....

V.V.S.P. Ramchandra Rao

,
Regional Director, Madhya Pradesh Region

Employees State Insurance Corporation
(Ministry of Labour & Employment , Government of India)






A PRESENTATION ON

SALIENT PROVISIONS OF E.S.I. BENEFITS AND
COMPLIANCE
BENEFITS UNDER ESI SCHEME
(PANCHDEEP)
2
MEDICAL
BENEFIT
SICKNESS
BENEFIT
MATERNITY
BENEFIT
DEPENDANTS
BENEFIT
DISABLEMENT
BENEFIT
MISC. BENEFITS



FUNERAL EXPENCES

CONFINEMENT EXPENCES

MEDICAL BENEFIT TO RETIRED / INVALIDED
OUT INSURED PERSONS

UNEMPLOYMENT ALLOWANCES (RGSKY)

REHABILITATION ALLOWANCES
MEDICAL BENEFIT
COVERAGE IMMEDIATELY ON BECOMING AN EMPLOYEE
UNDER THE ESI ACT. FAMILY IS ALSO COVERED FROM THE
SAME DATE.

NO CONTRIBUTORY CONDITIONS FOR PRIMARY AND
SECONDARY CARE, EITHER FOR SELF OR FOR THE FAMILY.

MINIMUM SERVICE OF 3 MONTHS AND CONTRIBUTION FOR
39 DAYS ARE NEEDED FOR SUPERSPECIALTY CARE FOR
SELF. IN CASE OF EMPLOYMENT INJURY, NO SERVICE/
CONTRIBUTORY CONDITION.

FOR GETTING SUPERSPECIALTY TREATMENT FOR THE
FAMILY, A MINIMUM SERVICE OF 6 MONTHS AND
CONTRIBUTION FOR 78 DAYS ARE NEEDED.

NO LIMIT OF EXPENDITURE ON TREATMENT.


SICKNESS BENEFIT
CASH BENEFIT PAID TO THE INSURED PERSON (I.P.)
DURING HIS TREATMENT AND ABSTENTION DULY
CERTIFIED BY MEDICAL AUTHORITY.

THE I.P. BECOMES ENTITLED AFTER 9 MONTHS OF HIS
SERVICE.

MINIMUM CONTRIBUTION OF 78 DAYS NEEDED DURING A
CONTRIBTION PERIOD WHICH IS OF 6 MONTHS.

PAYABLE FOR 91 DAYS IN A PERIOD OF ONE YEAR (TWO
CONSECUTIVE BENEFIT PERIODS OF 6 MONTHS EACH)

RATE OF BENEFIT IS 70 % OF HIS AVERAGE DAILY WAGES.
EXTENDED SICKNESS BENEFIT
FOR DISEASES NEEDING PROLONGED TREATMENT e.g.
T.B., CANCER ETC.
CASH BENEFIT PAYABLE FOR UPTO 730 DAYS IN A
PERIOD OF 3 YEARS.
RATE OF BENEFIT IS 80% OF HIS AVERAGE DAILY
WAGES.
HOWEVER, A MIN. OF 2 YEARS (4 C.P.) SERVICE AND 156
DAYS CONTRIBUTION IS NEEDED TO BECOME ENTITLED.
HE SHOULD ALSO BE ENTITLED FOR SICKNESS BENEFIT
IN AT LEAST ONE OF THE SAID 4 C.P.s
CONDITIONS CAN BE RELAXED IN EXCEPTIONAL CASES.
ENHANCED SICKNESS BENEFIT
PAID FOR OBSERVING SMALL FAMILY NORMS.

FOR AN I.P. UNDERGOING VASECTOMY 7 DAYS.

FOR IN I.W. UNDERGOING TUBECTOMY 14 DAYS.

CAN BE EXTENDED BY ANOTHER 7 DAYS IN CASE OF
COMPLICATION IN BOTH THE ABOVE CASES.

PAID @ 100% OF HIS / HER AVERAGE DAILY WAGES.

ABOVE ENTITLEMENT OVER & ABOVE THE 91 DAYS OF
ENTITLEMENT OF SICKNESS BENEFIT.

ELLIGIBILITY CRITERIA SAME AS SICKNESS BENEFIT.
DISABLEMENT BENEFIT
CASH BENEFIT PAID TO AN EMPLOYEE WHO SUSTAINS AN
EMPLOYMENT INJURY INCLUDING AN OCCUPATIONAL DISEASE.

COVERED AS SOON AS HE BECOMES AN EMPLOYEE UNDER THE
ACT. NO CONTRIBUTORY CONDITION.

DURING HIS TREATMENT OF THE INJURY AND ABSTENTION
(SHOULD BE MIN. 3 DAYS), HE GETS TEMPORARY DISABLEMENT
BENEFIT @ 90% OF HIS AVERAGE DAILY WAGES.

IN CASE THE INJURY RESULTS INTO PERMANENT DISABILITY, HE
GETS PERMANENT DISABLEMENT BENEFIT WHICH WILL DEPEND
UPON % LOSS OF HIS EARNING CAPACITY.

THE PAYMENT IS LIFE LONG.

THE RATE IS: %LOSS OF HIS EARNING CAPACITY x 90% OF HIS
AVERAGE DAILY WAGES.
DEPENDANTS BENEFIT
CASH BENEFIT PAID TO THE DEPANDANTS OF AN I.P. WHO DIES AS
RESULT OF AN EMPLOYMENT INJURY.
COVERED AS SOON AS HE BECOMES AND EMPLOYEE. NO
CONTRIBUTORY CONDITION.
PAID TO THE WIDOW TILL HER LIFE OR RE-MARRIAGE.
TO THE SONS TILL THE AGE OF 25 YEARS.
TO UNMARRIED DAUGHTERS WITHOUT AGE LIMIT.
TO INFIRM SONS TILL THE INFIRMITY LASTS.
TO THE WIDOWED MOTHER.
THE MAXIMUM PAYMENT IS 90% OF HIS AVERAGE DAILY WAGES
WHICH IS DISTRIBUTED AMONG ALL THE ELIGIBLE DEPENDANTS AT
SPECIFIED AMOUNT OF SHARE.
IN CASE THE I.P. DID NOT HAVE ANY OF THE ABOVE DEPENDANTS,
THEN TO HIS OTHER DEPANDANTS LIKE HIS PARENTS, BROTHERS,
SISTERS ETC.
MATERNITY BENEFIT
PAID TO AN INSURED WOMAN (I.W.) FOR HER CONFINEMENT
PROVIDED IT OCCURS OR EXPECTED TO OCCUR AFTER 9
MONTHS OF HER BECOMING AN EMPLOYEE.

SHE SHOULD HAVE CONTRIBUTED FOR AT LEAST 70 DAYS
DURING 2 CONSECUTIVE C.P. PRIOR TO HER CONFINEMENT.

PAID HER FULL WAGES FOR 84 DAYS PROVIDED SHE DOES NOT
JOIN WORK DURING THIS PERIOD.

FOR MISCARRIAGE, THE BENEFIT PAYABLE IS FOR 42 DAYS.

IN CASE OF SICKNESS RELATED TO PREGNENCY, CHILD-BIRTH
OR MISCARRIAGE, THE BENEFIT IS EXTENDABLE BY ONE MORE
MONTH.





MISC. BENEFITS



FUNERAL EXPENCES UPTO Rs. 10000/= REIMBURSED
TOWARDS THE EXPENSES IN PERFORMING THE LAST RITE OF
THE DECEASED I.P.

CONFINEMENT EXPENCES- Rs. 2500/= PAID TO THE I.W. AND
WIFE OF AN I.P. WHO CONFINE AT A PALCE WHERE ESIC
MEDICAL FACILITIES NOT AVAILABLE. PAID FOR ONLY 2
CONFINEMENTS.

MEDICAL BENEFIT TO RETIRED / INVALIDED OUT
INSURED PERSONS AND THEIR SPOUSE ON PAYMENT OF RS.
120/= P.A.

UNEMPLOYMENT ALLOWANCES (RGSKY)

REHABILITATION ALLOWANCES
RAJIV GANDHI SHRAMIK
KALYAN YOJANA

(UNEMPLOYMENT ALLOWANCE)


W.E.F. FROM 01 APRIL 2005
KINDS OF UNEMPLOYMENT COVERED
RETRENCHMENT AS DEFINED IN ID ACT, 1947

CLOSURE OF FACTORY/ESTT AS DEFINED IN ID
ACT, 1947

PERMANENT INVALIDITY NOT LESS THAN 40%
ARISING OUT OF NON-EMPLOYMENT INJURY. THE
INVALIDITY SHOULD BE CERTIFIED BY A MEDICAL
BOARD BY CENTRAL OR STATE GOVT.
ELIGIBILITY CONDITIONS
The Applicant should have been an I.P. on the date of loss of
employment.
Contribution i/r/o him/her should have been paid/payable for a
minimum period of 3 years prior to loss of employment. Contribution
paid/payable for 156 days or more in two consecutive contribution
period will deem as having worked for full year.
The period of service of an I.P. need not be continuous with one
employer
The I.P. need not satisfy any qualifying conditions afresh for claiming
unemployment allowance for any subsequent period but he/she
should be an I.P. on the date of subsequent unemployment. The rate
will remain same.
As per Sec 65 of the ESI Act, an I.P. shall not be entitled to any other
cash benefit simultaneously for the same period. He/she may opt for
either of the two. The term cash benefit excludes periodical payment
of P.D.B.
As per Sec 61 of ESI Act, an I.P. in receipt of UA shall not be entitled
to receive similar benefit under any Act.
There will be one month waiting period after retrenchment.
DISQUALIFICATION / TERMINATION OF
UNEMPLOYMENT ALLOWANCE
During Lock out.
Lay off/temporary closure of factory/estt.
Strike resorted to by the employees.
Voluntary abandonment of employment/ voluntary
retirement/premature retirement.
Less than 3 years contributory service.
On superannuation/attaining the age of 60 years, whichever is
earlier.
Convicted (i.e. punished for false statement) under the
provisions of Sec 84 of the ESI Act.
On being re-employed elsewhere during the period of receipt
of UA.
Dismissal / termination under disciplinary action.
On death of I.P.


RATE OF UNEMPLOYMENT
ALLOWANCE
At the Standard Benefit Rate as specified in the
Rule 54 of ESI (Central) Rule 1950.

The average daily wage will be worked out on the
basis of average daily wage during the last four
completed contribution period.
DURATION OF ALLOWANCE
A maximum of 12 months during his entire life.

In case the beneficiary gets gainful employment during the
above period, he can avail the balance allowance in case the
contingencies so arises provide he/she is an I.P. on the date of
subsequent unemployment.

The UA shall not be admissible for a period of less than one
month at a time.
MEDICAL CARE
I.P. and his/her family shall also be entitled to medical
care through ESI Dispensaries/ESI Hospitals/IMPs clinic
for the period the IP /IW is entitled for Unemployment
Allowance.


In the event of death of I.P. the family will continue to get
the care for the above period.


VOCATIONAL REHABILITATION SKILL
DEVELOPMENT SCHEME UNDER RGSKY
Training in AVTI under DGET, Min of L&E.

Maximum Period 6 months. Only once in life.

It should start during the period IP/IW is entitled for UA;
but once started it will continue provided he/she is not in
gainful employment.

Fee of the course will be paid directly to the Institute.
IP/IW will be reimbursed bus/train fare to and fro the
AVTI.


SUBMISSION OF CLAIM
Claim should be submitted not later than 9 months from date of
unemployment..

To Branch Office on Form UA -1.

Documentary evidence on Form UA-2 proving
retrenchment/unemployment/ invalidity.

Certificate to be signed by Inspector of factories, Asst./Dy
Labour Commissioner, Employees, Compensation
Commissioner etc.
From Employer on Form UA-2 alongwith R.C. under Regulation
26(b) on permanent closure of Fy./Est.

Certificate of Invalidity by a Medical Board.
SPECIAL PROVISION FOR COVERAGE
OF DISABLED EMPLYESS

THE WAGE CEILING FOR COVERAGE OF DISABLED
EMPLOYEES IS UPTO Rs. 25000/= P.M. AS AGAINST Rs.
15000/= FOR OTHER EMPLOYEES.

THE EMPLOYER IS EXEMPTED FROM CONTRIBUTING
EMPLOYERS SHARE OF CONTRIBUTION OF 4.75% OF THE
WAGES OF THE DISABLED EMPLOYEE FOR A PERIOD OF 3
YEARS.

THE EMPLOYERS CONTRIBUTION IS PAID BY CENTRAL
GOVT. FOR 3 YEARS.
HOW TO PROVIDED THESE BENEFITS
TO THE I.P.s
PROMPT REGISTRATION OF FACTORY / ESTABLISHMENT AS SOON
AS IT BECOMES COVERABLE UNDER THE ESI ACT ( GETTING CODE NO
OF THE FY/EST.) BY FILLING AND SUBMITTING FORM 01 ONLINE.

IMMEDIATE REGISTRATION OF ALL THE COVERABLE EMPLOYEES FOR
BENEFIT ( GETTING THE INS. NO. ) BY FILLING AND SUBMITTING THEIR
DECLARATION FORM ONLINE.

REGISTRATION OF EMPLOYEE JOINING THE FY./EST. FOR THE FIRST
TIME, BEFORE TAKING THEM INTO EMPLOYMENT.

THE I.P.s, AFTER REGISTRATION, MUST GET THE BIOMETRIC CARD OF
THEMSELVES AS WELL AS THEIR FAMILY MEMBERS.

THE I.P.s MUST REGISTRER THEMSELVES WITH ANY OF THE
DISPENSARIES / I.M.Ps AS PER THEIR CONVENIENCE.

PROMPT PAYMENT OF CONTRIBUTION AND TIMELY SUBMISSION OF
RETURN.
COMPLIANCE I/R/O CONTRACT/CASUAL
EMPLOYEES

NO DIFFERENCE BETWEEN REGULAR/
TEMPORARY/CONTRACT OR CASUAL
EMPLOYEES.

PRINCIPAL EMPLOYER, IN THE FIRST
INSTANCE, IS LIABLE FOR COMPLYING ALL THE
PROVISIONS OF THE ESI ACT IN RESPECT OF
ALL THE AMPLOYEES WHETHER EMPLOYED
DIRECTLY BY HIM OR THROUGH AN IMMEDIATE
EMPLOYER.



SECTION 40 : PRINCIPAL EMPLOYER TO PAY
CONTRIBUTION IN THE FIRST INSTANCE
THE PRINCIPAL EMPLOYER SHALL PAY IN RESPECT
OF EVERY EMPLOYEE, WHETHER DIRECTLY
EMPLOYED BY HIM, OR BY, OR THROUGH AN
EMMEDIATE EMPLOYER, BOTH THE EMPLOYERS
CONTRIBUTION AND THE EMPLOYEES CONTRIBUTION

BENEFIT TO THE EMPLOYERS
JUST BY PAYING A SMALL CONTRIBUTION, THE EMPLOYER IS
ABSOLVED OF HIS LIABILITIES UNDER:-

(a) EMPLOYEES COMPENSATION ACT, 1923.
(b) MATERNITY BENEFIT ACT, 1963.

HE GETS A HEALTHY AND MOTIVATED WORK FORCE WHICH IS
COMMITTED AND LOYAL TO HIM.

LABOUR TURNOVER DECREASES.

PRODUCTIVITY OF THE LABOUR INCREASES.

THUS, ESIC CONTRIBUTION IS NOT AN EXPENDITURE BUT IN
INVESTMENT.
26
NEW INITIATIVES
Minimum Dependant Benefit raised to Rs. 1200/- pm/per
family unit w.e.f. 01.03.2012.

Payment of Conveyance Allowance to Insured Person @ Rs.
100/- per visit for submission of Life Certificate in PDB cases.

Once in a year life certificate and no need for submitting
claim for PDB/DB beneficiaries has been introduced.

Cash Benefits especially the long term Benefits i.e.
Permanent Disablement and Dependants Benefits are being
directly credited to the bank account of the beneficiaries
through ECS system.

Continuing medical benefit to insured persons retiring under
VRS scheme or taking premature retirement.

27
NEW INITIATIVES
Scheme for Permanently Disabled Insured Persons:-
Permanently disabled persons working in factories and
establishments covered under the ESI Act and drawing
wages upto Rs. 25,000/- per month have been brought under
the scheme w.e.f.1-4-2008. In order to encourage
employment of disabled persons, the employers share of
contribution in respect of such disabled employees will be
paid by the Central Government for initial three years.

Daily rate of Sickness Benefit has been enhanced from
about 50% to 60% of average daily wage. The daily rate of
PDB and DB was enhanced from about 70% of wages to
about 75% of wages. These daily rates are enhanced from
time to time to protect the value of these benefits against rise
in the cost of living index.

28
NEW INITIATIVES
The confinement expense payable to insured women and
wives of insured persons was enhanced by 150% from Rs.
1000/- to Rs. 2500/- per confinement.

Low paid workers in receipt of daily wages up to Rs. 100/-
have been exempted from payment of their share of
contribution.

Enhancing age limit of dependent children for eligibility to
dependants benefit from 18 years to 25 years.

Extending medical benefit to dependant minor brother/sister
in case of IPs not having own family and whose parents are
also not alive.
29
NEW INITIATIVES
PROVISION OF SUPERSPECIALTY SERVICES:- Patients
can avail super specialty treatment from the networked / tie
up hospital of ESIC (14 in the state of MP and more than 700
all over the country). The total expenditure on such tie-ups is
borne by the ESIC. Major treatments such as kidney and
liver transplant, heart treatment, cochlear implant and joint
replacements have been included under the ESI Scheme.

Making an enabling provision for extending medical care to
other beneficiaries against payment of user charges to
facilitate providing of medical care from under-utilized ESI
Hospitals to the BPL families covered under the Rashtriya
Swasthaya Bima Yojana and other schemes framed by
Central Government.

30
LETS MARCH TOGETHER
TO HAVE A

SATISFIED MAN POWER BY PROVIDING:
Efficient
Services to
Insured Persons


Thank You
V.V.S.P. Ramchandra Rao, Regional Director
Employees State Insurance Corporation
Madhya Pradesh Region
E-mail: rd-mp@esic.nic.in, Phone: 0731-2550485
Website www.esicmp.in, www.esic.nic.in