

Occupational health hazards can be of two main types. Short term and high dose with acute on set,

synonymous with acute poisoning, included by large dose of a toxic substance in an industrial

environment, and the other one is chronic on set, which is the result of repeated or continuous

exposure of small doses of substances.

What is the benefit admissible to the family members?

1. Family members are also entitled to full medical care as and when needed.

2. The family members are also entitled to artificial limbs, artificial appliances etc. as a part of medical

treatment.

3. The medical benefit is also admissible to the family during the period the insured person is in

receipt of employment allowance. In case he dies during that period, his family continues to receive

the medical benefit till the end of those six months.

4. Reimbursement of expenditure incurred on the funeral of the deceased employee.

5. In case of the death of the insured employee due to employment injury, the spouse, widowed

mother and children are entitled to Dependants benefit.

6. Any benefit due to the insured employee at the time of death is paid to the nominee.