The Government of India launched the Employees State Insurance Scheme (ESIS) in 1952 to ensure the safety of workers as per provisions of the Employees’ State Insurance Act, 1948. It provides coverage to workers against temporary/permanent disability owing to employment injury, sickness, physical disability, or any other medical condition that may affect an employee’s earning capacity.
To be a beneficiary of ESIS, both workers and employers must make contributions towards the scheme on a monthly basis.
Here are some benefits offered by the Employees State Insurance Corporation (ESIC) under ESIS:
ESIS provides financial protection against medical expenses by offering access to affordable healthcare facilities. This coverage is effective from the first day of employment.
The ESIC scheme for employees offers maternity benefits, which enables the insured to get 100% of the daily wages for a maximum of 26 weeks. This period can be extended depending upon medical advice. Also, note that one will be eligible for 6 weeks’ pay in case of a miscarriage, whereas the timeframe is 12 weeks for adoption.
ESIS ensures an inflow of cash even during the period for which an employee is on medical leave. Insured individuals can get 70% of the daily wage for a timeframe not exceeding 91 days, in due course of two adjacent benefit periods.
The Employee State Insurance Scheme provides a maximum of 50% of the average monthly wages for two years to the insured if they lose their job. Employees who suffer from permanent disability owing to any non-employment injury can also avail this benefit.
If a worker passes away owing to an occupational hazard, the insured individual’s dependent family members are eligible to get 90% of his/her salary. Dependent children can be eligible for this benefit from the age of 21. However, dependent parents and spouses will continue to receive monthly payments until death.
This insurance provides an amount of up to Rs. 15,000 to cover funeral expenses. This amount is received by dependents of the insured or the individual who performs the last rites.
If insured individuals get confined at a location where they don’t have any access to medical care, they, or their dependents, are eligible for confinement cost benefits.
When individuals registered under the Employees State Insurance Scheme retire or resign owing to permanent disability, they or their spouses are entitled to receive old-age healthcare on the payment of Rs. 120 every year.
Insured individuals can avail this benefit, especially if they suffer from disability caused due to an employment injury.
Also read: What is Domiciliary Hospitalization?
As of March 31, 2019, ESIS was available in more than 30 states and union territories across India. Here’s a tabular representation of the beneficiaries under this social security scheme:
|Particulars||Coverage as of March 31, 2019|
|Total beneficiaries||13.32 crore|
|Total insured employees||3.14 crore|
|Total insured women||51.20 lakh|
|Total employers, etc.||12.11 lakh|
|Total insured individuals/ family units||3.49 crore|
Here are some restrictions in relation to the coverage under ESIS:
Here are the eligibility criteria to enjoy the benefits under the Employees’ State Insurance Scheme:
In case employees are not able to fulfil the eligibility criteria of ESIS, they can opt for medical coverage offered by leading health insurance providers.
Navi offers health insurance within 90 seconds via a paperless procedure. Individuals looking to purchase health insurance policies can download the Navi app without delay.
When a company or an entity employs 10 more employees earning less than Rs. 15,000 a month, ESI registration becomes mandatory. The employee would need to contribute 1.75% of his/her pay towards the ESI, while 4.75% will be contributed by the company he is employed with.
To complete the ESI registration procedure, business entities need to follow these steps:
Step 1: Sign up on the official ESIC portal by providing the necessary details, such as company name, region, etc.
Step 2: Sign in to the portal by using the newly received login credentials.
Step 3: Select ‘New Employer Registration’, and choose the unit type before clicking on submit.
Step 4: Enter details regarding the unit, which include the unit’s address, the name of the establishment, and more.
Step 5: Choose whether the establishment is owned/ hired and enter the nature of operations, PAN card details, etc.
Step 6: Enter the license details (if applicable) and the date of commencement of the establishment.
Step 7: Enter details of all owners and choose the constitution of ownership before clicking on ‘Save’.
Step 8: Enter the names of all employees who earn less than Rs. 21,000 every month.
Step 9: After moving on to the next page, enter the appointment dates of the first 10 or 20 employees before clicking on the ‘Employee Declaration Form’.
Step 10: Choose Yes/No based on whether an insured individual is registered or not.
Step 11: Enter the required details, including address, date of birth, marital status, etc. and click on submit.
Step 12: After clicking on close, choose the Employees’ State Insurance branch office and applicable inspection division.
Step 13: Select the checkbox to affirm that all information provided is correct before clicking on submit.
Step 14: Pay via the payment gateway to complete the application procedure.
Note that applicants will receive a Challan Number for future reference.
One can claim two types of benefits under the ESI scheme
Below are the steps to check the ESI claim status online:
Step 1: Open the UMANG App
Step 2: Enter the IP number or the ESIC Insurance Number and click on ‘Get OTP’.
Step 3: Enter the OTP and click on ‘Submit’.
Step 4: Select ‘Claim Status’ under the services menu.
Step 5: If you have raised any claims, you will be able to view the status.
The ESI Card also known as Pehchan Card is an identification card to avail benefits of the ESI scheme at empanelled hospitals. The card includes the beneficiaries name, address, the insured person’s photograph and dependent details along with a unique ESI insurance number.
Employees can follow these steps to apply for an ESI card:
Step 1: Sign in to the ESI portal with your login credentials.
Step 2: Click on ‘e-Pehchan card’ after navigating to the Employee section.
Step 3: Click on ‘view’ after choosing the unit details.
Step 4: Enter the name and insurance number of the respective employees to view their details.
Step 5: Choose the ‘View Counter Foil’ option against any particular employee; note that this ‘Counter Foil’ is the ESI Pehchan card.
Step 6: One can download it as a PDF document after clicking on ‘Print’.
After taking a printout, employees need to sign and affix photographs of dependents. Additionally, they must make sure to get their photo attested by an ESI official or their employer.
An employee covered by ESI benefits can opt-out of ESIC after submitting documentary proof of having got himself covered under the medical insurance. Once the employee exercises this option, the employee shall be deemed to have exited from the ESIC deductions.
Here are certain things that employees need to keep in mind regarding the Employees State Insurance Corporation Scheme:
Redressal of Public Grievances & List of Toll-Free Numbers
Toll-Free/Help Desk Number: 1800-11-2526
Medical Helpline: 1800-11-3839
For Grievances/Suggestions: firstname.lastname@example.org
The Employees State Insurance Scheme comes with a wide range of benefits. Individuals must be fully aware of them to make the most of the benefits. Also, it is essential that they keep all the necessary documents handy to avoid any hassle during the application procedure.
Ans: Yes, for organizations that fulfil the eligibility criteria of ESIS, it is compulsory to register themselves with ESIC. Also, the registration process has to be completed within 15 days once the business entities receive approval for the same.
Ans: Business entities need to complete the payment of contributions in 21 days from the last day of the previous month.
Ans: If individuals fail to complete the payment of contributions within the specified time limit, they need to pay 12% interest p.a. for each day they have defaulted on their payment.
Ans: No, any payment of benefits under this act is not transferable.
Ans: The time limit is 21 days from the last date of the month.
Ans: Apart from the worker’s income records, employers must also maintain an inspection book, employee’s attendance register and accident register.
Ans: Below are the types of establishments that can avail of the ESI scheme:
Hotels or restaurants that are engaged in sales
Cinemas or theatres
Road transport establishment
Private educational institutions.
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