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Employee State Insurance Scheme (ESIS) - Features and Benefits

Operated by the Employees State Insurance Corporation, the Employee State Insurance Scheme is a social security and health insurance fund.

This scheme offers a wide range of benefits, including a 26-week maternity cover, staggered payments in the event of an unfortunate incident, and unemployment coverage for 3 years, to name a few. This scheme also offers sickness benefits and disablement benefits. 

To avail of this scheme, you must necessarily be employed in a non-seasonal factory (with over 10 employees) and must have an upper wage limit of Rs.21,000.

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Overview on ESIS

If you are a working professional, you might have tons of responsibilities on your shoulders. Apart from work duties, there are financial needs of your family to be taken care of as well. There are times when a single income doesn’t cover the budgetary requirements of the entire family. A great way to ensure the security of the family in your absence is by enrolling on the Employee State Insurance Scheme (ESIS). This Employee Health Scheme is a broad plan, which covers multiple things under it. Before applying for ESIS insurance, every employee must know about Employee State Insurance details.

  • Employee State Insurance Scheme is an integrated social system specially designed for the safety of the employees under the Employee State Insurance Act 1948.

  • ESIS insurance protects the employee in the case of sickness, disability, physical injury, and more. Moreover, it provides the working individual and their beneficiaries with medical facilities.

  • In case an employee loses their steady flow of income, the ESIS card helps in availing cashless benefits.

Moreover, the government has been taking various initiatives to enhance the coverage of the ESI Scheme. These reforms have been a part of a series of “2nd Generation Reforms Agenda” known as ‘ESIC-2.0’. It was launched on July 20, 2015, and is going to be implemented within a stipulated time. Health Reforms Agenda of ESIC 2.0 include:

  • Online health record of the ESI beneficiaries

  • Special cleanliness drive as part of Swachh Bharat Mission

  • Abhiyan Indradhanush

  • New medical helpline for emergency and seeking guidance from casualty/emergency of Employee State Insurance hospital

  • Special OPD for senior citizens and differently-abled persons in Employee State Insurance hospital

The PMJAY Scheme is formed by subsuming multiple schemes including the Employee State Insurance Scheme (ESIS).

Features of ESIS

ESIS provides employees with a varied range of features. You can go through the list of features of ESIS mentioned below in detail:

  • It provides maternity cover for 26 weeks. Moreover, the cover can be extended up to one month if your wages are subjected to a contribution for 70 days.

  • It offers payment in instalments to beneficiaries during unfortunate events.

  • It offers an unemployed member with coverage for 3 years. However, it is possible only if the member discloses essential details like the previous workplace and permanent invalidity.

  • It supplies 90% of the employee’s wage when an individual becomes temporarily or permanently disabled.

  • Complete medical care and attention is provided to an employee registered under the ESI Act, 1948 at the time of their incapacity and restoration of health.

The significant benefit of availing ESIS is the financial protection to the employee and their dependents. Besides, ESIS grants other health insurance benefits for the betterment of each employee. Take a look at the benefits ESI scheme mentioned below:

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Benefits of ESI Scheme

  • Unemployment allowance

If you, as an employee, are fired from your previous job or choose to resign from your last position, the flow of your income reduces. ESIS acts as an income replacement when you are unemployed.

  • Death benefit

The financial security of your family is at stake after your death. However, ESIS ensures that your family receives a monthly payout in your absence.

  • Maternity benefit

Having a child marks the beginning of a new phase of life. With that, your responsibilities, as well as expenses increase. ESIS provides maternity benefits to every new parent.

  • Medical benefit

When you enter insurable employment, ESIS serves medical coverage for you and your entire family. The Government of India recently launched the Ayushman Bharat Yojana to facilitate quality healthcare services to the below poverty line segment of society. For Ayushman Bharat Yojana registration and eligibility check, you can head to the official PMJAY website.

  • Sickness benefit

You get cash benefits of up to 70% of the wages during the medical leave. This is provided for up to 91 days.

  • Benefits for the dependents

If you happen to suffer any health issues or injuries when at work, you do not have to worry about the financial crisis arising due to loss of pay. With ESIS, you and your dependents will get monthly payments.

  • Disablement benefit

For temporary disablement, ESIS provides monthly payments at a 90% wage until recovery. For permanent disablement, ESIS provides monthly payments at a 90% wage for the entire life.

Who is Eligible for the ESI Scheme?

To avail the benefits offered under the Employee State Insurance Scheme, you should meet certain criteria set by the committee. Those eligible for ESI Scheme –

  • Have to be employed in a non-seasonal factory that has more than 10 employees working for it. This eligibility criterion is applicable under Section 2(12) of the Act.

  • Need to have a wage limit of ₹21,000 per month, effective from January 01, 2017.

What is Covered in ESIS?

The ESIS covers a majority of employed Indian residents. However, before enrolling on the plan, one must take a look at its inclusions. Here’s a closer look at what is covered under ESIS.

  • The scheme is now extended to cinemas and preview theatres, restaurants, newspaper establishments, hotels, shops and road-motor transport undertakings.

  • Private educational and medical institutions with 10 or more employees. However, you should note that this is applicable to certain selected states and union territories only.

  • It is accessible to over 3.49 crore Indian families and individuals as of March 2021.

  • According to Section 1(5), the government has notified that ESIS insurance covers shops and restaurants involved in sales.

Cash Benefits of ESIS

Benefits

Cash Value

Disablement benefit

For temporary disablement, you will receive 90% of the last wages as long as the disablement lasts. For permanent disablement, you will receive the wages on a pro-rata basis for the rest of your life.

Maternity Benefit

You receive 100% of the wage for 12 weeks.

RGSKY for Unemployment

You receive 50% of the wage for one year in case of unemployment.

 

Dependant Benefit

You receive 90% of the wage.

Funeral Benefits

Funeral benefits are covered up to ₹10,000.

 

There is an increasing demand for ESIS after its launch in 1952. The prime reason for the growth of ESIS insurance is the fulfilment of the social needs of all the employees.

When is ESIS Registration Required?

For companies that have more than 10 employees, it becomes mandatory to register with the Employee State Insurance Corporation (ESIC). Also, employees earning less than ₹21,000 every month will contribute 1.75% of their salary towards the ESIS, whereas the employer will contribute 4.75% towards the same. This makes a total contribution of 6.5% towards ESS. The company has to register with ESIC within 15 days of its eligibility.

Procedure for ESIS Registration

When an organisation hires 10 or more employees, it is liable for the company to register under ESIS. As mentioned above, employees earning less than ₹21,000 monthly need to contribute 1.75% of their wage to ESIS, while the employer needs to contribute 4.75% of the employee’s wage. The organisation needs to register for ESIS within 15 days from the time the scheme applies to the company.

The procedures to register for ESIS are explained below:

Step 1: Download Form No.1 (Employers Registration Form) in PDF and fill in the necessary details.

Step 2: Submit the same online with the requested documents. Documentation plays an essential role while enrolling for a policy. Here’s a list of the required documents:

Documents Required for ESIS

  • Certificate of registration from the Factories Act and Establishment Act.

  • Memorandum and Articles of Association

  • Registration certificate for a partnership entity

  • Employee list of an organisation

  • Annual Income details

  • Cancelled bank leaf

  • Names of the company directors

  • Names of the company shareholders

  • Attendance account of the employees

Employee State Insurance Act 1948

ESIS was established with an aim to offer social insurance to individuals, according to the provisions of the Employees State Insurance Act. The primary objective of the act was to financially safeguard the salaried employees and their family members from unforeseen medical issues, temporary and personal disablement, maternity, and death.

In simple words, ESIS offers medical security to the insured people and their loved ones under unavoidable health issues. This scheme applies to employees of factories, shops, restaurants, hotels, and other business entities such as road transport, newspaper, cinemas, and educational institutions that have more than 10 employees earning a minimum of ₹15,000.

In certain states, this facility applies to institutes that have more than 20 employees. Also, ESIS authorities have decided to increase the monthly wage amount from ₹15,000 to ₹21,000, and the benefits are extended to people working in construction sites that are located in ESIS mentioned areas since August 01, 2015.

As mentioned above, the employer, as well as the employee, contributes towards the ESIS. However, employees earning ₹137 or less as a daily wage, are exempted from the contribution. In this case, only the employer makes the necessary contribution.

ESIS and its Application

The Employees State Insurance Corporation (ESIC) established the Employees’ State Insurance Act, 1948. It is their responsibility to ensure the seamless administration of the scheme.

The ESIS has its headquarters in New Delhi but has an extended network across the country. Today, over 151 hospitals and 42 hospital annexes are available for inpatient services under the scheme. Other primary and out-patient medical facilities are offered via a network of about 1450/188 ESI dispensaries/AYUSH units and 954 panel clinics. Also, there is a Medical Benefit Council offering expert guidance to the ESIC regarding its administrative responsibilities.

Dos and Don’ts of ESIS

As a beneficiary of ESI, you should be aware of the following important dos and don’ts.

  • If you are switching from one organisation to another, make sure that your new employer is informed about the ESI Registration Number. That way, you can continue to enjoy the benefits under it as and when needed.

  • Ensure that you do not lose or damage the Pehchan Card as it serves the purpose of social security.

  • In case the card is lost, you or any of your dependents will have to immediately report the loss at the nearest Branch Office or Dispensary.

  • The suggested processes for referrals should be strictly followed.

  • In case you plan to relocate for professional purposes, you have to get Form 105 signed by your existing employer so as to continue availing the benefits under the ESI scheme in another location.

  • You have to mandatorily follow the doctors’ medications and prescribed treatments (if any).

Redressal of Public Grievances

You can lodge your complaint regarding the ESI scheme by using any of the following methods:

  • By going to the official ESIC website at 222.esic.nic.in and selecting the ‘Grievance Redressal’ option in the ‘Services’ section on the homepage.

  • By using the CPGRAMS portal at https://pgportal.gov.in/signin

  • By sending an e-mail to pg-hqrs@esic.in or by using any Hqrs office or field office’s e-mail address.

  • Through toll-free helpline numbers: 1800-11-2526 (general Helpline) and 1800-11-3839 (medical helpline).

  • Through hard copy complaints like by post, by hand, through complaint box, etc.

  • By walking into the respective field office or headquarter office.

Final Takeaway

Despite all this, there is certain unawareness of the scheme that leads to multiple queries in the minds of the buyers. Some frequently asked questions (FAQs) about this scheme are mentioned below.

To sum up, the responsibilities of an employee increase with a rise in workload. Moreover, our sedentary lifestyle demands special attention, which is possible only with ESIS. The guaranteed protection from ESIS makes multiple lives easier. Apart from ESIS, you can also buy a health insurance plan to give yourself financial backing. Go to the official website of Bajaj Markets now and choose the best-suited insurance plan from a wide range of options available.

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FAQs on ESIS

✔️What is the ESI Act?

The Employee State Insurance (ESI) Act covers the administrative duties of a statutory body called Employee State Insurance Corporation (ESIC).

✔️Are there age restrictions for availing the ESIS scheme?

The age limit for every benefit provided by the ESIC Scheme is different.

✔️How should I find my ESI code number?

ESI Code number is a 17-digit number given to every employer. It is usually provided to an employee who owns business entities and is registered under this act.

✔️How do I register under ESIS Plan?

Follow the steps given below to register:

  1. Download Form no 1, which is an employer’s registration form.

  2. Fill in the required details.

  3. Submit the form along with the relevant documents online. 

✔️Is it necessary to register for the ESIC?

Every employer eligible under this act must compulsorily register for the ESIS scheme.