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.
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 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.
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:
**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:
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:
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:
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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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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