Welcome: Salient Provisions of E.S.I. Benefits and Compliance
Welcome: Salient Provisions of E.S.I. Benefits and Compliance
Welcome: Salient Provisions of E.S.I. Benefits and Compliance
TO A SESSION ON
MEDICAL DEPENDENTS ’
BENEFIT BENEFIT
3
MISC. BENEFITS
•Funeral expenses
•Confinement expenses
•Rehabilitation allowances
ESI Contribution Period and Benefit Period
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.
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
• Can be extended by another 7 days in case of complication in both the above cases.
• Above entitlement over & above the 91 days of entitlement of sickness benefit.
• 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 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).
• Paid her full wages for 26 weeks (182 days) provided she does not join
work during this period.
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.
Rehabilitation allowances
CONCLUSION
Thank You