Maternity Benefits for ESIC-Covered Employees: What Options Are Available for Private Hospital Deliveries?

Hello All,

I have one query regarding Maternity Benefit. One employee who has been working in our organization for the past 1 and a half years is covered under the ESIC Scheme. Now, the issue is that his wife is pregnant. I would like to know if his wife is eligible for Maternity Benefit and if yes, what benefits should be provided to her. If the husband does not want to avail the maternity benefit from ESIC, what are the other options? Can the employee ask for medical reimbursement if the delivery is done in a private hospital? Please guide me. I will be waiting for your reply.

Dear Friend,

I would like to bring to your attention that the Maternity Act applies to working women (employees) whose salary exceeds Rs. 10,000 per month. Otherwise, the ESIC will provide maternity benefits if they are covered under the ESI Act. If an employee is not covered under the ESI Act, then the Maternity Benefit Act is applicable to them exclusively. It is important to note that nowhere does the spouse of an employee qualify for maternity benefits under the Maternity Benefit Act or the ESI Act. However, if the employee is covered under the ESI Act, all maternity-related treatments will be provided by the ESI. The responsibility does not lie with the employer to reimburse expenses for the spouse of the employee, whether they choose to avail themselves of the benefits under the ESI scheme or not.

Thanks and regards,
Kameswarao

Dear Friend,

What if a working woman is covered under ESIC and wants to avail the maternity benefit? What benefits can she avail?

Dear,

In order to be eligible for maternity benefits under ESI, a woman employee should have contributed for 70 days in the preceding two consecutive contribution periods. Therefore, the actual or expected date of confinement should fall within the first benefit period. Even a woman employee who had contributed for more than 70 days in the contribution period will not be eligible for benefits if her date of delivery takes place before her first benefit period.

In the absence of information about the contributions for the preceding two contribution periods (the post only indicates that there were 30 days of contribution in the contribution period just preceding the date of delivery) and the actual or expected date of delivery to see whether it falls within her first benefit period, it is not possible to give a proper reply.

Regards
Vipin8-)8-)

Hi,

The Maternity Benefit is applicable only to working women in the organization who are covered under the ESIC Scheme. If the working woman is not covered under ESIC, then the company will provide Maternity leave to her.

Employees' wives can receive treatment through ESI and avail all medical benefits. The employee is not benefited with any leave through ESI. However, he is not eligible for any reimbursement if the treatment is taken in a private hospital.

If the company has a Group Mediclaim Policy for their employees and their dependents, which includes maternity benefits, he shall receive the reimbursement.

Arasu

If a person's salary is more than $10,000 and he is not availing ESIC benefits, what is the procedure to claim maternity reimbursement for his spouse?