Employees' State Insurance Corporation

2
What is ESIC…???
An Act to provide for certain benefits to
employees in case of sickness, maternity and
employment injury and to make provision
for related matters.
mishrcha

mishrcha
3
Eligibility & Contributions
 Monthly Gross Wages less than or equal to 21000K.
 Employees Share:- 1.75% on total monthly gross wages.
 Employer Share:- 4.75% on total monthly gross wages.

4
Contribution Period & Corresponding Benefit period
 There are two contribution periods each of six months duration and two
corresponding benefit periods also of six months duration as under.
 In the case of a newly joined person, the first contribution period shall
commence from the date of employment, and the corresponding first benefit
period shall commence on the expiry of 9 months from the said date.
mishrcha
Contribution Period Corresponding Benefit period
1st April to 30th Sept. 1st Jan of the following year to 30th
June
1st Oct to 31st March of the year
following.
1st July to 31st December.

5
Accessing ESI services
 If you already registered with ESI, then at the time of joining, please inform your
existing registered Insurance No. to your new employer.
 You can continue to use your any existing ESI card / Insurance no. for availing
ESI benefits even on change of employment/ employer.
 Provide your Mobile No./ Telephone No./ E-Mail address/ Family details etc.,
particulars to your employer for updating it in portal.
 Certain benefits are based on your length of contribution. Hence, in case of
change of employment, registering yourself with existing ESIC Insurance No.
will entitle you to such enhancement/contribution related benefits.
 The insurance number is unique for each employee and is valid throughout the
life of the employee, irrespective of his changing jobs.
For Attentions of employees
(insured persons)
mishrcha

6
Always carry your Smart Pehachan Card and/or
computer generated OPD slip while visiting ESI
Dispensary/ Hospital for availing benefits.
 Your previous history can be easily seen to
improve treatment under ESI.
For Attentions of employees
(insured persons)
mishrcha
Accessing ESI services

7
Procedures for ESI Registration
 Employees registration under the ESI Scheme: At
the time of joining the insurable employment,
employee is required to provide his/her and family
details along with a family photo.
 Also employer will require his/her Aadhar details
along with family members Aadhar details so that
they can register the employee online.
 It is an one time exercise of registration for entire insurable employment
of an employee.
 The insurance number generated Online on the first occasion of
registration is to be used throughout his life time irrespective of change of
employment including change of place.
mishrcha

8
Procedures for TIC, PIC & Availing Benefits
 Temporary Identity Certificate (TIC): After Online registration of an employee under
the scheme, the employer can take a print out of the Temporary Identity Certificate
(TIC).
 On linking of Aadhar with IP insurance number, TIC will be automatically converted
into a Permanent Identity Card (PIC).
 With PIC the IP and his family members can avail benefits under the ESI Scheme.
 If Aadhar number of IP/family is not available, then employer will ensure to affix the
IP’s photo along with the family members on TIC duly authenticated with his stamp &
signature. This TIC will be valid for a period of one month only.
 As soon as possible but not later than a month, the insured person along with his
entire family should link their Aadhar number using the web site www.esic.in for
availing medical benefit at dispensary/ hospital and availing cash benefits at the ESI
branch Office.
 Any changes in his residence/ dispensary/ employment can be carried out by the
employer in the ESIC Portal as and when arises.
mishrcha

9
Benefits to IPs under ESIC scheme
ESIC Scheme provides the following major social security benefits to the
insured person.
Sickness
Benefit
Medical
Benefit
Maternit
y Benefit
Disablement
Benefit
Dependent’s
Benefit
ESIC Scheme
Enhanced Sickness
Benefit
Extended Sickness
Benefit
General Sickness
Benefit
Permanent Disablement
Benefit (PDB)
Temporary Disablement
Benefit (TDB)
mishrcha
Funeral
Benefit

10mishrcha
Sr.
No.
ESI Benefits Conditions Period of Benefit Payable
Wages
1) Sickness Benefits
a) General Sickness
Benefits
a). Payment for at least
78 days in the relevant
contribution period.
b). Insured Person is
not entitled to the
benefits for the first two
days of sickness
a). 91 days in any two
consecutive periods.
b). Sickness benefits shall not be
paid to any person for more than
91 days in any two consecutive
benefit periods.
70% of the
average daily
wages in
cash.
b) Extended Sickness
Benefits
a). 2 years continuous
employment.
b). 156 days
contribution in four
consecutive contribution
periods.
2 Years 80% of daily
average
wages
c) Enhanced
Sickness Benefits
Same as for General
Sickness Benefit.
a).7 days for vasectomy.
b). 14 days for tubectomy.
c). extendable in cases in post
operative complication etc.
100% of daily
average
wages

11mishrcha
Sr.
No.
ESI Benefits Conditions Period of Benefit Payable Wages
2) Disablement Benefits
(Employment Injury)
a) Temporary
Disablement Benefit
(TDB)
He/ She should be
an employee on
the date of
employment
injury.
Till the
incapacity lasts.
90% of the daily
average wages
b)
Permanent
Disablement Benefit
(PDB)
- For life time.
Depends upon the
loss of earning
capacity of
workers.

12mishrcha
Sr.
No.
ESI Benefits Conditions Period of Benefit Payable Wages
3)
Dependent's
Benefit (Rule
58)
Deceased
should be an
employee on
the date of
fatal
accident.
a) To widow for life or until
remarriage.
b) To widowed mother during life.
c) To Unmarried daughter/ son till
the age of 25 years.
d) To other dependents for life or
till marriage or upto the age of 18
years, as the case may be
90% of the
daily average
wages to be
divided
amongst the
dependent's.

13mishrcha
Sr.
No.
ESI
Benefits
Conditions Period of Benefit Payable Wages
4) Maternity
Benefit
Payment of
contribution for 70
days in immediately
preceding one or two
consecutive
contribution periods.
a) Payable for 26 weeks, also is
extendable by further one month on
medical advice.
b) Payable for 6 Weeks in case of
miscarriage or MTP.
c) Payable for one month in case of
Sickness arising out of pregnancy.
100% of daily average
wages.
5) Medical
Benefit
IP and his family is
eligible from the date
of entry into
insurable
employment.
Till the disability/disease lasts.
Full medical care (all
facilities including
hospitalization) for I.P. and
members of their family.
6) Funeral
Expenses
He/ She should be an
insured person on the
date of death.
-
Actual expenditure on
funeral not exceeding Rs.
10,000/-

14
Frequently Asked Questions
Q.1). What is the criteria to avail the benefits?
Answer: ESI provides reasonable Medical Care for self and family from day one of
entering into insurable employment.
Q.2). If I have salary Rs-25000, am I eligible for ESI?
Answer: No. The existing wage limit for coverage under the Act is Gross Salary of Rs.
21,000/- per month (w.e.f. 01/01/2017).
Q.3). If my wife is pregnant what is process to avail the medical benefit?
Answer: Employee should visit ESIC branch office to avail medical benefits. She is not
entitled for cash benefits.
Q.4). If I met with an accident and my body is totally / temporary disable, what kind of
benefits I am eligible for?
Answer: Such case covered under disablement Benefit, employee is eligible from the day
he joins the insurable employment. The benefit is depending up on the loss of earning
capacity of the employee.
mishrcha

15
Q.5). Maternity Benefit under ESIC Scheme? And process to claim it?
Answer: An IWs can avail the Maternity Benefit as per below mentioned steps:
 A female employee can get the maternity benefit for 26 weeks.
 Maternity benefit rate is 100% of average daily wages.
 Female employee will get this benefit after her delivery.
 She should fill form 21 & 23 and should visit local ESIC office.
 If miscarriage or MTP arises she is eligible for 6 weeks (42 days) of leave &
payment by filling of Form 20 and 23.
 Almost 84 days contribution from her wages should be deducted or is necessary
to get this benefit.
 If sickness arises during pregnancy or Premature birth-which is payable for a
period not exceeding one month-on the basis of Forms 8, 10 and 9.
 If female employee expires leaving behind a child, Maternity Benefit is payable
to her nominee on production of Form 24 (B).
mishrcha

16
Q.6). If I am sick due to fever or any other diseases & was absent for a week or more
than that, can I get the wages / salary for the absent period??
Answer: Yes:
 Employee is eligible for sickness benefit under the Act.
 Employee will get Sickness benefit is 70% of the average daily wages and is
payable for 91 days during 2 following benefit periods.
 For which an IP should have paid contribution for not less than 78 days during
the corresponding contribution period.
 A person who has entered into insurable employment for the first time has to
wait for nearly 9 months for becoming eligible to sickness benefit.
 Sickness Benefit is not payable for the first two days.
 This period of 2 days is called "waiting period".
Q.7). If yes what is the process for claiming the benefits & what % of amount I will get?
Answer: When IP requires medical treatment and attendance with abstention from work
on medical grounds. He/ She should fill Forms 8,9,10,11 & ESIC-Med.13, for availing the
benefit.
mishrcha

17
Q.8). How many days I should be present to avail the sickness benefit??
Answer: 78 days during the corresponding contribution period.
Q.9). My parents lives at my native place, however, I want to add their name in ESIC to
get the treatment through ESIC, what is the procedure for same??
Answer: Yes, IP can add their family members name, for the same IP required to provide
family members details along with a family photo to avail the benefit.
Q.10). Can I include my brother / sisters name in ESIC??
Answer: Yes, However, they should not be working anywhere.
Q.11). Is it compulsory to keep wife as a nominee if I am married?? Or I can keep my
parents as a nominee in ESIC??
Answer: Employee is suggested to keep their spouse as a nominee on legal terms it is
compulsory to put spouse name. you can add mother father name in family details.
mishrcha

18
Q.12). If I don’t link my Aadhar in ESIC can I get the ESIC benefit???
Answer: Now it is compulsory to link Aadhar to get benefit.
Q.13). Is it compulsory to linked Aadhar of my family members in ESIC?
Answer: yes, to get benefit under the act it is compulsory to link your Addhar No. along
with family members Aadhar No.
Q.14). If I am orphan / if my parents are no more, can I keep my brother / sister as
nominee??
Answer: Yes.
Q.15). If my parents are no more, can I get funereal benefit for them also?
Answer: No- Funeral benefit is only for someone (nominee) who is baring the expenses
for the funeral of Insured person.
Q.16). What benefits my nominee will get after my death?
Answer: Eligible for funeral benefit mentioned above. Also, nominee will get pension up
to life time & 2 children’s will get pension up to the age of 25 years but the condition is
spouse as a nominee should not get married again. The same affidavit is compulsory to
be provide to ESIC branch office.
mishrcha

19
Q.17). Is it compulsory to deduct ESIC amount from wages/ salary as I am not availing
any facility through ESIC?
Answer: It’s a statutory deduction as per law which is compulsory to deduct all the
employees covered under the Act.
Q.18). If my ESIC pehchan card is misplaced how I will get the treatment / benefit from
ESIC?
Answer: Employee can get treatment by online e-pehchan card hence Aadhar card is
compulsory for all.
Q.19). I am a new joinee / fresher my father has problem in heart and dr. has suggested
to do heart surgery can I do this from ESIC?
Answer: No. To avail this facility employee should work for 45 days minimum. & surgery
should be happen in ESIC hospital.
Q.20). Can I get list of ESIC hospitals & Doctors?
Answer: Yes, one can visit on http://www.esic.nic.in/directory for the same.
mishrcha

20
Q.21). In emergency situation, If got admitted in a private hospital, still can I get benefit
from ESIC?
Answer: Yes, you can get the benefit through ESIC. You need to contact your local ESIC
office before 48 hours & need to submit the medical bills.
Q.22). I get married recently however couldn’t change my name in ESIC portal. Is it
compulsory to change my name in ESCI? (in case of female employee)
Answer: Yes. It is compulsory to get your name change in ESIC to avail the facility of
maternity benefit, you contact the employer and will have to submit relevant documents
for updation.
mishrcha

By: Chandresh Mishra
HR compliance
27

Employees' State Insurance Corporation

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Employees' State Insurance Corporation

Similar to Employees' State Insurance Corporation (20)

Recently uploaded

Recently uploaded (20)

Employees' State Insurance Corporation