dineshkumarji.dks Started The Discussion:
I have an employee who is covered under esic since his joining in the organistation. Now, the said employee is being retired and he wants to avail medical benefit from esi after his retirement. But to avail medical benefit one should have minimum 5 years continuous contribution in esi. But the problem is that in 2009 when the esic coverage limit was 10000 he crossed the limit as his salary was Rs. 12000. Again in 2010 when the coverage limits was extended to Rs. 15000 he was again covered under esic. So, there is a break period of 1 year in his contribution. Can the employee still avail the medical benefit as he has a break.
Please help me
Dear Mr Dinesh Kumar,
For a person who is retiring from your company services any scheme
that you suggest should be with the approval of your Management.
Please check with the provisions of ESI. I just referred the pdf file
that is posted along side this message. Unfortunately it does not
say anything about about retired employees.
You may have to refer to the ESI act.
I am aware of schemes by Private Insurance Companies
who extend the benefits to employees after their retirement also.
If it is within your company policy, you can explore these provisions.
The ESI Scheme says that one should have been in insurable employment for a minimum period of five years immediately preceding his date of superannuation. The words "immediately preceding" is used to cover those who have continuous contribution for 5 years just before retirement. But at the same time, since he was in insurable employment for more than 5 years but with a break due to out of cover in between, the case may be considered by the ESIC. Therefore, you may write to ESIC furnishing the details regarding his contributions showing the out of cover period also in it.
Dear Shri Madhu T.K.
Thanks for replying. Sir, We have written to the ESIC official about the break but they denied by saying that one should have minimum 5 years of contribution and there should be no break in between. Sir, can you please quote me any case regarding this matter so that we can show this to the ESIC official
There seems to be no case law because the facility is strictly for employees and not for those who are out of employment and this old age benefit is only an extension of the benefits. Therefore, courts cannot interfere and order that one should get it. As ESIIC has denied it following the conditions applicable for the extension of medical benefits to retired persons, I don't think that we can get it.
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