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12-09-2018 1
Objective of Employees State Insurance Scheme
The ESI scheme is an integrated measure of “SocialInsurance” through Employees’ State Insurance Act1948, and is designed to complete the task ofprotecting “Employees” as defined in the ESI Act –1948, against the hazards of Sickness, Maternity,Disablement or Death due to Employment Injuryand to provide full Medical care to insured personsand their family.
12-09-2018 2
Applicability of the ESI Act:
• Section 2 (12) – Applicable to “Factories” employing 10 ormore persons irrespective of whether power is used in theprocess of manufacturing or not.
• Section 1 (5) – Extended to Shops, Hotels, Restaurants,Cinemas, Road motor transport undertakings and Newspaperestablishment employing 20 or more persons.
• Also extended to Private Medical institution and Educationalinstitutions employing more than 20 persons in certain states
• Existing wage limit for coverage under the Act is Rs,21000/- permonth (excluding remuneration for overtime) w.e.f 01st January201712-09-2018 3
Employee DefinitionSection 2 (9) “ employee ” means any person employed for wages in or in connection with the work of a factory orestablishment to which this Act applies and —
(i) who is directly employed by the principal employer on any work of, or incidental or preliminary to or connectedwith the work of, the factory or establishment, whether such work is done by the employee in the factory orestablishment or elsewhere ; or
(ii) who is employed by or through an immediate employer on the premises of the factory or establishment or underthe supervision of the principal employer or his agent on work which is ordinarily part of the work of the factoryor 3 establishment or which is preliminary to the work carried on in or incidental to the purpose of the factory orestablishment ; or
(iii) whose services are temporarily lent or let on hire to the principal employer by the person with whom the personwhose services are so lent or let on hire has entered into a contract of service; [and includes any personemployed for wages on any work connected with the administration of the factory or establishment or any part,department or branch thereof or with the purchase of raw materials for, or the distribution or sale of theproducts of, the factory or establishment; [or any person engaged as an apprentice, not being an apprenticeengaged under the Apprentices Act, 1961 (52 of 1961), [and includes such person engaged as apprentice whosetraining period is extended to any length of time]
but does not include
(a) any member of [the Indian] naval, military or air forces ; or
(b) any person so employed whose wages (excluding remuneration for overtime work) exceeds Rs.21000/-
Provided that an employee whose wages (excluding remuneration for overtime work) exceed Rs.21000/- at any timeafter (and not before) the beginning of the contribution period, shall continue to be an employee until the end ofthat period
12-09-2018 4
FAMILY DEFINITIONSection 2 (11) “ family ” means all or any of the following relatives of an insured person,namely : —
(i) a spouse ;
(ii) a minor legitimate or adopted child dependent upon the insured person
(iii) a child who is wholly dependent on the earnings of the insured person and who is —
a) receiving education, till he or she attains the age of twenty-one years,
b) an unmarried daughter ;
(iv) a child who is infirm by reason of any physical or mental abnormality or injury and iswholly dependent on the earnings of the insured person, so long as the infirmitycontinues
(v) dependant parents,
(vi) in case the insured person is unmarried and his or her parents are not alive, a minorbrother or sister wholly dependant upon the earnings of the insured person
12-09-2018 5
WAGES DEFINITION
Section 2 (22) “ wages ” means all remuneration paid or payable in cashto an employee, if the terms of the contract of employment, express orimplied, were fulfilled and includes [any payment to an employee inrespect of any period of authorised leave, lock-out, strike which is notillegal or layoff and] other additional remuneration, if any, [paid atintervals not exceeding two months], but does not include —
(a) any contribution paid by the employer to any pension fund orprovident fund, or under this Act ;
(b) any travelling allowance or the value of any travelling concession ;
(c) any sum paid to the person employed to defray special expensesentailed on him by the nature of his employment ; or (d) anygratuity payable on discharge12-09-2018 6
Exempted Employee
In respect of employees whose average daily wages is less than
Rs.100 per day, the employee’s share need not be paid.
However, the employer’s share (4.75% of the wages) need to be
paid.
12-09-2018 7
WHO IS A PRINCIPAL EMPLOYER?(A) In the case of a factory, any of the following:-
(i) Owner;
(ii) Occupier;
(iii) Managing Agent of the owner or occupier;
(iv) Legal representative of a deceased owner or occupier;
(v) Manager of the factory under the Factories Act, 1948.
(B) In the case of Establishments belonging to or under the control of Government of India:
(i) The Specified Authority
(ii) The Head of the Department (In the absence of specified Authority).
(C) In the case of other establishments:
Person responsible for the supervision and control of the establishment.12-09-2018 8
IMMEDIATE EMPLOYER
Immediate Employer can be any or all of the following:-
(i) One who executes any work inside the premises of the principal employer of
a factory or an establishment;
(ii) One who executes the work of a factory or establishment outside the
premises under the supervision of its principal employer or his agent;
(iii) One who lets on hire the services of his employees to the principal employer
of a factory or establishment; and
(iv) A Contractor (Sec. 2(13)).12-09-2018 9
ESI Contribution Share
Employe’s ESI Contribution
1.75% of Gross Salary
Employer’s ESI Contribution
4.75% of Gross Salary
Total ESI Contribution
6.5% of Gross Salary
12-09-2018 10
The State governments, as per the provisions of the Act, contribute 12.5% ofexpenditure on medical care on ESI beneficiaries in their respective Stateswithin the per capita ceiling.
ESI Wage Ceiling Amendment dates
12-09-2018 11
500 1000 16003000
65007500
10000
15000
21000
0100020003000400050006000700080009000
10000110001200013000140001500016000170001800019000200002100022000230002400025000
1974 1975 1984 1992 1-Jan-97 1-Apr-04 1-Oct-06 1-May-10 1-Jan-17
Contribution period and Benefit period
CONTRIBUTION PERIOD
1st April 2017 to
30th September 2017
BENEFIT PERIOD
1st January 2018 to
30th June 2018
1st October 2017 to
31st March 2018
1st July 2018 to
31st December 2018
Benefit period starts 3 months after the end of each contribution period
12-09-2018 12
ESI COVERAGE, IF EMPLOYEE’S WAGES EXCEED WAGE CEILING DURING CONTRIBUTION PERIOD
Calendar Months April 2017 May 2017 June 2017 July 2017 August 2017 September 2017
Gross Wages 20000/- 20000/- 22000/- 22000/- 22000/- 22000/-
ESI Wages 20000/- 20000/- 22000/- 22000/- 22000/- 22000/-
12-09-2018 13
Calendar Months October 2017
November2017
December 2017
January 2018
February2018
March 2018
Gross Wages 20000/- 20000/- 22000/- 22000/- 22000/- 22000/-
ESI Wages 20000/- 20000/- 22000/- 22000/- 22000/- 22000/-
CASE -1
CASE -2
Even if the employee’s wage crosses the ESI wage ceiling of Rs,21000/- in between contribution period, the ESI coverage shall be till end of the respective
contribution period.
ESI CONTRIBUTION IN RESPECT OF OVERTIME WAGES
12-09-2018 14
Calendar Months
April 2017 May 2017
June 2017 July 2017 August 2017
September 2017
Gross Wages 24000/- 24000/- 22000/-(Due to Loss of Pay}
24000/- 24000/- 24000/-
ESI Coverage Exempted Exempted Exempted(Notional Wage is 24000/-)
Exempted Exempted Exempted
CASE -3
Calendar Months October 2017
November2017
December 2017
January 2018
February2018
March 2018
Gross Wages 20000/- 20000/- 20000/- 20000/- 20000/- 20000/-
Overtime Wages 500/- 2000/- 5000/- NIL 3000/- 8000/-
ESI coverage Covered Covered Covered Covered Covered Covered
ESI Wages 20500/- 22000/- 25000/- 20000/- 23000/- 28000/-
CASE - 4
WHAT ARE CONSIDERED/ NOT CONSIDERED AS ESI WAGES
SlNr
Description of Allowance
Whether contribution payable or not
1. Washing Allowance Not treated as wages
2. Annual Bonus Not treated as wages
3. Incentive Bonus Not treated as wages provided the periodicity of payment is > 2 months
4. Production Bonus Not treated as wages provided the periodicity of payment is > 2 months
5. Inam Not treated as wages provided the periodicity of payment is > 2 months
6. Annual Commission Not treated as wages
7. Conveyance Allowance Not treated as wages under Section 2 (22) of the ESI ActM/s.Hyderabad Asbestos Cement Products Vs. ESIC, Punjab & Haryana High Court, Chandigarh & M/s.Harihar Polyfibres, the Supreme Court, Mgmt Oriental Hotels Vs ESI 2002-I-LLJ-14
8. Service Charges Not treated as wages
9. Newspaper allowance Not treated as wages if the cost of Newspapers is reimbursed to the employee.
10 Education Allowance If paid monthly for the children studying in the Schools/Colleges, the same is to be considered as wages under Sec.2(22) of the ESI Act and the contribution is chargeable on the said amount.However, in such cases where instead of paying the education allowance on monthly basis, the amount spent as fee is reimbursed to the employees and booked under education allowance, in such cases no contribution is payable.12-09-2018 15
WHAT ARE CONSIDERED/ NOT CONSIDERED AS ESI WAGES
SlNr
Description of Allowance
Whether contribution payable or not
11. Tiffin/Food/Milk/Lunch Allowance
If paid in cash at a fixed rate irrespective of attendance of the person will be treated as wages. But, if it is paid based on attendance of the employee it may not be treated as wage. Likewise if it is paid in kind i.e. canteen subsidy/food subsidy etc. may not be treated as wages.
12. Ex – gratia payment during strike for travelling expenses
Amount will neither be considered as wage under Sec.2(9) nor under Sec.2(22) of the ESI Act High Court of Bombay in the case of ESIC Vs. Willman (India) (P) Ltd. in case No.210 of 1976, held the same view.
13. Saving Scheme Certain factories/establishments contribute towards the saving scheme for the welfare of the workers. Such amount, will not constitute wages under Sec.2(22) of the ESI Act and contribution is not payable.
14. Attendance Bonus Not treated as wages provided the periodicity of payment is > 2 months
15. Loading & Unloading charges when they are employees of Truck operators
Not treated as wages
16. Servicing of Machines/ Service Contract
Not treated as wages
17. Payment to consultants Not treated as wages12-09-2018 16
WHAT ARE CONSIDERED/ NOT CONSIDERED AS ESI WAGES
SlNr
Description of Allowance Whether contribution payable or not
18. Payment for unavailed leave at time of discharge Not treated as wages
19. Fuel Allowance/ Petrol Allowance Not treated as wages
20. Entertainment Allowance Not treated as wages
21. Shoe Allowance Not treated as wages
22. Gratuity on discharge or retirement Not treated as wages
23. Payment made for encashment of leave Not treated as wages
24. Suspension/ Subsistence Allowance Supreme Court has held in the case of RD, ESIC Vs.M/s.PopularAutomobiles judgment dt. 29.9.97 in Civil appeal no.3850/ 1993 that ‘suspension/subsistence allowance is wage and contribution is payable under Sec.2 (22) on the said amount’.
25. Overtime Considered as Wage
26. Wages paid during Lay off Considered as Wage
27. House Rent Allowance Considered as Wage
28. Night Shift/ Heat/ Dust Allowance Considered as Wage
29. Medical Allowance Considered as Wage12-09-2018 17
WHAT ARE CONSIDERED/ NOT CONSIDERED AS ESI WAGES
SlNr
Description of Allowance Whether contribution payable or not
30. Driver’s Allowance Considered as Wage
31. Gazetted Allowance Considered as Wage
32. Wages & DA for unsubstituted holidays Considered as Wage
33. Matinee Allowance Considered as Wage
34. Shift/ Plant Allowance Considered as Wage
35. Location/ Machine Allowance Considered as Wage
36. Compensatory Allowance Considered as Wage
37. Cash Handling Allowance Considered as Wage
38. Supervisory Allowance Considered as Wage
39. First Aid Allowance/ Training Allowance Considered as Wage
40. Canvassing Allowance Considered as Wage
41. Personal/ Special Allowance Considered as Wage
42. Computer/ Photocopier/ Printer Allowance Considered as Wage
43. Honararium to look after hospital/ dispensary Considered as Wage 12-09-2018 18
CONVEYANCE ALLOWANCE NOT WAGES CASE LAWManagement of Oriental Hotels, Ltd. v. Employees' State Insurance Corporation 2002-I-LLJ-14 (Mad-DB) while dealing with the definition of
"wages" with reference to payment of HRA and conveyance allowance, held as follows:
"In so far as the conveyance allowance is concerned, even though it forms part of the wages being the amount payable in terms of the
contract of employment, having regard to the settlement and even de hors the settlement, the payment of the amount would fall within the
ambit of 'additional remuneration.' Nevertheless, that amount will have to be excluded having regard to the specific exclusion provided in
the definition itself for travelling allowance or the value of any travelling concession. The conveyance allowance paid is in the nature of
travelling allowance as the object of that payment is to enable the employee to reach his place of work and to defray a part of the cost
incurred on the travel from his place of residence to the place of work. If instead of paying the conveyance allowance, the employer had
provided free transport to the employees, the monetary value of that benefit of free travel from his residence to the place of work would not
have been capable of being regarded as forming part of the wages. The conveyance allowance paid in cash for the purpose of being utilised
on the travel from place of residence to the place of work, is of the same character and there is no reason why it should not be regarded as
travelling allowance for the purpose of Section 2(22)(b) of the Employees' State Insurance Act."
From the above said decision, it is clear that though such a payment towards conveyance allowance falls within the ambit of additional
remuneration, it will come under the exclusion clause as provided under the above said definition. The conveyance allowance paid to the
employees for the purpose of being utilised on the travel from the place of residence to the place of work has to be construed as travelling
allowance and thereby it cannot be construed as wages, as travelling allowance has been excluded from the purview of the said definition.
We agree with the said decision reported (supra), and so the Employees' Insurance Court is correct in holding that the conveyance allowance
cannot be construed as "wages" and the respondents are not liable to pay contribution taking into consideration the said amount as
"wages."
12-09-2018 19Meaning of de hors : other than, not including, or outside the scope of.
BENEFITS UNDER ESI
12-09-2018 20
Sickness Benefit
Disablement Benefit
DependantBenefit
Funeral Benefit
Medical Benefit
Maternity Benefit
Extended Sickness Benefit
Enhanced Sickness Benefit
Temporary Disablement Benefit
Permanent Disablement Benefit
Rajiv Gandhi ShramikKalyan Yojana
(Unemployment Allowance)
Incentive for employers for
employing persons with disabilities
Medical care for retired IP’s
DISABLEMENT BENEFIT
Temporary disablement benefit (TDB) : From dayone of entering insurable employment &irrespective of having paid any contribution incase of employment injury. TemporaryDisablement Benefit at the rate of 90% of wage ispayable so long as disability continues.
Permanent disablement benefit (PDB) : Thebenefit is paid at the rate of 90% of wage in theform of monthly payment depending upon theextent of loss of earning capacity as certified by aMedical Board12-09-2018 21
DEPENDANT BENEFITIn case of death, as a result of employment injury, the dependants of an insured personare eligible for periodical payments. Pension at the rate of 40% more than the StandardBenefit Rate will be paid periodically to
1) Widow: Till death or re-marriage at 3/5th of the full rate.
2) Widowed mother till death @ 2/5th of the full rate.
3) Sons @ 2/5th of the full rate each till he attains the age of 25 years.
4) Unmarried daughters@ 2/5th of the full rate till they get married.
5) If the son/ daughter is infirm and wholly dependant on the earnings of the insuredperson at the time of his death, they continue to receive the benefit even afterattaining the age of 25 years/marriage as the case may be. If the total dependants’benefit for all the dependants worked out as above exceeds at any time, the full rate,the share of each of the dependant s shall be proportionately reduced, so that the totalamount payable to them does not exceed the amount at full rate.
ESI Corporation has enhanced the minimum pension to Rs.1200/- per family.12-09-2018 22
MATERNITY BENEFITSection (6A) Insured woman means a woman who is or was an employee in respect of whomcontribution is or were payable under the Act and shall include
i) A “Commissioning mother” who as biological mother wishes to have a child and prefers to get theembryo implanted in any other woman is entitled to Maternity benefit as per provisions of theact.
ii) A woman who legally adopts a child upto three months of age.
In Central Rule 56 (sub Rule 2) of the Principle Act Maternity benefit shall be twenty six weeks of whichnot more than eight weeks shall precede the expected date of confinement.
An insured woman having two or more than two surviving children shall be entitled to receivematernity benefit for a period of twelve weeks of which not more than six weeks shall precede theexpected date of confinement.
Payment of contribution for not less than 70 days in the immediately preceding two contributionperiods.
Benefit payable at almost 100% of average daily wages.12-09-2018 23
MATERNITY BENEFIT - ContinuedConfinement should actually occur or expected to occur in a benefit period relevant to the insured woman, i.e., ifshe actually confines or expected to confine before the start of the first benefit period, is not entitled to claim,even though, a part of the maternity leave will fall within her first benefit period.
If an insured woman’s actual date or expected date of confinement, falls within her first benefit period, she willbe entitled to maternity benefit even if a part of the maternity leave may fall before the start of the first benefitperiod.
12-09-2018 24
FIRST BENEFIT PERIOD OF THE INSURED PERSON
September2017
October 2017
November 2017
December 2017
January 2018
February 2018
March 2018
April 2018
May 2018
June 2018
Confinement before first benefit period
FIRST BENEFIT PERIOD OF THE INSURED PERSON
September2017
October 2017
November 2017
December 2017
January 2018
February 2018
March 2018
April 2018
May 2018
June 2018
Confinement within first benefit period
Confinement Expenses for confinement taking place outside ESI Dispensaries/Hospital isRs.5,000/-
MEDICAL BENEFIT “Full Medical Care" including hospitalisation, free ofcost, to the Insured Persons in case of sickness,employment injury and maternity.
Employees and their dependants are administeredmedical care, through ESI dispensaries, hospitals, etc;in case the requisite facilities are not available in theESI hospitals, the employees are referred to premierprivate / government hospitals for medical treatmenton ‘cashless’ basis. The employees / dependants ofthe employees are also entitled for super specialtytreatment, without any ceiling on the cost of medicaltreatment.
12-09-2018 25
MEDICAL BENEFIT - CONTINUEDInsured persons and their dependants are entitled to full medical care from day one of taking up employment The scheme provides full range of medical care, namely;
Out – patient services
Diagnostic services
Specialists services
Hospital service through a network of ESI dispensaries,diagnostic centers and ESIC Hospitals.etc
The package covers all aspects of health care from primary to super-specialist facilities as detailed below:-
Outpatient treatment
Domiciliary treatment
Super-specialty treatment
Specialist consultation and diagnostic facilities
In-Patient treatment
Free supply of drugs and dressings
X-ray and laboratory investigations
Vaccination and preventive inoculations
Ante-natal care, confinement and post natal care
Ambulance Service or conveyance charges for going to hospitals, diagnostic centers, etc. wherever admissible
Free diet during admission in hospitals
Free supply of artificial limbs, aids and appliances for physical rehabilitation
Family welfare services and other national health program services
Medical certification12-09-2018 26
SUPER SPECIALITY TREATMENT
Contribution status Eligibility
Contributed for 80 days during contribution period from 1.10.03 to 31.3.04
YES for spell of sickness falling in benefit period from 1.7.04 to 31.12.04, since Sickness Benefit is admissible during the period.
Contributed 76 days during the above period NO for spell of sickness falling in the above period, since Sickness Benefit is not admissible during the period.
12-09-2018 27
Condition (A) – Insured person should have contributed for not less thatn 78 days during the correspondingcontribution period and should thus be eligible for sickness benefit, during the relevant benefit period (in whichthe spell of sickness requiring speciality treatment falls)
Condition (B) – In the case of a new entrant (into insurable employment), insured person and/or his familywill not be eligible for speciality / super speciality treatment , till start of first benefit period irrespectiveof payment of contribution for not less than 78 days in the relevant /current contribution periodContribution status Eligibility
Contributed for 79 days in the first contribution period from 01.01.04 to 31.3.04 (date of entry into insurable employment being 01.01.04)
NO till 30.9.04 since benefit period starts from 1.10.04 only.(Normal OP/IP medical facilities will however be available for insured person / family from 01.01.04 itself)
Contributed for 79 days in the first contribution period from 01.01.04 to 31.3.04 (date of entry into insurable employment being 01.01.04)
YES for spell of sickness falling in benefit period from 1.10.94 to 31.12.04.
SUPER SPECIALITY TREATMENT - CONTINUED
12-09-2018 28
Condition (C) – All arising cases including emergent / outstation cases, are subject to medical/specialist opinion by ESI Hospital andconfirmation of title to medical benefit by ESI Corporation.Beneficiaries covered by medical scheme under Rule 60 & 61 of the ESI (Central) Rules 1950 are not eligible for speciality/ super specialityfacilities, since they do not qualify for Sickness Benefit at any stage.
Rule 60 : Medical benefits to insured person who ceases to be in an insurable employment on account of disablement caused due to anemployment injury.Rule 61 : An insured person who leaves the insurable employment on attaining the age of superannuation or retires under a VoluntaryRetirement Scheme or takes premature retirement after being insured for not less than five years
Family of a deceased insured person, who is not entitled for sickness benefit at the time of death, is not eligible for speciality / super speciality treatment.
Super speciality treatment includes Open Heart Surgery, Neuro Surgery, Bone Marrow Transplant, Kidney Transplant or specialized investigations like CAT scan,MRI, Angiography etc.Referral arrangements have been made with the reputed, premier hospitals of the country. The total cost of such treatment, diagnostic facilities or surgicalintervention is borne by the ESI Scheme.
Though medical care is provided, by and large, to the beneficiaries in modern system of medicine (Allopathic), facilities in indigenous systems such as (i) Ayurveda(ii) Unani (iii) Homoeopathy & Siddha are also being provided to the insured persons, on demand in many areas.
A newly registered employee is entitled to avail super speciality treatment for self on completion of three months of service ininsurable employment and contribution should have been paid/ payable for not less than 39 days during that period,
A newly registered employee’s dependants are entitled to avail super speciality treatment on completion of six months ofservice in insurable employment and contribution should have been paid/ payable for not less than 78 days during that period.
SICKNESS BENEFITSickness Benefit represents periodical cash payments made to an IP during the period of certified sickness occurring in a benefit period when IP
requires medical treatment and attendance with abstention from work on medical ground provided contributions should have been paid for not less
than 78 days in the corresponding contribution period. Prescribed certificates are Forms 8,9,10,11 & ESIC-Med.13. Sickness benefit is roughly 50% of
the average daily wages and is payable for 91 days during 2 consecutive benefit periods.
i) Extended sickness Benefit:
In addition to 91 days of sickness benefit, insured persons suffering from certain long-term diseases are entitled to extended sickness benefit for 34
diseases.
ii) Enhanced Sickness Benefit:
The ESI Corporation has also extended additional cash incentive to insured persons to promote acceptance of sterilization method by providing
sickness cash benefit equal to full wage for a period of 7 days for vasectomy and 14 days for tubectomy. The period for which cash benefit is
admissible is extended beyond the above limits in the event of any complications after Family Planning operations.
Benefit payable for 14 days for tubectomy and 7 days for vasectomy.
For post operative complications of tubectomy, benefit can be extended by the appropriate authority beyond 21 days.
Benefit is payable @ 100% of average daily wages.12-09-2018 29
FUNERAL BENEFITA lump sum payment towards expenditure on the funeral of a deceased insuredperson is paid either to the eldest surviving member of the family or if he has nofamily or not residing with his family at the time of death, to the person whoactually performs the funeral of the deceased insured person.
The funeral expenditure can be claimed subject to the following :-
The insured person should have been an insured person at the time of his/herdeath.
There is no contributory condition for admissibility to this benefit but should beentitled at least to medical benefit on date of death.
The dependents of an insured person in receipt of Permanent Disablement Benefit,even though may not have been in insurable employment at the time of death, canclaim funeral expenditure.
The actual amount incurred or a maximum amount of Rs.10,000/- whichever is less,is payable to the claimant based on proof of death of insured person.
12-09-2018 30
Rajiv Gandhi Shramik Kalyan Yojana – RGSKY (Unemployment Allowance)
An insured person can claim unemployment allowance under this scheme subject to the following situations –
He / she is rendered unemployed due to retrenchment or closure of an factory/establishment as defined under the Industrial Disputes Act, 1947
Due to permanent invalidity above 40% arising due to non-employment injury and which is duly certified by a Medical Board duly constituted by the
State or Central Government.
The insured person is required to fulfil the following criterion to claim the allowance:
The applicant should have been an insured person as per the ESI Act as on the date of loss of employment due to retrenchment, closure or permanent
invalidity arising out of nonemployment injury.
Contributions should have paid payable for a minimum period of three years prior to the loss of employment
Should have paid 156 days or more in any two consecutive contribution periods which are to be reckoned.
Claim should be submitted within 9 months from the date of being rendered unemployed.
The benefit is payable for a maximum period of twelve months during their entire life time.
Entitled to medical benefit along with their dependent family members during the period from ESI Hospital/dispensaries, panel doctors to which they
were attached prior to loss of employment.
Benefit is payable @ 50% of the average daily wages.12-09-2018 31
Rehabilitation of IP rendered unemployed
The insured person entitled to this skill development scheme
should be in receipt of unemployment allowance under RGSKY.
The duration of the course is for a maximum period of six months
and within the period when they are receiving unemployment
allowance.
Should not go beyond the last date of receipt of RGSKY
Training is admissible only once in the entire life time.12-09-2018 32
Old Age Medical CareFor retired employee and spouse on payment of Rs.120 per year; the beneficiaries are entitledto all medical facilities available in ESI hospitals
a) An insured person who ceases to be in insurable employment on account of permanentdisablement can receive medical benefit till the date on which he would have vacatedemployment on attaining the age of superannuation had he not sustained such permanentdisablement.
b) An insured person who has attained the age of superannuation or retires under voluntaryretirement scheme or takes premature retirement and their spouse can avail medicaltreatment.
The above insured persons can avail the benefit subject to the following eligibility criteria :
• Should have been an insured person on the date of leaving employment due tosuperannuation, voluntary retirement or premature retirement.
• Submits proof that he has remitted contributions for not less than 5 years.
• No other member of the family other than the spouse shall be eligible for this benefit.
• Entitled to medical facilities as if he is a regular insured person, except that super specialitytreatment will be not be admissible to such a person and his spouse.
• On the death of insured person, the spouse will be entitled to medical care upto the date theinsured person would have been entitled had he/she been alive.
12-09-2018 33
BENEFITS NOT TO BE COMBINEDAn insured person shall not be entitled to receive for the same period
(a) both sickness benefit and maternity benefit ; or
(b) both sickness benefit and disablement benefit for temporary disablement.
(c) both maternity benefit and disablement benefit for temporary disablement.
12-09-2018 34
VOCATIONAL REHABILITATATION SCHEME• Vocational Rehabilitation Scheme for disabled IPs is provided to
insured persons whose loss of earning capacity resulting fromemployment injury has been assessed as not less than 40% asper the Second Schedule to the Act and for scheduled as well asnon-scheduled injuries resulting from and employment injury.Subject to the following :-
• Should be in receipt of PDB• Should not be in any gainful employment
• Should not be more than 45 years of age as on the date of hisapplication A cash allowance of Rs.123/-per day will be paid bythe centre/vocational rehabilitation centre during the period oftraining and conveyance /journey fare by second classrailway/bus whoever is applicable will be paid.
12-09-2018 35
Contributions in respect of arrears of wages
12-09-2018 36
As and when any increase in the wages/ remuneration isdeclared with retrospective effect, the liability towardspayment of contribution accrues only in the month inwhich the decision is announced and no contribution ispayable on the arrears pertaining to the period prior tothe month of declaration/ announcement
ESI Scheme Medical Benefit Versus MediclaimCommercial Medical Insurance ESI Scheme – Medical Benefit
Commercial motive Welfare motive
Premium based on age, sum insured & claims experience
Uniform rate of contribution for all age groups
Medical check up required for certain persons No medical checkup required for any one
Ceiling on overall benefit (sum insured) as well as compartmental limits
No limit on medical benefit
Exclusions prescribed No exclusions
Extra premium for covering family of insured person (IP)
Family members of IP covered at no extra cost
Only Medical benefit Many benefits in addition to medical benefit
Choice of class of treatment (General ward, private, semi private ward etc)
No choice of class of treatment – Only general ward
12-09-2018 37
OBLIGATION OF EMPLOYERS
12-09-2018 38
Complete the Registration process within 15 days after the Act becomes applicable.
Submit Form – 01 to the Regional office or apply through Online to get the Registration Number under this Act.
Responsibilities
Generate TIC & handover to the employee for Smart Card.
Maintain an Accident Book in Form – 11 (under Regulation 66)
Submit an Accident Report in Form – 16 within 24 hours of Accident.
Grant leave to insured employees on the basis of sickness certificates
Records Maintenance
Register of Employees in Form – 6 (under Regulation 32)
Accident Bok in Form – 11 (under Regulation 66)
Inspection Book (under Regulation 102A)
File for copies of return of declaration forms
File for copies of Return of Contributions, Challans etc
File for general correspondence and copies of Accident Reports.
COMPLIANCE CALENDAR FOR ESI
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CALENDAR MONTH DATES ACTIVITY
JANUARY 15th ESI monthly ECR
FEBRUARY 15th ESI monthly ECR
MARCH 15th ESI monthly ECR
APRIL 15th ESI monthly ECR
MAY 15th ESI monthly ECR
12th ESI Half Yearly return
JUNE 15th ESI monthly ECR
JULY 15th ESI monthly ECR
AUGUST 15th ESI monthly ECR
SEPTEMBER 15th ESI monthly ECR
OCTOBER 15th ESI monthly ECR
NOVEMBER 15th ESI monthly ECR
11th ESI Half Yearly return
DECEMBER 15th ESI monthly ECR
OMITTED WAGES - INTEREST & DAMAGES AS PENALTY
Under Section 39 (5) of ESI Act read with Regulation 31 (A) of ESI (General) Regulations 1950,
the employer is liable to pay simple interest @ 15% per annum in respect of each day of
default or delay in payment of contributions. In addition, under the Provision of Regulation 31
– C of ESI (General) Regulations, 1950, read with 85 (B) (i) of ESI Act, the Corporation is
empowered to recover damage as under:
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Period of delay in payment of Contribution Rate of Damages on the amount due
i) Upto less than 2 months 5%
Ii) 2 months & above but less than 4 months 10%
iii) 4 months & above but less than 6 months 15%
iv) 6 months & above 25%
WORK PERMIT SYSTEM – ESI COMPLIANCE
EMPLOYEES
He/ She is on rolls & covered under ESI
Ensure payment of ESI contribution
He/ She is on contractor rolls & covered under ESI
If contractor has ESI code, ensure he remits ESI in respect of that
employee
If contractor has no ESI code, remit ESI for that employee
under your code
Contractor carries out job work at your premises by employing
workers
If contractor has ESI code, ensure he remits ESI in respect of that
employee
If contractor has no ESI code, obtain split up of contractual
amount (Material + Labour). Get bills for materials & remit ESI for
labour content
He/ She will carryout AMC jobs
If he is covered under ESI by his employer, obtain his ESI Penchancard photocopy & have it in your
file.
If his employer has no ESI code, obtain split up of AMC amount
(Material + Labour) & get declaration form before he
commences work & remit ESI for Labour charge
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