ESI Benefits

ESI benefits
Presented by,
Sisira
ESI Scheme
• ESI Scheme for India is an integrated social
security scheme tailored to provide Social
Production to workers and their
dependents, in the organised sector, in
contingencies, such as Sickness,
Maternity and Death or Disablement due
to an employment injury or Occupational
hazard .

•
COVERAGE …
The ESI Act 1948 applies to

• Non – seasonal Factories using power in

and Employing ten (10) or More persons
• Non – seasonal and non- power using
factories and establishments employing
twenty(20) or more persons
•
Finances …
• The Scheme is primarily funded by
contribution raised from Insured
Employees and their employers
•
• Payable such as
 1. Employees’ Contribution – 1.75% of the
Wages
 2. Employers’ Contribution – 4.75% of the
Wages
 Total Wages - 6.5 % of the wages
•
Benefits to Employees
• ESI Scheme Major Social Security Benefits in
Cash and Kind include …

 1. Medical Benefit – for self & Family

 2. Sickness Benefit – for self
 3. Maternity Benefit - for self
 4. Disablement Benefit
 a). Temporary Disablement Benefit – for self
 b). Permanent Disablement Benefit – for self
 5. Dependents’ Benefit– for dependents in case of
death due to employment injury


BENEFITS
Subject to the provisions of this Act, the insured persons, 82 [their
dependants or the persons hereinafter mentioned, as the case may

be,] shall be entitled to the following benefits, namely,-
1.
2. Sickness Benefit
3. Maternity Benefit
4. Accident/ Disablement benefit
5. Dependant benefit
6. Medical Benefit
7. Funeral Benefit
Medical Benefit …
• Medical Benefit means Medical care of IPs and their families,

wherever covered for medical benefit.
•
• The Standard medical care consists of out-door treatment, in-
patient treatment, all necessary drugs and dressing,
pathological and radiological specialist consultation and
care, ante-natal and post natal care, emergency treatment
etc.,

• Out-door medical care is provided at the state Insurance

Dispensaries or Mobile Dispensaries manned by full-time
doctors (service’ system) or at the private clinics of
Insurance Medical Practitioners (Panel System)
Medical Benefit …
• Insured worker and members of his family are eligible for

medical care from the very first day of the worker coming
under ESI Scheme.
• A worker who is covered under the scheme for first time is
eligible for medical care for the period of three months. If
he/she contributes at least for 78 days in a contribution
period the eligibility is there up to the end of the
corresponding benefit period.
• A worker is also eligible for extended sickness benefit when
he/she is suffering from any one of the long term 34
diseases listed in the Act. This is admissible after the
worker has been under ESI these conditions are satisfied
medical benefit is admissible for a maximum period of 730
days for the IP and his/ her family.
Sickness Benefit …
• Sickness signifies a state of health necessitating

Medical treatment and attendance and abstention
from work on Medical grounds. Financial support
extended by the corporation i such a contingency is
called sickness Benefit
•
• Sickness Benefit represents periodical payments
made to an Insured Person for the period of
certified sickness after completing 9 Months in
insurable employment.
•
•
Benefits to Employees …
• To qualify for this benefit, contributions should have

been payable for at least 78 days in the relevant
contribution period.
• The Maximum duration for availing sickness Benefit
is 91 days in two consecutive benefit periods
• Standard benefit rate – this rate corresponds to the
average daily wage of an Insured person during the
corresponding contribution period and is roughly
half of the daily wage rate.
•
Extended Sickness Benefit …
• Extended Sickness Benefit is a Cash Benefit
paid for prolonged illness (Tuberculosis /
Leprosy, Mental and Malignant diseases)
due to any of the 34 Specified diseases
•
• The IP should have been in continuous
employment for a period of 2 years and
should have contributed for atleast 156 days
in 4 preceding contribution periods
Maternity Benefit…
• Maternity Benefit is cash payable to an Insured

women for the specified period of abstention
from work for
• 1. confinement or mis-carriage or for sickness
arising out of pregnancy,
• 2. “confinement” “premature birth of child or
miscarriage” “confinement”
• connotes labour after 26 weeks of pregnancy
whether the result issue is alive or dead.
•
Maternity Benefit…
• Criminal abortion or miscarriage does not, however, entitle to
benefit.
• The contribution condition is the same as for Sickness Benefit.
• The daily benefit rate is double the sickness Benefit rate and is
thus roughly equivalent to the full wages. Benefits is paid
for Sundays also.
• Medical Bonus
 Medical Bonus is lump sum payment made to an Insured
woman or the wife of an insures person in case she does not
avail medical facility from an ESI hospital at the time of
delivery of a child. This bonus of Rs. 250/- has been increased
to Rs. 1000/- from 1st April 2003
•
Disablement Benefit …
 a). Temporary disablement benefit :
 In case of temporary disability arising out of an employment
injury or occupational disease.,
 Disablement benefit is admissible to insured person for the
entire period so certified by an Insurance Medical officer /
Practitioner for which IP does not work for wages.
 The benefit is not subject to any contributory condition and is
payable at a rate which is not less than 70% of daily average
wages.
 However, not payable if the incapacity lasts for less than 3 days
excluding the date of accident.

Permanent disablement benefit …
• In case an employment injury or occupational disease
results in permanent, partial or total loss of earning
capacity,
•
• Periodical payments are made to the IP for life at a
rate depending on the actual loss of earning
capacity as may be determined and certified by a
duly-constituted Medical Board.
•
• The rates of Disablement Benefits are determined in
accordance with the provisions of Rule 57 of ESI
(Central) Rules, 1991.
Permanent disablement benefit …
• Commutation of periodical payments into

lump sum (one time payment) is permissible
where the permanent disablement stands
assessed as final and daily rate of benefit
does not exceed Rs. 150. per day.
• Commutation of Permanent Disablement
Benefit into lump sum payment is also
allowed in case the total commuted value
does not exceed Rs.10000/- (The ceiling is
now being raised to Rs.30000/-).
Dependants’ Benefit …
• Dependents Benefit is a monthly pension payable to the
eligible dependents of an insured person who dies as a
result of an Employment Injury or occupational disease
• Beneficiaries and Duration of benefit
 a). Widow / widows during life or until remarriage
 b). Legitimate or adopted son until age 18 or if legitimate son
is infirm, till infirmity lasts.
 c). Legitimate or adopted unmarried daughter until age 18 or
until marriage, whichever is earlier, or if infirm, till infirmity
lasts and she continues to be unmarried.
 In the absence of any widow or legitimate child, the benefit is
payable to a parent or grandparent for life, to any other male
dependent until age 18 or to an unmarried or widowed female
dependent until age 18.
Dependants’ Benefit …
• How much …
•
• The total divisible benefit is equivalent to the temporary
disablement benefit rate (roughly 70% of the wage rate). The
widow / widows share 3/5th of the benefit and the legitimate
or adopted son and daughter 2/5th each of the benefit. If the
total benefit so divided exceeds the full rate, there is a
proportionate reduction in the respective shares of the
beneficiaries.
• The amount of pension paid to the dependents of a deceased
insured person is reviewed vis-à-vis the cost of living index
and increases are granted from time to time to compensate for
erosion in its real value.


Other Benefit …
(i).
• Funeral Expenses
•
Funeral Expenses are in the nature of lump sum
payment up to a maximum of Rs.2500/- made to
defray the expenditure on the funeral of deceased
IP. The amount is paid either to the eldest surviving
member of the family or, in his absence, to the
person who actually incurs the expenditure on the
funeral.

ESI Benefits

Uploaded by

Copyright:

Available Formats

ESI Benefits

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

ESI Benefits

Uploaded by

Copyright:

Available Formats

ESI benefits

• Non – seasonal Factories using power in

 1. Medical Benefit – for self & Family

dependants or the persons hereinafter mentioned, as the case may

• Medical Benefit means Medical care of IPs and their families,

• Out-door medical care is provided at the state Insurance

• Insured worker and members of his family are eligible for

• Sickness signifies a state of health necessitating

• To qualify for this benefit, contributions should have

• Maternity Benefit is cash payable to an Insured

• Commutation of periodical payments into

You might also like