ESI Vs Medical Insurance - CiteHR
Madhu.T.K
Industrial Relations And Labour Laws
Ybalajisantosh
Employee Relationship, Grievance Handling,
Pon1965
Construction
Iinfrasolservices
Hr & Back End Operations
Deepakmendiratta
Health Insurance ( Mediclaim ) - Policy Design,
+3 Others

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Dear Seniors,

My organisation is planning to medically insure its emloyees. We are a construction company having our operations in Orissa, AP and Karnataka. We have seen that upon taking a medical insurance, the policy needs to be taken in individuals name and once the individual leave the company the policy can be discontinued or the individual might carry on with the policy. This is not very benifitial keeping in view the number of employees leaving our company every for better oppertunities.

The second option is that of availing ESI benifits for employees drawing a gross salary below 15000/month. The remaining employees can be insured by a private service provider.

My questions are as below.

1. What are the medical benifits under ESI plan to the employees.
2. What will be the monthly payments that i need to make towars ESI.
3. How to include employees under the ESI brackets whose gross salary/month is above Rs. 15000.
4. If I need to insure the remaining employees under Group Medical Insurance Plan or an Individual medical Insurance plan which company will be cheaper and is it recomended.

Please help me with my queries.

Santosh
s

Dear Santosh, can you visit online website of esic for all details. if you come in limit area in esic than its compulsory to take its. Regards, Sarvang Shah 9067408464
Let the medical insurance be part of CTC and even if they leave in between, it does matter for the company. pon
ESIC website dosent provide much details on the benifits. If someone could answer my questions. Regards Santosh
Hi,
From an insurance perspective, a group health insurance cover for your employees will allow for greater benefits ( ie Lesser upsets) and you will also get the benefit of paying premium only till the employee is working for the organisation.
Regards,,Deepak

Dear Mr. Santosh,
ESI and medical insurance are totally different thing. ESI is a statutory obligation of the employer whereas medical insurance is not.
If the area where your organization is located is covered under ESI then your organization is bound to give ESI to its employees whose gross salary is less or equal to 15000. Organizations have no option on this.
1.) To know about medical benefits under ESIC plz visit ESIC <link updated to site home>
2.) a. Employer's contribution - 4.75% of gross salary, b. Employee's contribution- 1.75% of gross salary
3.) If gross salary is above 15000/- employees are out of ESI coverage.
4.) Its better to go for Group Mediclaim Policy as premium will be less and company will get tax benefit. You can go for Familiy Floater Group Mediclaim Policy so that family members of employee are aslo covered.
-Kamal

ESIC is a waste of Money for both employees & employer....First the government should provide the platform for Medical Health Facilities before making compulsions on ESIC ...nobody is in favour of such shoddy treatment.....ESIC Hospitals should be only those Hospitals where our Politicians & Bureaucrats take treatment.....not any lalla hospital who pay bribe money and get themselves registered as ESIC Hospitals..........in my office even Peons avoid going to such so called ESIC Facilities because there is more chance of you catching on a disease rather than getting the right treatment for one...............just find out the number of companies which have opted for both ESIC as well as Mediclaim facilities..........its a proof that Employees and Employers dont believe in this Hogwash of a system.................rgrds
Dear Mr. Santosh,
ESI and medical insurance are totally different thing. ESI is a statutory obligation of the employer whereas medical insurance is not.
If the area where your organization is located is covered under ESI then your organization is bound to give ESI to its employees whose gross salary is less or equal to 15000. Organizations have no option on this.
1.) To know about medical benefits under ESIC plz visit ESIC <link updated to site home>
2. a. Employer's contribution - 4.75% of gross salary, b. Employee's contribution- 1.75% of gross salary
3.) If gross salary is above 15000/- employees are out of ESI coverage.
4.) Its better to go for Group Mediclaim Policy as premium will be less and company will get tax benefit. You can go for Familiy Floater Group Mediclaim Policy so that family members of employee are aslo covered.
-Kamal

Hi Santosh,
Group medical insurance is any time better than ESIC as the network of Hospitals with Group medical insurance is vast and the employee has 2 options (cashless and reimbursement) facility which they can opt for across India. Some of the Insurance company are New india Assurance, United India, ICICI Lombard and latest one is Max Bupa.They have tie ups with TPA for processing the claims.
But on the other hand ESIC comes under HR compliance. So getting the ESIC code is a kind of compulson or else it would create a problem on compliance point of view. In some companies the employees are cover under ESIC as well as Group Medical Insurance so that they can avail medical facility in wide network of hospitals and not in panel hospitals of ESIC.
Regards,
Radhika Thaker

ESI is a statutory scheme which is mandatory for establishments set up in the implemented areas. Therefore, if your establishment is set up in an implemented area, then all employees whose salary does not exceed Rs 15000 are required to be covered. the scheme is contributory in nature whereby the employees' contribute 1.75% of their salary and the employer contribute 4.75%. By doing so, all medical, sickness and compensation by way of accidents while on duty including death which will otherwise been the responsibility of the employer under the Workmen's Compensation Act will be taken care of by the ESI Corporation. Similarly, maternity benefits like 84 days of paid leave and maternity bonus to the tune of Rs 1000, which are required to be given to women employees will also be borne by the ESIC.

Medical Insurance is a different scheme but it is not as per any statute but is optional for an employer who would like to get his obligations shifted to an insurer for a consideration called premia. It would be beneficial to cover the risks in respect of those employees whose salary exceed Rs 15000. For these employees ESI will not give any coverage.

Regards,

Madhu.T.K


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