Can Company Medical Insurance Replace ESI? Seeking Guidance on This Transition

If we have a group medical insurance in our company, is it possible to replace the ESI? Can you assist me with this?

Medical insurance is beneficial for employees who don't come under the ESI bracket. However, for employees falling within the bracket, ESI coverage is mandatory.

Thank you for your attention to these details.

Hi Sultan,

Mediclaim cannot be replaced by ESIC. There are different coverages for both of them. As per the law, an employee whose annual income is less than or equal to 120,000/- (one lakh twenty thousand) will be covered under ESIC. Any employee whose annual income exceeds that amount will be covered under mediclaim insurance. You cannot replace it with ESIC at all.

Dear Sultan,

There is a difference between ESIC and insurance. The main one is if you have a certain number of employees and gross below Rs. 10,000, ESIC is compulsory. Insurance is a matter of choice.

Thanks & Regards,

Sonali Wagle
wagle.sonali@gmail.com

ESIC is a social sector organization under the Ministry of Labour that provides medical facilities to employees working in the unorganized sector with a salary of Rs. 10,000 per month, inclusive of all allowances. They also provide cash benefits to employees based on their contributions. However, the Group Medical facility only provides services to employees who are not covered under ESIC, offering cashless benefits.

Group Medical Insurance benefit is at the discretion of the management. It is a part of the welfare scheme. So, do not confuse it with ESI and Medical Insurance. You cannot replace the ESI scheme; it is a compulsory scheme with various benefits available.

:razz: MANOKAVIN

Dear Sumit,

Based on my experience, ESIC cannot replace medical facilities. If an employee is receiving Rs. 10,000 per month, ESIC is mandatory. However, the availability of Group Medical Insurance depends on your company's policy.

In my company, ESIC-covered employees are also included in the (Private) group medical facility as per need, with insurance coverage of Rs. 100,000. Additionally, they are eligible for a medical allowance of Rs. 1,250 per month, which is reflected in their salary slip.

Please let me know if you need further clarification or assistance.

Thank you.

Dear Sultan,

1) You cannot replace ESIC with another medical facility. ESIC coverage is compulsory for an employee who is earning Rs. 10,000/- per month.

2) You can provide (as per company policy) private medical insurance/allowance/reimbursement along with ESIC.

Regards,
Deeps