Employee State Insurance Scheme (ESIS) is a government health insurance scheme for lower income group (LIG) whose monthly salary is less than Rs. 21,000/-. This scheme provides financial protection to the members towards health related eventuality and provides medical treatment benefit including hospitalisation, disability benefit, maternity benefit and unemployment allowance. Primarily all blue coloured employees in India are covered under this scheme.
As per labour ministry guideline, all establishments and factories with more than 10 employees must register with ESIC (Employee State Insurance Corporation) and provide ESIS cover to the eligible employees. Not only manufacturing but Shops, Hospitals, Hotels, Cinemas, Educational Institutions, Logistic Companies etc. all are mandated to provide ESIC cover to their employees. Government of India has separately formed Employee State Insurance Corporation (ESIC) which looks after the Employee State Insurance Scheme (ESIS). Key benefits are discussed below.
- Coverage – scheme provides protection/health benefit to the employee and family members from day one of joining.
- ESIC Pehchan card – are issued to employees. This card is required to take the benefits at hospitals.
- Who all in family can be covered under ESIS? Spouse, dependent kids up to age of 25 years, dependent father & mother, minor brother & sister if parents have died.
- Medical benefit- medical consultation & hospitalisation is provided to the employee and covered family members from ESI Hospitals/Dispensaries spread across the country.
- Retirement & permanent disability benefit – Medical treatment is also provided even though employee get retired or permanently disabled. In this case they have to pay nominal fees of Rs. 120/- per instant.
- Death benefit – in case of death of the employee due to injury or hazard at work place, 90% of wage will be paid as monthly payments to the dependents. Nominee/dependents need to submit ESIC dependent benefit claim form & ESIC Pehchan card to the nearest ESIC branch office to get the benefit.
- Funeral expense – Rs.10,000/- is paid to the dependents or the person who performs the last rites of the deceased employee. This claim has to be submitted within 6 months of death.
- Unemployment allowance – 50% of wage for a maximum period of up to two years is provided to the employee in case of absenteeism from work due to illness, maternity or factories accidents which result in loss of wages.
- Vocational training is provided for upgrading skills. All cost of fees and travelling are paid by ESIC.
- Contribution – after joining the ESIS scheme, monthly contribution has to be deposited with ESIC. Presently a total of 4% of monthly wage is deducted and contributed (of which employee contributes 0.75% by way of deduction from his monthly salary & employer contributes 3.25% from their side).
For list of hospitals and more details visit https://www.esic.nic.in/