BENEFITS UNDER THE SCHEME

S.THIAGARAJAN12-08-2011

• Under the ESI Scheme Benefits are available both to the employers and employees

BENEFIT TO THE EMPLOYERS

Employers are absolved of all liability, of providing medical care to

employees.

employers are exempted from the applicability of the:

Maternity Benefit Act, 1961 &

Workmen Compensation Act, 1923

Employers have a well secured workforce, an

essential ingredient for better productivity

BENEFITS TO EMPLOYERS• By employing physically challenged employees employers need not

pay employers share of 4.75% contribution for three years from the date of commencement of the contribution period.

• Wage limit for the coverage of the physically challenged employee is Rs.25000

• Under Rule 51-A of ESI Rules person with disability under the persons with Disabilities(Equal opportunities Protection of Rights and Full Participation)Act, 1995(1 of 1996), and under the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999(44 of 1999) respectively, shall be twenty five thousand rupees a month .

• This facility is available only to the new entrant and not to the existing physically challenged employee

BENEFITS TO EMPLOYEES

• There are two types of Benefits• Cash Benefit • Medical Benefit

SO MUCH TO GAIN FOR SO LESS PREMIUM

• MEDICAL BENEFIT(There is no cap for the Medical Benefit)

• CASH BENEFIT (SICKNESS AND DISABLEMENT)

• DEPENDANT BENEFIT

• MATERNITY BENEFIT(Cash Benefit is based on Average Daily wages)

4.75% EMPLOYERS CONTRIBUTION

• UNEMPLOYMENT ALLOWANCE

• VOCATIONAL REHABILATION

• FUNERAL EXPENSES• OLD AGE HEALTH

CARE.

1.75%EMPLOYEES CONTRIBUTION

CASH BENEFIT

(1) SICKNESS BENEFIT

normal

extended

enhanced

(2) DISABLEMENT BENEFIT (employment injury)……temporary & permanent

SICKNESS BENEFIT

Contributory condition

DURATION RATE

Payment for78 days in relevant contribution period

91 days in any two consecutive period

About 70% of Average daily Wages

EXTENDED SICKNESS BENEFITfor 34 specified long term diseases

Contributory period

Duration Rate

Continuous employment for a period of two years and contribution for 156 days in four consecutive contribution period

two years 80% of the Average daily Wages

ENHANCED SICKNESS BENEFITFor undergoing sterilization operation for family

planningContributory period

Duration Rate

Payment for at least 78 days in the relevant contribution period

7 days for vasectomy and14 days for tubectomy ; extendable in case of POC

Equal to Average daily wages

DISABLEMENT BENEFIT(employment injury or occupational diseases)

BENEFIT Contributor-y condition

Duration Rate

TDB (incapacity should be > 3 days Exc DOI

He should be employed on the date of injury, no relation to contribution.

Till the incapacity lasts

90% of the Average Daily Wages

PDB (partial or total)

same For life Determine by the medical board, depends upon loss of earning capacity. Commutation of PDB is not > Rs 30,000

DEPENDANTS BENEFIT

Contributory

condition

To whom entitled/Duration

Rate

Deceased should be employee on the date of fatal accident.

1.To widow/s for life or until remarriage(3/5 DBR)

2.To widowed mother during life(2/5 DBR)

3.To legitimate or adopted son and legitimate or adopted daughter till the age of 25 yrs(2/5)

4.To parents 3/10

.Distribution does not exceed the full rate of DBR

90% of Average Daily Wages to be divided among the dependents in the prescribed ratio)

The amount of DBR is reviewed vis-à-vis the cost of living index and increases are granted from time to time to compensate for erosion in its real value.

MATERNITY BENEFIT

Contributory condition Duration Rate

Payment of contribution for 70 days in immediately preceding two consecutive contribution periods.

12 weeks of which not more than six can precede the expected date of confinement;

6weeks for miscarriage and additional one month for sickness arising out of pregnancy confinement, premature birth of child or miscarriage

Double the Standard Benefit Rate(approx full wages)

Maternity benefit continues to be payable even in the event of death of an insured woman during delivery or immediately following date of delivery for leaving child whole of period and in case child also dies ,during the said period until the death of child

FUNERAL BENEFIT

• HE SHOULD BE AN INSURED PERSON ON DATE OF DEATH.

• ACTUAL EXPENDITURE ON FUNERAL NOT EXCEEDING Rs 10000/-

• AMOUNT IS PAID TO ELDEST SURVIVING MEMBER OF THE FAMILY OR IN HIS ABSENCE TO THE PERSON WHO ACTUALLY INCURS THE EXPENDITURE ON THE FUNERAL.

REHABILATIONAL ALLOWANCE

Contributory condition

Duration Rate

Entitlement to medical benefit or if disabled due to employment injury

For each day on which insured person remains admitted in artificial limb- centre for fixation/repair or replacement of artificial limb.

Double the SBR

(full wage)

MEDICAL BENEFIT

Contributory condition

Duration Benefit

Insured person and his family is eligible from the date of entry of I.P. into insurable employment

Till the disability / disease lasts

Full curative and preventive medical care for I.P. and his/her dependants

Including super specialty treatment

SUPERSPECIALITY CONDITIONS

• IN CASE OF INSURED PERSONS 39 DAYS OF CONTRIBUTION AND 3 MONTHS CONTINUOUS SERVICE

• IN CASE OF FAMILY MEMBERS 78 DAYS OF CONTRIBUTION AND ENTILTED FOR SB

• NO CONTRIBUTORY CONDITIONS IN CASE OF ANY TYPE OF INJURY

• FACILITY AVAILABLE BASED ON IMOS REFERENCE

CONFINEMENT EXPENSES

Contributory condition

Duration Rate

To an insured woman or an I.P. in respect of his confinement are not available in esi insitution

Up to two confinement only

Rs 2500/- per case.

Unemployment Allowance named as Rajiv Gandhi Shramik Kalyan Yojana

a) Unemployment Allowance named as Rajiv Gandhi Shramik Kalyan Yojana, is payable to those workers facing involuntary unemployment due to closure of factory/establishment; retrenchment or permanent invalidity arising out of non-employment injury. The daily rate of Unemployment Allowance is at par with the sickness benefit rate . This allowance is payable for a maximum period of 1 year either in one spell or in different spells of not less than one month’s duration.

•Contributory conditions for unemployment allowance

•He should be an IP

•He should have contributed for at least three years

Medical benefit to retired/disabled insured person and his/ her spouse

Contributory condition Duration Benefit

Rs On payment of 120/- in lump sum for one year in advance

(1)Retired I.P being insured for not less than five years.

(2)By insured person who cease to be in insurable employment on account of disablement due to an employment injury

Period for contribution is paid

Full medical benefit for that period.

VOCATIONAL REHABILATIONAL ALLOWANNCE

Contributory condition

Duration Rate

Not more than 45 years of age and disability not less 40% due to employment injury

All the days of training in vocational rehabiliational centre

Rs 145/- per day or the amount charged by vocational rehabitational centre whichever is higher

OBLIGATION OF EMPLOYERS

Maintain register of employees in form – 6 (reg.32)

Ensure maintenance of separate register of employees by contractor and settle contractor’s bills only on production of this register to esic. ( sec-41 (1-a)

Deposit both employee’s and employer’s contribution as per specified rates within 21 days of the following month. {reg. 31}

Insure all employees by by generating Ins no. through online

Facilitate proper inspection of records/registers and the premises by visiting officers of ESIC as and when so required. { u/s 45}

Report promptly about the accident so as to enable esic to provide benefit in time

Not to make any false declaration or mis-representation of facts, concerning the applicability of the act, or, admissibility of benefits to employees –regular, hired or contractual.

Report promptly the date of closure of a factory/establishment to the esic branch office/regional office, preferably within seven days of such closure and clear esi liabilities.

Report any change in business activity, address, ownership or the management to esic authorities forthwith.

Ascertain the liability towards esi dues, while taking over the ownership of a factory/establishment through purchase, gift, lease, license or otherwise as the new owner is liable to discharge past liabilities. (sec. 93-a)

•Furnish any additional information called for sec. 44 (2) and reg. 109

•Help and assist employees to avail their legitimate esi benefits.

•Maintain sanitary standard in and around the workplace and employees housing colony so as to minimize the risk of exposure to occupational hazardous and diseases.

•The employer shall render all necessary assistance which the corporation may require in connection with the registration of his factory or establishment and the registration of his employees and especially for photographing such employees and their families for issue of bio metric cards affixing the photographs to the identity cards. (reg.16)

•Indicate insurance number of Insured Person in chronological order in the return of contribution and his own code number in all correspondence.

IMPORTANT INFORMATION FOR THE EMPLOYERS

1. Employer should get factory/establishment registered online, immediately

on applicability of ESI Act to his unit.

2. Employer should get his employee including the employee employed

through the contractors registered online and T.I.C. generated immediately

after taking him in insurable employment.

3. The employer should direct and pursue his employees to get photographed

for Pehchan Card.

4. The employer should not re-register a new employee, if

he/she was already registered with E.S.I. Corporation

while working with another employer.

5. The employer should immediately inform the RO/SRO

about the permanent closure or transfer of

factory/establishment within 21 days of such

closure/transfer.

PROCEDURE FOR AVAILING BENEFIT•Insured Person has to submit leave certificate along with his claim to the Branch Office.

•Branch Office after verifying the eligibility settle the claim either by cash or through ECS System.

•It is proposed to introduce online settlement of claim shortly.

•In that case Insured Person need not visit the Branch Office.

•To avail Super Specialty Benefit IP need not spend any amount and cashless treatment will be provided to the Insured Person and his family.

•With the introduction of Pehachan Card and computerization the Insured Person and his family can take treatment at his choice.

•Two Pehachan cards will be issued. One for the Insured Person and other for the family.

VAZGAVALAMUDAN

Thank You

12-08-2011