Employees’ State Insurance Scheme of India, is a comprehensive Social Security Scheme tailored to accomplish the task of socially safeguarding the ’employees’ in the organized sector against the events of sickness, disablement and death due to employment injury, maternity, and to provide medical care to the insured employees and their families. The employees registered under the scheme can leverage the benefits of complete medical care while he/she is not in the capacity to restore his/her health and working capacity.
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The major cause of distress for an employee during the period of his abstention from work is the loss of his/her wages. Hence, in order to assist an employee financially during this period and to provide him/her a financial backing the ESI Act 1948 was promulgated. The family members of the employee are also provided with medical care under this scheme. ESI Registration Benefits
The ESI registration is mandatory for the following establishments that employs 10 or more persons
- Shops, Hotels or restaurants not having any manufacturing activity, but only engaged in ‘sales’.
- Cinemas including preview theatres;
- Road Motor Transport Establishments;
- Newspaper establishments.(that is not covered as factory under Sec. 2(12); (vi) Private Educational Institutions (those run by individuals, trustees, societies or other organizations and Medical Institutions (including Corporate, Joint Sector, trust, charitable, and private ownership hospitals, nursing homes, diagnostic centers, pathological labs).
Note : However, in some states the establishments with 20 or more employees are covered under this scheme. Also, there are certain states where the government has not extended scheme to Medical & Educational Institutions.
(A) Medical Benefit
Let us look at the six social security benefits provided under ESI registration scheme in India:
From the day an employee enters insurable employment, he/she and his/her family members are liable to get full medical care under this scheme. There is no upper limit set on expenditure on the treatment of an Insured Person or his/her family member. Retired and permanently disabled insured persons and their spouses are also provided with medical care under this scheme on payment of a token annual premium of Rs. 120/-.
(B) Sickness Benefit (SB)
As the name suggests, Sickness Benefit is provided during the periods of certified sickness in the form of cash compensation at the rate of 70 % of the wages which is payable to insured workers for a maximum of 91 days in a year. The insured worker is required to contribute for 78 days in a contribution period of 6 months in order to qualify for sickness benefit.
- Extended Sickness Benefit (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.
- Enhanced Sickness Benefit : 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 3 months. It can be further extended for 1 month on medical advice at the rate of full wage subject to contribution for 70 days in the preceding year.
(E) Dependents' Benefit (DB)
- Temporary disablement benefit (TDB) : In case of employment injury, whether the contribution has been made or not Temporary Disablement Benefit is payable at the rate of 90% of wage from day one of entering insurable employment as long as the disability continues.
- Permanent disablement benefit (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.
(D) Disablement Benefit
The dependants of a deceased Insured person where death occurred due to employment injury or occupational hazards receives DB paid at the rate of 90% of wage in the form of monthly payment to the dependants of the deceased.
(F) Other Benefits
Funeral Expenses : From day one of entering insurable employment an amount of Rs.10,000/- is payable to the dependents or to the person who performs last rites. Confinement Expenses : In case confinement of an Insured Woman or an I.P. in respect of his wife occurs at a place where necessary medical facilities under ESI Scheme are not available.
In addition, some other need based benefits are also provided to insured workers for example, vocational rehabilitation, physical rehabilitation, old age medical care and Rajiv Gandhi Shramik Kalyan Yojana, the scheme of Unemployment allowance