ESIC INSURANCE BENEFITS TO EMPLOYEES
What is ESIC ?
“An act to provide for certain benefits to employees in case of sickness, maternity, disablement and death due to employment injury and to make provisions for related matters. And Provide medical care to insured persons and their families.”
ESIC Eligibility and Contributions
- Monthly Gross Wages less than Rs. 21,000/- per month.
- Employees’ : .75% on Gross monthly wages.
- Employer : 3.25% on Gross monthly wages.
ESIC Insurance Benefits to employees
- Sickness Benefit
- Disablement Benefit
- Dependants’ Benefit
- Maternity Benefit
- Medical Benefit
Other benefits being provided to the beneficiaries are Confinement Expenses, Funeral Expenses, Vocational Rehabilitation, Physical Rehabilitation, Unemployment Allowance and Skill Up gradation Training.
Eligibility conditions, duration & scale of benefits
SICKNESS BENEFIT
A.Sickness Benefit
Eligibility: Payment of contribution for 78 days in corresponding Contribution Period.
Duration & scale of benefits: Up to 91 days in two consecutive Benefit Periods.
Rate: 70% of the average daily wages.
B.Enhanced Sickness Benefit (For Vasectomy/Tubectomy)
Eligibility: Payment of contribution for 78 days in corresponding Contribution Period.
Duration & scale of benefits: 14 days for Tubectomy & 7 days for Vasectomy, extendable on medical advice.
Rate: 100% of the average daily wages.
C.Extended Sickness Benefit
Eligibility: For 34 specified long term diseases, continuous insurable employment for two years with minimum 156 days’ contribution in four consecutive Contribution Periods.
Duration & scale of benefits: 124 days during a period of two years. This may be extended up to two years on medical advice.
Rate: 80% of the average daily wages.
DISABLEMENT BENEFIT
A.Temporary Disablement Benefit
Eligibility: From day one of entering insurable employment for disablement due to
employment injury.
Duration & scale of benefits: As long as temporary disablement lasts.
Rate: 90% of the average daily wages approx.
B.Permanent Disablement Benefit
Eligibility: From day one of entering insurable employment for disablement due to
employment injury.
Duration & scale of benefits: For whole life.
Rate: For permanent total disablement – 90% of the average daily wages. For permanent partial disablement – Proportionate to the loss of earning capacity as determined by medical board.
DEPENDANTS’ BENEFIT
Eligibility: From day one of entering insurable employment in case of death due to
employment injury.
Duration & scale of benefits: For life to the widow or until her re-marriage. To dependant children till the age of 25 years. To dependant parents etc. subject to conditions.
Rate: 90% of the average daily wages shareable in fixed proportion among all dependants.
MATERNITY BENEFIT
Eligibility: Payment of contribution of 70 days in two consecutive contribution periods.
Duration & scale of benefits: Up to 12 weeks which can be further extended upto 16 weeks on medical grounds in case of confinement. Up to 6 weeks in case of miscarriage. Extendable by 1 Month on medical advice in case of Sickness arising out of Pregnancy, Confinement, Miscarriage.
Rate: 100% of the average daily wages.
MEDICAL BENEFIT
Eligibility: ‘Reasonable medical care’ for self and family from day one of entering insurable employment.
Duration & scale of benefits: Reasonable medical care till he/she remains in insurable employment.
Medical Benefit under the ESI Scheme has now been extended to the widow/spouses of deceased/retired/superannuated Insured Persons as well as to the widow/spouses of Insured Persons who ceases to be in an insurable employment on account of Permanent Disablement, and also to widows of Insured Persons who are in receipt of Dependants’ Benefit.
OTHER BENEFITS
A.Confinement Expenses
Eligibility: An Insured Woman or an I.P. in respect of his wife is eligible if confinement occurs at a place where necessary medical facilities under ESI Scheme are not available.
Duration & scale of benefits: Up to two confinements only.
Rate: @ Rs.1000/- is paid to an insured woman or in respect of the wife of an insured person in case she does not avail medical facilities of the scheme for child delivery.
B.Funeral Expenses
Eligibility: From day one of entering insurable employment.
Duration & scale of benefits: For defraying expenses on the funeral of an Insured Person.
Rate: Actual expenses subject to a maximum of ` 15000/- .
C.Vocational Training
Eligibility: in case of disabled insured persons under 45 years of age with 40 percent or more disablement.
- Physical Rehabilitation
Eligibility: In case of physical disablement due to employment injury.
Duration & scale of benefits: As long as a person is admitted in an artificial limb centre.
Rate: 100% of the average daily wages.
- E. Unemployment Allowance – Rajiv Gandhi Shramik Kalyan Yojna (RGSKY)
Eligibility: In case of involuntarily loss of employment due to closure of factory, retrenchment or permanent invalidity due to non-employment injury and the contribution in respect of him have been paid/payable for a minimum of three years prior to the loss of employment.
Duration & scale of benefits: Maximum twelve months during life time.
Rate: 50% of the average daily wages.
F.Skill Up gradation Training under RGSKY
Eligibility: In case of involuntarily loss of employment due to closure of factory, retrenchment or permanent invalidity due to non-employment injury and the contribution in respect of him have been paid/ payable for a minimum of three years prior to the loss of employment.
Duration & scale of benefits: For a duration of maximum 6 months.
Covid Pandemic Benefits
Eligibility: In case the IP or family member being infected with COVID-19 takes treatment in any private institution, the reimbursement of expenditure may be claimed.
Cash Benefit
In case the Insured Person abstains from his work being infected with COVID-19, he can claim Sickness benefit for his period of abstention as per his entitlement. Sickness benefit is paid @ 70% of average daily wages for 91 days.
In case any Insured person becomes unemployed, he may avail relief under Atal Beemit Vyakti Kalyan Yojana (ABVKY) under @ 50% of average per day earning for a maximum 90 days. For availing this relief, the Insured Person can submit his claim online at www.esic.in.
In case, any Insured Person becomes unemployed due to retrenchment or closure of factory/ establishment as per ID Act, 1947, he may claim unemployment allowance for a period of 02 years subject to qualifying conditions under RGSKY.
In the event of unfortunate demise of any Insured Person, funeral expenses of Rs 15000/- are paid to the eldest surviving member of his family.
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