We are a small scale engg industry with 30 employees covered under ESI , recently most of the employees have crossed the Rs 15,000/ ceiling due to which they do not enjoy ESI benefits , kindly advice how to cover these employees for medical insurance . What is the standard procedure followed by most companies .

From India, Madras
Ashutosh Thakre
Hr Professional
+2 Others

Ashutosh Thakre

Dear Raghuvir,
Employee who are not covered by the ESIC, need to be covered by the Mediclaim policy for them and their family.
You can approach the Mediclaim companies within your area and take the quotes. While going with the minimum is a std. practice, you will need to see the coverage amount, the illness covered and see that maximum is applicable to the employees.
You have also policies, where the normal doctor visit for cough and cold like small illness is also covered, try and get them to your employees, this will also help them immensely.
Ashutosh Thakre

From India, Mumbai

Many thanks for your reply , as suggested by you i was trying to find out mediclaim policy covering out patient treatments but could not find so seems all mediclaim policies require hospitalisation.
Can you provide me some info on this aspect.
Thanks again

From India, Madras
Pan Singh

Dear Mr. Raghuvir,
Recently some Mediclaim companies covered some diseases in which hospitalization is not mandatory. Even Day care treatment is also covered. There are lot of schemes. You take corporate scheme and covered member, spouse and two children. Even they can covered the parents as well. However, for cost optimization you can adopt co-payment system for parents. Any reputed company can give you customized plan as per requirement. But pls check all aspects like Re-imbursement of Pre-Post Hospitalization exp., cashless panel, approval procedures etc. Keep the detailed plan in writting from the company. There could be many turns (hidden cost) which could hamper employee benefits.
However, as you described yours is a engg company. Many times the employees had to work some Hazardeous (risk involved) job. I would suggest to take some WC Policy as well to make compensation in case of any hard time.

From India, Delhi

Dear friends, If an employee is not covered under ESI , whether it is compulsory to cover the employee by medical insurance policy ??. Pl. quote the legal requirement if any for the same .
From India, Bangalore

Dear friend
At shopfloor workers do get hurt or get ill.Earlier they were covered under ESI and used to go to esi dispensary/ hospital for treatment.
Esi provides medical treatment as well as salary reimbursement for the days of absence due to health reasons.
Now these benefits are lost and they have spend from pocket for every visit to doctor.
They come and ask management for support in some cases which we do.
If they are covered under some medical insurance their burden will be reduced.

From India, Madras
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