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Ready Reckoner of ESI Benefits

Posted by: The ADP Team on 13 June 2019 in Compliance, Non classé

(Volume – 42 of Coffee Break Compliance Guide from Anandan Subramaniam)

The ESI Act 1948, the biggest Social Security Benefit from Indian, encompasses certain health related contingencies that the workers are generally exposed to.  The Legislation covers incidents related to worker and their dependants, such as sickness, maternity, temporary or permanent disablement, Occupational disease or death due to employment injury, resulting in loss of wages or earning capacity-total or partial. There are several benefits which are incomparable, made available to the Insured person (worker) and his dependents.

Following is a ready reckoner of all benefits available to Insured Persons and the dependents:

Medical Benefit

  • Entitlement being, the individual should be Insured Person
  • Duration of benefit for the Insured person is from the date of entering into the insurable employment and during the corresponding benefit period
  • The Benefits will be limited to Medical care. Super Speciality treatment, comprehensive medical care and clinical investigations are done as per the policy

Sickness Benefit

  • Entitlement being, the individual Insured Person should have been contributed for 78 days in relevant contribution period
  • Duration of benefit for the Insured person is upto 91 days in two consecutive period
  • The Benefits will be Hospitalization, Treatment and 70% of average daily wages during the absence (paid by the ESI corporation)

Enhanced Sickness Benefit

  • Entitlement being, the individual Insured Person should have been contributed for 78 days in one contribution period
  • Duration of benefit for the Insured person is 7 days / 14 days for male / female insured person respectively, for undergoing sterilization operation
  • The Benefits will be Hospitalization, Treatment and 100% of average daily wages during the absence (paid by the ESI corporation)

Extended Sickness Benefit

  • Entitlement being, the individual Insured Person should have been contributed for 156 days in 4 consecutive contribution period
  • Duration of benefit for the Insured person is 124 to 309 days and may be extended to 730 days in case of specified long term disease
  • The Benefits will be Hospitalization, Treatment and 80% of average daily wages during the absence (paid by the ESI corporation)

Temporary Disablement Benefit

  • Entitlement is, from the day one, the Insured Person entering Insurable employment
  • Duration of benefit for the Insured person is as long as temporary disablement lasts
  • The Benefits will be, Treatment and 90% of average daily wages during the absence (paid by the ESI corporation)

Permanent Disablement Benefit

  • Entitlement is, from the day one, the Insured Person entering Insurable employment
  • Duration of benefit for the Insured person is for Whole life
  • The Benefits will be depending upon loss of earning capacity of Insured (paid by the ESI corporation)

Dependents Benefit

  • Entitlement is, from the day one, the Insured Person entering Insurable employment
  • Paid to the dependents of the Insured Person, who dies as a result of employment injury
  • The Benefits will be to the dependents which is 90% of average daily wages shareable in fixed proportion (paid by the ESI corporation)

Maternity Benefit

  • Entitlement being the individual woman employee being an Insured Person should have been contributed for 70 days in immediately preceding 1 or 2 consecutive contribution periods
  • Duration of benefit for the Insured person is 26 weeks in case of normal delivery for 1st two surviving child thereafter 12 weeks. 6 weeks in case of miscarriage, 12 weeks for commissioning / adopting mother
  • The Benefits will be Treatment and 100% of average daily wages during the absence (paid by the ESI corporation)

Funeral Benefit

  • Entitlement is, from the day one, the Insured Person entering Insurable employment
  • The Benefits will be actual expenses subject to a maximum of Rs.15,000

Confinement Expenses

  • No condition other than Insurable employment
  • Upto two confinements the Benefits will be 5,000/- per case of confinement to an Insured Woman or an Insured Person in respect of his wife in case facilities for confinement are not available in ESI institutions

Atal Beemit Vyakti Kalyan Yojana

  • Entitlement being the individual Insured Person should have been contributed for not less than 78 days in each of the 4 consecutive contribution period, immediately preceding to the claim of the relief
  • Duration of benefit for the Insured person is 90 days once in a life time
  • The Benefits will be 25% of average earning per day

Medical Care to Retired Insured Persons

  • Entitlement for Superannuated / permanently retired / retired under VRS / Pre mature retirement / Permanently retired due to employment injury after being in insurable employment for 5 years / spouses of such deceased insured persons / spouses of such deceased Insured Persons / Spouse receiving dependent benefit
  • Duration on yearly basis
  • Benefits of Medical facility within ESIC on payment of Rs.120 for self
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TAGS: Compensation and Benefits

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