The Act provides for medical attendance and treatment (in kind), cash benefits during sickness, maternity and employment injury, pension for dependants on the death of workers due to employment injury and funeral towards expenses on funeral of insured person.. Wherever the E.S.I. Scheme is extended the employers are absolved of their liability under the Employees’ Compensation Act, 1923 and under the Maternity Benefit Act, 1961 from the date from which maternity benefit becomes payable under the E.S.I. Act.
1. Applicability
a.
All factories excluding seasonal factories employing 10 or more persons.
b.
An Establishment covered under the Shops & Establishments Act, 1948 employing 20 and more coverable employees for carrying out the business activity.
Note :- Coverable employees means employee drawing Gross Salary upto & including 15,000/- (w.e.f. 1st May, 2010).
c.
Once Act applies, it continues to apply even if employment strength falls below the statutory limit.
Note:- As soon as the above conditions are fulfilled the employer should furnish details in Form- 01 to ESI office for registration under the ESI act , 1948 & Obtaning of the employer’s Code No.
2. ELIGIBILITY
a.
Any person employed for wages (upto 15,000/-) a month, excluding remuneration for overtime work in or in connection with the work of a factory or establishment.
b.
Any person who is directly employed by the employer in a factory or through his agent on work which is ordinarily part of the work of the factory or incidental to purpose of the factory.
c.
Any person who is classified as disabled employee and working in the private sector, with monthly wages upto 25,000/- per month provided they are appointed on or after 01.04.2008.
3. REGISTRATION OF FACTORY / ESTABLISHMENT (EMPLOYER)
Fill up Form O1 correctly and forward it to the Regional Office of your area within 15 days of the date of coverage/extension of the Scheme.
4. REGISTRATION OF EMPLOYEES i.e. INSURED PERSON
The Code Number of the Factory/ Establishment having been received from the Regional office and the employees who are coverable under the Act having been identified, the next step is registration of employees of the factory/establishment, registration of employees of branch offices/sales offices/head office. The following points to be kept in mind to fill up Declaration Forms and should be submitted to appropriate office (i.e. Local office allotted for the purpose) within ten days of joining of service by employee.
5. Contribution Period and Corresponding Benefit Period
There will be two contribution periods of six months each in a year in respect of an employee with corresponding benefit period of six months each, as under:-
Contribution Period
Corresponding Benefit
Date ofSubmission of Return
1st April to 30th September
1st January to 30th June of the year following.
11th November
1st October to 31st March
1st July to 31st December of the year following
12th May
In the case of a person who becomes an employee within the meaning of the Act for the first time, the first contribution period will commence from the date he enters into insurable employment for the first time in the contribution period current on that day and his corresponding benefit period will commence on the expiry of nine months from the date of such employment.
Example :If a person joined insurable employment for the first time, say on 5th January 2001, his first contribution period will be from 5th January to 31st March, 2001 and his corresponding first benefit period will be from 5th October, 2001 to 31st December, 2001.
In the case of a new employee, the employer will have to ascertain from the person appointed whether he was previously registered under the ESI Act and, if so, he may be asked to produce the identity card or temporary identification certificate. If he so produces the same, no fresh Declaration Form is required to be filled-in, in respect of such person and the insurance number already allotted will hold good.
Note: W.e.f.01.04.2008, before filing the Return in Form-5 (Return of Contribution) with the ESI authorities, based on the no. of employees, employer has to certify the return as under;
1.The Employers employing 40 and more employees shall have to append a certificate duly certified by a Chartered Accountant,
2. The Employers employing less than 40 employees will have to provide self-certification without any certification from the Chartered Accountants in Return of Contributions.
The Scheme is based on the principle of single contribution, single administration for comprehensive package of social security benefits that include:
Medical Benefit
Sickness Benefit
Maternity Benefit
Employment Injury Benefit
Temporary Disablement benefit
Permanent Disablement benefit
Dependants' benefit.
In addition, the scheme also provides some other need based benefits to insured workers. These include :
Funeral expenses
Rehabilitation allowance.
Vocational Rehabilitation.
Old age medicare
E.S.I. Benefits at a glance
Benefit
Contributory conditions
Duration
Rate
To whom Payable
1
(a) Sickness Benefit
(b) Extended Sickness Benefit for
long term diseases like
TB, Leprosy etc.
(c) Enhanced Sickness Benefit
(for undergoing sterilization operation for family Planning)
I.P. should work for wages for 78 no of days, in the corresponding C.P (w.e.f 19.9.98)
In insurable employment for at least two years. Should pay contribution for minimum of 156 days in the preceeding 4 C. P’S
Same as for Sickness Benefit at (a)above
91 days in any two consecutive B.P.
309 days duration has been extended beyond 400 days (91 days S.B plus 309 days E.S.B) to two years in deserving cases.
7 days for vasectomy & 14 days for tubectomy extended in cases of post-operative complications etc.
As per
S.B.R
40% above
S.B.R.
Twice the
S.B.R.
Only to the Insured Person.
Only to the Insured Person.
Only to the Insured person.
2.
Disablement Benefit
(Employment injury)
No condition
In case of temp. disablement: as long as incapacity lasts & in case of permanent disablement: for life time.
(a) For
temporary
Disablement,40% above
S.B.R.
Only to the
Insured
Person.
(b) For Permanent Total Disablement specified in PART-1 of 2nd Schedule at the FULL RATE of TDB
(c) For permanent partial Disablement resulting from an injury specified in Part-II of the 2nd Schedule at such %age of the FULL RATE as specified in the said schedule as being the %age of the loss of earning capacity caused by the injury.
(d) For permanent partial Disablement resulting from an injury not specified in Part-II of the 2nd schedule at such %age of the FULL RATE payable in the case of Permanent Total Disablement as is proportionate to the loss of earning capacity permanently caused by the injury.
EXPLANATION
Where more injuries than one are caused by the same accident, the rate of benefit payable under clauses (c) & (d) shall be aggregated but not so in any case as to exceed the FULL RATE and in cases of disablement not covered by clauses (a),(b),(c), & (d) at such rate, not exceeding the FULL RATE, as may be provided in the regulations.
3.
Dependents' benefit
(Employment injury)
No condition
1.To the widow/s during life time until remarriage.
2. To the widowed Mother.
To the legitimate or adopted SON/S until he attains the age of 18 years
To the legitimate or adopted unmarried Daughter/s until she attains the age of 18 yrs. or until marriage whichever is earlier.
(In case the deceased person does not leave a widow or legitimate or adopted child. D.B. shall be payable to .....
a) Parent or grand parent, for a life.
b) Any other male dependent, until he attains the age of 18 yrs.
c) Any other female dependent, until she attains the age of 18 yrs. or until marriage whichever is earlier.
3/5th of the FULL RATE, if there are 2 or more widows, the amount payable to the widow shall be divided equally between the widows.
2/5 of the FULL RATE, if there are 2 or more sons, the amount payable to the son shall be divided equally between the sons.
Subject to minimum of 14/-.
--------------- do ----------------
3/10th of the FULL RATE
2/10th of the FULL RATE
--------------- do ----------------
N.B.:-An insured person whose PERMANENT DISABLEMENT has been assessed as final and who has been awarded permanent disablement benefit at a rate not exceeding 5.00 per day may apply for a lump-sum payment and such amount shall be determined by multiplying the daily rate of permanent disablement benefit by the figure indicated in Col.2 of the Schedule III of the Regulations.
4.
Maternity Benefit
Payment of contribution for 70 days in one or two consecutive periods.
12 weeks of which not more than the 6 weeks can precede the expected date of confinement.
6 weeks for miscarriage or for medical termination of pregnancy. Additional payment for one month for Complications (pre or post) arising out of Pregnancy
Twice the S.B.R. Subject to min of 20/- p.d.
Medical bonus of 2,500/- where ESI hospital facility is not availed for child delivery.
Only to the Insured person.
To insured woman or in r/o wife of I.P
5.
Medical Benefit
No condition
From the date of entry of an employee into an Insurable employment so long as he remains in insurable employment and thereafter for certain additional period.
Full medical care including Hospitalisation.
Insured person as well as his/her Family members as defined u/s 2(11) of the Act.
6.
Funeral Expenses
No condition (i.e. merely by virtue of being an insured person)
One time lump-sum payment
Not more than 5,000/-( w.e.f. 01/09/2009)
To the eldest surviving member of the family of the deceased I.P. or to the person who actually incurs the expenditure on the Funeral of an I.P.
7.
Rehabilitation allowance
No condition
For each day of which I.P. remains admitted in Artificial Limb Centre for fixation, repair or replacement of artificial limb.
Double the Standard Sickness Benefit Rate but not less Full wages.
Only to the I.P.
8.
Medical Benefit to insured persons who ceases insurable employment on account of permanent disablement.
No condition but an I.P. has to pay 10/- pm in lump-sum for one year in advance every year.
Till the date on which an I.P. would have attained the age of superannuation
Medical Benefit to I.P. and spouse.
9.
Rajiv Gandhi Shramik Kalyan Yojana- Unemployment to the IPs who have been rendered unemployed involuntarily due to closure of factory/establishment/retrenchment or permanent disablement
Minimum period of 5 years prior to loss of employment
Maximum period of Six months during the lifetime of I.P.
S.B.R.
Insured Person
10.
Medical Benefit to retired
Insured period.
1) Insurable employment for a period of 3 years and
2) Payment of Contribution @ 10/- pm in Lump-sum for one year in advance, each year.
Till the time yearly contribution is paid to the Concerned Office of the Corporation.
Insured person and his spouse
OTHER BENEFITS
Supply of special aids: Insured persons and members of their families are provided artificial limbs, hearing aids, artificial dentures, spectacles (for insured person only) & artificial appliances like spinal supports, cervical collars, walking calipers, crutches, wheel chairs and cardiac pace makers, dialysis/dialysis with kidney transplant etc. as part of medical care under the ESI Scheme.
An interesting feature of the ESI Scheme is that the contributions are related to the paying capacity as a fixed percentage of the workers wages whereas they are provided social security benefits according to individual needs without distinction.
Table of Standard Benefit Rate (S.B.R.)
Sr.No
Average Daily Wages are
Standard Benefit Rate
1
Below 28.00
14.00 or Full average daily Wages whichever is less
For employees contribution : Imprisonment for 2 years to max. 5 years and/or fine of 25,000/- For employers contribution : Imprisonment for 6 months to max. 3 years and/or fine of 10,000/-
15,000/- (w.e.f. 1st May, 2010). 
