About-us

The section 46 of the Act envisages following six social security benefits :-

• Medical Benefit

  • System of Treatment

  • Scale of Medical Benefit

  • Benefits to Retired IPs

  • Administration

  • Domiciliary treatment

  • Specialist consultation

  • In-Patient treatment

  • Imaging Services

  • Artificial Limbs & Aids

  • Family Welfare

  • Special Provisions

  • Reimbursement

  • Forms

• Sickness Benefit (SB)

  • Sickness Benefits

  • Extended Sickness

  • Enhanced Sickness

• Maternity Benefit (MB)

• Disablement Benefit

  • Temporary disablement benefit(TDB)

  • Permanent disablement benefit(PDB)

• Dependants’ Benefit (DB)

• Funeral Expenses

In addition, the scheme also provides some other need based benefits to insured workers.
These includes :

• Rehabilitation Allowance

• Vocational Rehabilitation

• Unemployment Allowance

An interesting feature of the ESI Scheme is that the contributions are related to the paying capacity as a fixed percentage of the workers wages, whereas, they are provided social security benefits according to individual needs without distinction.
Cash Benefits are disbursed by the Corporation through its Branch Offices and Pay Offices, subject to certain contributory conditions.

S.NO

Name of the benefits

Contributory conditions

Duration of Benefit

Rate/type of benefit/ remarks

1

Medical Benefit

One should be an insured person under ESI Act.

From day one of entering into insurable employment

Reasonable medical care, comprehensive medical care & clinical investigation for IP and his/her dependent family members.

1(a)

Medical care to permanently disabled –Ips/Iws who ceases to be in insurable employment due to employment injury

On payment of Rs 120/- per annum.

On yearly basis.

Medical facility for primary and secondary care (excluding SST) within ESI medical institutions to IP/IW and his/her spouse till the date of superannuation.

1(b)

Medical care to retired

Insured person.

To an IP who leaves the insurable employment (on attaining the age of superannuation, or retires under a VRS or takes premature retirement after being insured for not less than five years) on payment of Rs 120/- per annum

On yearly basis

Medical facility for primary and secondary care (excluding SST) within ESI Medical institutions to IP & his/ her spouse for whole life. This benefit is also provided to the widow of deceased IP who had enrolled for this benefit.

2(a)

Sickness Benefit

On payment of contribution for not less than 78 days in corresponding contribution period

Upto 91 days in any two consecutive benefit Periods

70% of the average daily wages.

2(b)

Enhanced sickness Benefit

As of Sickness Benefit

7 days to an IP for Vasectomy & 14 days to IW for Tubectomy

100% of the average daily wages.

3

Extended Sickness

Benefit

For 34 specified long term diseases. IP/IW should have continuous insurable employment for two years with minimum 156 days contribution in four consecutive contribution periods.

124 to 309 days which may be extended upto 2 yrs. (730 days) on medical advice specified for long term diseases

80% of average daily wages.

4

Disablement Benefit

4(a)

Temporary Disablement Benefit

From day one of entering into insurable employment. Paid for employment injury arising in the course & out of insurable employment.

• Not payable if disability lasts for less than 3 days (excluding the day of accident.)

• Otherwise payable for the entire period, so long as the temporary disability lasts.

90% of average daily wages.

4(b)

Permanent Disablement Benefit

• No contributory conditions are there.

• Paid for permanent disablement, whether total or partial, caused by accident or an occupational disease arising out of and in the course of insurable employment.

For the whole life

• For permanent total disablement- 90% of average daily wages. For permanent partial disablement- proportionate to the loss of earning capacity as determined by the medical board.

• this is commuted into lumpsum in case the daily rate benefit is upto Rs 10 or the total commuted value does not exceed Rs 60,000/-

5(a)

Dependent Benefit

From day one of entering insurable employment in case of death due to employment injury.

For life to the widow or until her re- marriage and to each legitimate or adopted son upto the age of 25 years. To each legitimate or adopted unmarried daughter until marriage. For infirm child till infirmity lasts.

90% of average daily wages shareable among dependents in fixed proportion.

5(b)

Medical care to the widow in receipt of Dependent Benefit

For widow in receipt of dependent benefit

Yearly basis

Medical facility for primary and secondary care (excluding SST) within ESI medical institutions on yearly payment of Rs 120/- to the widow of deceased IP who is in receipt of dependent benefit.

6

Maternity Benefit

70 Days contributions payable in the immediately preceding 2 consecutive contribution periods

• 26 weeks upto two surviving children and thereafter.

• 12 weeks for 3^rd surviving child and onwards

• 6 weeks in case of miscarriage.

• 12 weeks for the commissioning mother.

• 12 weeks for the adopting mother.

100% of the average daily wages.

7

Confinement Expenses

An Insured woman or an Insured Person in respect of his wife shall be paid medical bonus on account of confinement expenses at a place where necessary medical facility under the ESI scheme is not available.

Upto two confinements

Rs 5,000 /- per case subject to two cases.

8

Funeral Expenses

• IP should have been eligible for any of the benefit under the ESI Scheme.

• On production of a death certificate by the eldest surviving member/ dependents/any person who actually incurs the expenditure on funeral.

Onetime payment for defraying expenses on funeral of an Insured person

Actual Expenses subject to maximum Rs 10,000/- only.

9

Unemployment Allowance under ‘Rajiv Gandhi Sharmik Kalyan Yojna’ (RGSKY)

• Insurable employment for the last 2 years with 78 days contribution paid/payable in each contribution period.

• Involuntary unemployment rendered due to closure of Factory/ Establishment, retrenchment or permanent disablement due to non-employment injury not less than 40%

Unemployment Allowance for a maximum period of 24 months during the entire insurable employment.

• Unemployment allowance at the rates of

1. 50% of last avg. daily wages for 0-12 months

2. 25% of last avg. daily wages for 13-24 months.

• Vocational training for duration upto 1 year for Insured upgrading skills of Person receiving unemployment allowance

• Medical care for self and family during receipt of unemployment allowance .

• Entire fee charged by Government approved/ accredited institutions reimbursed by ESIC

10

Vocational Rehabilitation Allowance under Rule 60

Not more than 45 years of age and disability not less than 40% due to Employment Injury

Training in any field in a Govt. Institution or Govt. accredited Institution as per norms of the Vocational Rehabilitation Centre/Institution.

• Conveyance charges at normal rate/second class railway/bus fare as applicable.

• Expenditure charged by the centre or Rs 123/- per day, whichever is more.