Presentation of Shri Alok Gupta Dy. Director ESIC

2. AN INSIGHT INTO ESI SCHEME
• Promulgation of Employees’ State Insurance Act, 1948 (ESI
Act), by the Parliament was the first major legislation on
Social Security for workers in independent India.
• ESI Scheme is a protective measure against deprivation and
destitution in the event of loss of wages or loss of earning
capacity due to
- Death
- Disease
- Disability
- Old age and unemployment

3. The ESI Scheme is based on the principle of ‘pooling of risks
and resources’ in which every contributor, at any given
point of time, emerges as a beneficiary or a benefactor and
society, at large, is the net gainer. The role of employers, in
particular, remains pivotal to the success of the scheme, be
it registration of the factories/establishments, registration
of employees, regular payment of contribution, facilitating
inspections and timely action to ensure steady flow of
benefits to the employees.
AN INSIGHT INTO ESI SCHEME

4. • ESI Scheme was first started on 11th July 1954 in
Nagpur & In Mumbai on 3rd Oct. 1954
• ESI Scheme has been fully implemented in 22
districts and partially implemented in 09 districts in
Maharashtra
ESIC IN
MAHARASHTRA

5. Extent in Maharashtra
 Regional office Mumbai (Lower Parel)
 Six Sub-Regional Offices at -
 Pune
 Marol
 Thane
 Nagpur
 Aurangabad
 Nasik
 Number of Branch Offices - 72

6. MEDICAL INFRASTRUCTURE IN MAHARASHTRA
As on 30-09-2019
1.Total No. of ESI hospitals 15
(i)Hospitals run by ESI Corporation 3
(ii)Hospitals run by State Government 12
2.Total number of Dispensaries
(i) ESIC dispensaries
(ii) ESIS Dispensaries
55
03 (DCBOs)
52
3.Total number of ISM unit 10
4.Total number of hospital beds ( Including annexes/
reserved beds)
2,665
5.Total number of Doctors 604
6.Total number of IMP clinics 501
7.Total number of IMP/CHC/PHC 938
8.No. of tie-up (private) hospitals 264

7. The scheme provides the following Benefits:
1. Medical Benefit
2. Sickness Benefit
3. Disablement Benefit
4. Dependants Benefit
5. Maternity Benefit
6. Funeral Expenses
7. Rehabilitation Allowance
8. Vocational Rehabilitation
9. Medicare in old age and disabled
10. Medical Bonus for I.W. and wives of I.P.
11. Unemployment Allowance.
BENEFITS AVAILABLE UNDER ESI SCHEME

8. Super Specialty…..
 Tie-up arrangements: in Maharashtra with reputed Hospitals
made for cashless / hassle-free treatment to I.Ps and their
dependent family members.
 Entitlement conditions for availing Super Specialty Treatment :
For IP minimum 6 months insurable Employment with 78 days
payment of contribution.
For the dependent of IP, IP should be in 12 months insurable
Employment with 156 days payment of contribution

9. Comparison between Commercial
Insurance Scheme and ESI Scheme
Commercial Insurance Scheme ESI Scheme
Covers only one person viz. the
insured
Covers the insured person along
with his family unit
Provides only one service
stipulated in the policy
Provides five services – Medical
Benefit, Sickness Benefit,
Disablement Benefit, Maternity
Benefit and Dependents’ Benefit
with single contribution
Covers only identified diseases Covers all types of diseases.
The saving go into the profit of
the company
The savings are kept in the corpus
for being ploughed back into the
Scheme.

10. 10
NEW INITIATIVES
• Enhancing the income limit of dependent parents from 5000/- to
9000/- uner Rule 61 (A) of ESI Act.
• 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.

11. • The Government of India has taken a historic decision to
reduce the rate of contribution under the ESI Act from
6.5% to 4%(employers’ contribution being reduced from
4.75% to 3.25% and employees’ contribution being
reduced from 1.75% to 0.75%). Reduced rates will
be effective from 01.07.2019. This would benefit 3.6 crore
employees and 12.85 lakh employers.
• Grant of increase in monthly pension of PDB & DB to
compensate the erosion in the real value due to inflation
w.e.f. 01/08/2017
• Extension of Coverage Wage Limit from Rs.15000/- pm
to 21000/- pm w.e.f. 1-1-2017.
NEW INITIATIVES
14

12. 12
NEW INITIATIVES
Central Analysis and Intelligence Unit (CAIU)
• Setting up of Central Analysis and Intelligence Unit (CAIU)
and notification of scheme of inspection linked with the
Unified Web Portal (UWP).
• CAIU has been formulated with an aim to achieve the
objective of simplifying business regulations, with system
driven triggers equipped with relevant norms and criteria for
ensuring more accountability, transparency and for
minimising frequent inspection of the same unit.

13. 13
NEW INITIATIVES
• The confinement expense payable to insured women and
wives of insured persons was enhanced by 100% from Rs.
2500/- to Rs. 5000/- per confinement.
• Enhancement of exemption limit from payment of
employees’ contribution for employees’ drawing wages up
to Rs. 137/- per day form existing Rs. 100/- per day.

14. 14
NEW INITIATIVES
ESIC Launches e-Pehchan Card and Health Passbook
• Aadhar Number of Self and family can be linked online to
the IP no by the employer or by the staff of branch office
or by directly IP through IP portal link available on
website www.esic.in.
• Issuance of Health Passbook to Beneficiaries to maintain
Health Records.

15. 15
Medical Benefits by ESIC during COVID-19 Pandemic
ESI Hospitals are working as COVID centres for treatment/
isolation of COVID-19 positive patients.
Sr No. Location Bed Capacity Category (Dedicated/
Quarantine ward)
1 ESIS Hospital, Kandivali 130 Dedicated
2 ESIS Hospital, Solapur 40 Dedicated
3 ESIS Hospital, Nasik Order issued on 18/06/2020 to
make provision of 50 bedded
COVID-19 wards
Quarantine ward
4 ESIS Hospital, Chinchwad 100 Dedicated
5 ESIS Hospital,
Aurangabad
40 Quarantine ward
6 ESIS Hospital, Ulhasnagar 100 Dedicated
7 ESIS Hospital, Kolhapur 50 Quarantine ward
8 MGM Hospital, Parel 300 Quarantine ward
Order issued on 09/05/2020 to
make provision for dedicated
COVID-19 Hospital
Dedicated

16. 16
Medical Benefits by ESIC during COVID-19 Pandemic
 Primary, Secondary and Tertiary care are provided in ESIC
Empanelled Hospitals. The list of Hospitals can be found on
https://www.esic.nic.in/rosro_tie_up_hospitals.
 Cashless COVID-19 tests are provided which can be done after
being referred by authority from ESI Hospitals.
 During emergency, the test may be conducted at the ICMR
approved labs at own cost and reimbursement can be claimed from
ESIC.
 Dialysis centres have been empanelled exclusively for dialysis
services during the time of COVID-19 Pandemic.
 Due to imposition of Lockdown if medicines for chronic diseases
prescribed earlier by the ESIC Hospital/ESIC Tie-up Hospitals
earlier are bought out of one’s own pocket, the same will be
reimbursed by ESIC.
 In view of Lockdown, Migrant Workers across the Country, with
valid ESI Medical benefit entitlement , may seek medical care
services from ESI Hospital nearest to their home town , in case of
emergency.

17. Benefits to Employers
Employers are exempted from the applicability of the:
 Maternity Benefit Act, 1961 &
 Workmens’ Compensation Act, 1923.


18. Benefits to Employers
 Online registration facility for all the employers.
 Online filing of employee details, employers are able to file
details online and check the status online.
 Online contribution payment activated, employers are
relieved from physical payment at the banks through
challans and then submission of challan details physically.
 Online filing of returns, processing done automatically,
status or queries can be tracked and submitted online.
 Faster and timely delivery of service through automation
across all ESIC departments.

19. 19
SUVIDHA SAMAGAM
• Suvidha Samagam is being held regularly in RO/SRO on 2nd
Wednesday of every month and at Branch Offices on 2nd
Friday of every month for redressal of grievances/
complaints.

20. Benefits to IPs
 One Card accepted in all ESI hospitals and
dispensaries across India.
 Card and the insurance no. remains valid even after
change of employer, no need to apply for new card.
 Hence, employers are requested not to issue new
Insurance Numbers to those who are already
registered.
 IPs can view their details, contributions and
entitlements online using IP Portal.

21. Better Medical Care
Using Technology
 Empowering the IP : All the details of medical history as
well as treatment received are available online on the click
of a button
 For emergency/Super Specialty Treatment, entitlement can
be checked online. Entitlement period for superspecility
treatment will be counted from the date of registration in
place of date of appointment.
 Re-imbursement of all the medical bills done online and
payment transferred directly to IP through ECS.
 Lists of Super Specialty Hospitals all over the country are
available on ESIC website.

22. e-Kranti – Online Services of ESIC
 Stakeholders may lodge their grievances online and
get redressal through internet facility anytime and
anywhere in ESIC.
 Stakeholders can also lodge complaint on PG Portal
http://pgportal.gov.in

23. 23
LETS MARCH TOGETHER
TO HAVE A
SATISFIED MAN POWER BY PROVIDING:
Efficient
Services to
Insured Persons

24. Thank You
Alok Gupta, Deputy Director
Employees’ State Insurance Corporation
Regional Office
E-mail: alok.gupta@esic.nic.in, Phone: 9826843644
Website – www.esic.nic.in