Harsh Kumar Mehta
Consultant In Labour Laws/hr
+1 Other

The ESI Act applies to non-seasonal factories or manufacturing units, shops & establishments, Private Medical & Educational Institutionsemploying 10 or more persons. Under the enabling provisions of the Act, a factory or establishment, located in a geographical area, notified for implementation of the scheme falls in the purview in the Act. Employees of the aforesaid categories of factories and establishments and drawing wages o upto Rs.15,000/- a month are entitled to health Insurance cover under the ESI Act. The wage ceiling for purpose of coverage is revised from time to time to keep pace with rising cost living and subsequent wage hikes. The present ceiling of Rs.15,000/- has been effective from 1.5.2010. However, this is a mere guidance and details may be seen from ESI Act 1948, as amended.
2nd December 2013 From India, Surat
Dear

Please find below the Aplicability, Eligibility and Benefits

Applicability:

1) All factories excluding seasonal factories employing 10 or more persons and working with electric power.

2) All factories excluding seasonal factories employing 20 or more persons and working without electric power.

3) Any establishment which the Government may specifically notify as being covered.

4) Shop employing 20 or more persons.

Note: As soon as the above conditions are fulfilled the employer should furnish the details in Form-01 to ESI office for registration under the ESI Act, 1948 & Obtaining of the employer’s Code No

Eligibility:

1) Any person employed for wages (up to Rs. 6,500) in or in connection with the work of a factory or establishment end.

2) Any person who is directly employed by the employer in a factory or through his agent on work which is ordinarily part of the work of the factory or incidental to purpose of the factory.

Benefits:

1) Free medical treatment is offered to covered employees at hospital and dispensaries run by the ESI Corporation.

2) About 7/12th of employees normal wage will be payable to him by ESI during sickness.

3) Maternity benefit for 12 weeks of which not more than 6 weeks should be preceding confinement.

4) Injury during/in course of employment resulting in temporary/permanent disablement entitles the covered employee to a regular payment to substitute his lost wages.

BENEFITS AT A GLANCE



Benefits Contributory Conditions Duration Rate To Whom Payable

a) Sickness Benefit.

I.P. Should work for wages for 78 days in the corresponding C.P.(wef 19-9-98). 91 days in any two consecutive B.P. As per S.B.R. Only to the insured person

b) Extended sickness benefit for long term diseases like TB, leprosy, etc. Continuous employment for the period of two years. 124 days which may be extended upto 309 days in specified chronic cases during a period of three yrs. 25% Above S.B.R. Only to the insured person

c) Enhanced sickness benefit (for under-going sterilization operation for family planning) Same as for Benefit (a)above 7 days for vasectomy & 14 days for tubectomy extended in cases of post-coperative complications etc. Twice the S.B.R Only to the insured person

2} Disablement Benefits (employment injury) No Conditons In case of temporary disablement: as long as incapacity lasts & in case of permenant dis-ablement: for life time. a) For temp. Only to disablement the injured 40% above person S.B.R



EXPLANATION: Where more injuries than one are caused by the same accident, the rate of benefit payable under clauses (c) & (d) shall be aggregated but not so in any case as to exceed the FULL RATE and in cases of disablement not covered by clauses (a), (b), (c) & (d) at such rate, not exceeding the FULL RATE, as may be provided in the regulations.



3} Dependent’s Benefit (employment injury) No condition To the WIDOW/S during life time until remarriage.

To the legitimate or adopted SON/S until he attains the age of 18yrs. 3/5 of the FULL RATE, if there are 2 or more widows, the amt. payable to the widows shall be divided equally between the widows.

2/5 of the FULL RATE, if there are 2 or more sons, the amt. payable to the sons shall be divided equally between the sons. Subject to a min of Rs. 14/-



Benefits Contributory Conditions DurationRate To Whom Payable



To the legitimate or adopted unmarried Daughter/s until she attains the age of 18 yrs. or until marriage, whichever is earlier, -----do-----

In case the deceased person does not leave a widow or legitimate or adopted child. D.B. shall be payable to...



a) Parent or grand parent, for life 3/10th of the FULL RATE

b) Any other male dependent, until he attains the age of 18 yrs. 2/10th of the

FULL RATE

c) Any other female dependent, until she attains the age of 18 yrs. Or until marriage whichever is earlier. -----do-----



N.B. An insured person whose PERMANENT DISABLEMENT has been assessed as final and who has been awarded permanent disablement benefit at a rate not exceeding Rs. 1.50 per day may apply for a lumpsum payment and such amount shall be determined by multiplying the daily rate of permanent disablement benefit by the figure indicated in Co. 2 of the Schedule III of the Regulations.

Benefits Contributory Conditions Duration Rate To Whom Payable

4} Maternity Benefits

Payment of contribution for 70 days in one or two consecutive periods.

12 weeks of which not more than 6 weeks can precede the expected date of confinement. Twice S.B.R. Subject t o min of Rs.20/- p.d. Only to the insured person.



6} weeks for miscarriage or for medical termination of pregnancy

Additional payment for one month for Complications (pre or post) arising out of Pregnancy Medical bonus of Rs.250/- where ESI facility is not available.

5} Medical Insured Benefit No Condition From the date of entry of an employee into an insurable employment so long as he remains in insurable employment and three after for certain additional period Full Medical care including hospitalisation Person as well as his/ her Family Members as defined u/s 2(11) of the Act.

6} Funeral Expenses:

No condition (i.e.merely by virtue of being an insured person) One time lump sum payment Not more than Rs. 1,500/- To the eldest surviving member of the family of the deceased I.P. Or to the person who actually incurs the expenditure on the funeral of an I.P.

7} Rehabilitation Allowance

No condition For each day of which I.P. remains admitted in Artificial Limb Center for fixation,

repair or replacement of artificial limb.Same as at

1(a) Up to Rs. 15 L for Rehabilitation. Only to the I.P.



8} Medical Benefit to insured persons who ceases insurable employment on account of permanent disablement.



No condition but an. I.P. has to pay Rs. 10/- pm in lump sum for one year in advance every year.

Till the date on which an I.P. would have attained the age of superannuation Medical Benefit IP and spouse.

9} Medical Benefit to retired Insured Period

1) Insurable employment for a period of 5 years and

2) Payment of Office of the Contribution @ Rs. 15/- PM in lump sum for one year in advance, each year. Till the time yearly contribution is paid to the Concerned Office of the Corporation.

3) Death during course of employment entitles specified dependents to a regular payment.

4) One time payment of Rs. 1,500 to help meet funeral expenses

Thanks

Srinivasan
2nd December 2013 From India, Bangalore
Dear MR.Srinivasan Thank for your valuable reply on my post. Can you please send me ESIC Ahmedabad Region last amendment. Thank&Regards, Parmar Shailesh
3rd December 2013 From India, Surat
Respected Srinivasanji,
Thanks for the information you furnished in above columns. However, if I am not wrong, the information regarding coverage of shops, wage ceiling, funeral expenses etc.have undergone changes since some time.
For example present eligibility of coverage of wage ceiling is Rs.15000/- and for coverage in respect of shops, it is 10 or more persons in some states. In addition, the amount of Funeral Expenses and other cash benefits have also been enhanced/ revised by the appropriate Government.
May like to correct me if I am wrong.
With regards;
3rd December 2013 From India, Noida
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