2. Employees' State Insurance Scheme of
India is an integrated social security
scheme tailored to provide social
protection to workers and their
dependents , in the organized sector, in
contingencies, such as, sickness,
maternity and death or disablement
due to an employment injury .
Came into force on 19th April 1948.
INTRODUCTION
3.
The objective of the act is to secure
sickness, maternity and medical
benefits to employees of factories
and establishments and
dependents benefits to the
dependents of such employees.
OBJECTIVE
4.
Act applies to factories using power not using
power and employing 20 or more persons
Gradually extended to the following:
Smaller power-using factories with 10-19
persons
Non-power factories with 20 or more persons
Shops
Hotels and restaurants
Cinemas including preview theaters
Newspaper establishments
APPLICABILITY
5. Road motor transport undertakings employing 20 or
more persons.
For Employed
The existing wage limit for coverage under the Act is
Rs. 15,000/- per month ( w.e.f. 01/05/2010).
Any employee earning 15000 or less per month has
to be covered under ESI act.
APPLICABILITY
(CONTD.)
6.
No. of Insured Person
family units
1.95 Crores
No. of Employees 1.74 Crores
Total No. of Beneficiaries 7.58 Crores
No. of Insured women 0.29 Crores
No. of Employers, etc 6.69 Lacs
Coverage
(as on 31st march 2014)
Source: : esic.nic.in
7. Covered employees contribute 1.75% of the wages,
Employees earning up to Rs.100/- a day are exempted from
payment of their share of contribution.
Employers contribute 4.75% of the wages, payable to their
employees.
The State Governments contribute 1/8th of the expenditure of medical
benefit within a per capita ceiling of Rs. 1200/- per Insured Person per
annum.
** These contributions are subject to change from time to time
CONTRIBUTIONS
8. For employer
within 21 days of the last day of the Calendar month in which the
contributions fall due,
An employer (both employer share and employee share) shall pay
these contributions at the above specified rates to the Corporation.
Contribution Period and Benefit Period
Contribution once started shall continue till end of the cycle even if the employee
has moved out of 15000 per month wage limit. Subsequently is the benefit period.
CONTRIBUTION PERIODS
10.
Represents periodical payments made
to an insured person for the period of
certified sickness after completing 9
months in insurable employment.
To qualify, contributions should be for
minimum 78 days in the relevant
period.
Maximum duration for benefit is 91
days.
SICKNESS AND EXTENDED
SICKNES BENEFITS
11.
Rates of payment vary from rs.14-125 per
day, i.e. Average of 50% of daily wages.
Insured persons suffering from tb,
leprosy, mental and malignant diseases or
other specified long term diseases are
entitled to extended benefits at higher
rates, provided he has been continually
employed for at least two years.
Contd.
12.
Implies cash payment to an insured
woman in case of confinement or
miscarriage or sickness arising out of
pregnancy or premature birth.
Woman should have contributed for
minimum 70 days in the preceding two
consecutive contribution periods.
Daily rate of benefits double the standard
sickness benefit rate, i.E. Full wages
MATERNITY BENEFIT
13.
Normally payable for max 12 weeks for
confinement and 6 weeks for
miscarriage or medical termination of
pregnancy.
Payable even in the event of the death
of the woman
Contd.
14. In case of temporary disability arising
out of employment injury, this benefit
is admissible for the entire period
certified by an insurance medical
officer/practitioner for which the
insured person does not work for
wages.
Rate payable not less than 70% of daily
wages; minimum 3 days of incapacity
required
DISABLEMENT BENEFIT
15.
In case injury results in permanent,
partial or total loss of earning capacity,
periodical payments to be made for life.
One-time lump sum is permissible in
certain cases.
Contd.
16.
Periodical pension paid to dependants of
deceased where death occurs out of
employment injury or disease.
Widows: 3/5th of benefit rate for life or
until remarriage
Children: 2/5th of benefit rate until 25
years.
Total amount distributed not to exceed
ceiling of disablement benefit.
Benefit not paid to married daughters.
DEPENDANT’S BENEFIT
17.
In case there is no widow or child,
benefit can be paid to other dependants
including parents.
Amount paid is reviewed and increases
granted from time to time to
compensate for erosion in real value
and cost of living.
Contd.
18.
Insured persons and their families
entitled to free, full and
comprehensive medical care.
Extended upto two years for chronic
and long-term diseases.
Treatment continues even if person
goes out of coverage, till sickness
ends.
MEDICAL BENEFIT
19.
Package covers all aspects of health care
from primary to super-specialist facilities,
such as:
1) Out-patient treatment
2) Domiciliary treatment
3) Specialist consultation and diagnostic
facilities
Contd.
20.
In-patient treatment :
Free supply of drugs and dressing
X-ray and laboratory investigations
Vaccination and preventive inoculations
Ante-natal, confinement, post-natal care
Ambulance service or conveyance charges
Free diet during admission in hospitals
Contd.
21.
Free supply of artificial limbs, aids and appliances
for physical rehabilitation
Family welfare services and other national health
programme services
Medical certification
Special provisions including super-speciality
treatment
Contd.
22.
Funeral expenses are in the nature of a
lump sum payment up to a maximum of
rs. 10000 made to defray the expenditure
of the funeral of deceased insured person.
The amount is paid either to the eldest
surviving member of the family or, in his
absence, to the person who actually incurs
the expenditure on the funeral.
FUNERAL BENEFIT
23.
ALL BENEFITS UNDER THE
ESI SCHEME ARE PAID IN
CASH EXCEPT MEDICAL
BENEFIT, WHICH IS GIVEN IN
KIND.
24.
An employer cannot dismiss or punish an
employee under treatment for sickness
of in receipt of any benefit or absent
from work due to illness. Any notice of
dismissal, discharge or reduction is
invalid.
PROTECTION
25.
However, the employer can discharge or
punish the employee if:
He has received temporary
disablement benefit and remained
absent for 6 months or more
Is under treatment for sickness other
than tb or arising out of pregnancy and
remained absent for 6 months or more
Contd.
26.
Right to receive benefit is not transferable.
Disputes under the provisions of the act to
be decided by the employees’ insurance
court (eic) and not by a civil court.
Appeals to the high court only by an order
of the eic on a question of law.
Period of limitation for appeal is 60 days.
MISCELLANEOUS
