WELCOME

TO A SESSION ON

SALIENT PROVISIONS OF E.S.I.

BENEFITS AND COMPLIANCE
 PHILOSOPHY OF
SOCIAL SECURITY
 BENEFITS UNDER ESI SCHEME
(PANCHDEEP)
MATERNITY
BENEFIT
SICKNESS DISABLEMENT
BENEFIT BENEFIT

MEDICAL DEPENDENTS ’
BENEFIT BENEFIT

3
 MISC. BENEFITS
•Funeral expenses

•Confinement expenses

•Medical benefit to retired / invalided out insured persons

•Unemployment allowances (rgsky)

•Rehabilitation allowances
 ESI Contribution Period and Benefit Period

• ESIC has divided the year in to 2 Contribution Periods and its

associated Benefit Periods.

• 1st April to 30th September is Contribution period and its

associated Benefit Period is 1st Jan to 30th June
This implies that the contribution paid by the employee between 1 st April to 30th September entitles the
employee to take benefit between 1st January to 30th June in the coming year.

• 1st October to 31st March is Contribution period and its

associated Benefit Period is 1st July to 31st December

This implies that the contribution paid by the employee between 1 st October to 31st March entitles the
employee to take benefit between 1st July to 31st December .
 MEDICAL BENEFIT
• Coverage immediately on becoming an employee under the
ESI Act. Family is also covered from the same date.

• No contributory conditions for primary and secondary care,

either for self or for the family.

• In case of employment injury, no service/ contributory

condition.

• Super Specialty treatment for self and family from Day 1 of

coverage subject to approval by ESIC as per orders of Delhi
High Court. Conditions apply, see the incoming slide

• No limit of expenditure on treatment if treated with prior

approval of ESIC. Any private treatment reimbursement is
subject to approval from ESIC.
 SICKNESS BENEFIT
• Cash benefit paid to the insured person (IP) During his treatment
and abstention duly certified by medical authority.

• The IP Becomes entitled after 9 months of his service.

• Minimum contribution of 78 days needed during a contribtion

period which is of 6 months. The same contribution condition
now applies for availing super specialty treatment for self.

• Payable for 91 days in a period of one year (two consecutive

benefit periods of 6 months each)

• Rate of benefit is 70 % of his average daily wages.

 Super Specialty Treatment

The insured person will become eligible for ESI super specialty treatment when
he has 6 months insured employment in ESIC from the date of registration of
ESIC and 78 days contribution to ESI in One ESIC contribution period.

His family members will become eligible for ESIC super specialty treatment
when he has 1 year insured employment and 156 days ESIC contribution
including Two ESI contribution periods (78 days in each ESI contribution
period.)

Once the insured person fulfills the above criteria then he and his family
members will become eligible for ESI super specialty treatment in the following
ESIC benefit period.
 EXTENDED SICKNESS BENEFIT
• FOR DISEASES NEEDING PROLONGED TREATMENT
• T.B., Cancer etc.
• Cash benefit payable for upto 730 days in a period of 3 years.
• Rate of benefit is – 80% of his average daily wages.
• However, a min. Of 2 years service and 156 days contribution is
needed to become entitled. The Insured Person should also be entitled
for sickness benefit in at least one of the said 4 contribution periods.
• Conditions can be relaxed in exceptional cases.
 ENHANCED SICKNESS BENEFIT
Paid for observing Family Planning Norms. Hum 2 Hamare 2

• For an Insured Person Undergoing vasectomy – 7 days.

• For an Insured Woman Undergoing tubectomy – 14 days.

• Can be extended by another 7 days in case of complication in both the above cases.

• Paid @ 100% of his / her average daily wages.

• Above entitlement over & above the 91 days of entitlement of sickness benefit.

• Elligibility criteria – same as sickness benefit .

 DISABLEMENT BENEFIT
• Cash benefit paid to an employee who sustains an employment injury including an occupational disease.

• Covered as soon as he becomes an employee under the act. No contributory condition.

• During his treatment of the injury and abstention (should be min. 3 days), he gets temporary disablement
benefit @ 90% of his average daily wages.

• In case the injury results into permanent disability, he gets permanent disablement benefit which will
depend upon % loss of his earning capacity.

• The payment is life long.

• The rate is: %loss of his earning capacity x 90% of his average daily wages.
 DEPENDANTS, BENEFIT
• Cash benefit paid to the depandents of an Insured Person / Insured Woman, who dies as
result of an employment injury.
• Covered as soon as he/she becomes an employee. No contributory condition.
• Paid to the widow till her life or re-marriage.
• To the sons till the age of 25 years.
• To unmarried daughters without age limit.
• To infirm sons till the infirmity lasts.
• To the widowed mother.
• The maximum payment is 90% of his average daily wages which is distributed among all
the eligible dependants at specified amount of share.
• In case the Insured Person did not have any of the above dependants, then to his other
depandants like his parents, brothers, sisters etc.
 MATERNITY BENEFIT
• Paid to an insured woman (Insured Woman) For her confinement
provided it occurs or expected to occur during a benefit period (after 9
months of her becoming an employee).

• She should have contributed for at least 70 days during 2 consecutive

Contribution Periods, prior to her confinement.

• Paid her full wages for 26 weeks (182 days) provided she does not join
work during this period.

• For miscarriage, the benefit payable is for 6 weeks (42 days).

• In case of sickness related to pregnancy, child-birth or miscarriage, the

benefit is extendable by one more month and this is granted only upon
approval from ESI Doctor.
 MISC. BENEFITS
FUNERAL EXPENSES – Rs. 15000.00 reimbursed towards the expenses in
performing the last rite of the deceased Insured Person / Insured Woman.

Confinement expenses- Rs 7500/= paid to the Insured Woman and to the wife of
an Insured Person who is confined for maternity at a place where ESIC Medical
facilities are not available, this benefit is available only for 2 confinements
(pregnancies)

Medical benefit to retired / invalided out Insured persons and their spouse on
payment of Rs. 120.00 per year per couple, which is paid at ESIC Branch Office,
provided the retired or invalid insured person was contributing to ESIC for 5
continuous years immediately preceeding the retirement / being invalided out.

Unemployment allowances: ATAL BIMIT VYAKTI KALYAN YOJNA which

will entitle the Insured Person / Insured Woman to get unemployment allowance
is being rolled out, details will be available soon.

Rehabilitation allowances
CONCLUSION
Thank You