Can My Company Switch from ESI to Mediclaim? Seeking Advice from Fellow Professionals

Hello all,

I'm working in a manufacturing company in Chennai. Now, my company wants to convert ESI policy to MEDICLAIM. Is it possible? Please help me.

S. Sarkar

If your establishment is a covered establishment and you want to be exempted from the operation of the ESI Act, you will have to prove to the satisfaction of the ESI Authorities that you provide facilities in the form of medical and other benefits to your employees and their family members better than those provided by the ESI Corporation. This means you have to demonstrate that you have your own hospitals where you can offer super-specialty treatments to your employees and their family members, provide leave and cash benefits to the members, offer pensions to the family members of employees who die after employment injury, and provide similar other benefits. Merely having a mediclaim policy that does not guarantee many of the above may not be sufficient for you to obtain an exemption from ESI.

Regards, Madhu.T.K

Dear Mr. Syam,

As per Mr. Madhu, if we are able to show that the company can provide better services, then we can seek exemption. However, your email clearly states that it is not possible. Could you please help us clarify whether it is possible or not?

Warm Regards,

Sita Prakash
Human Resources

That is the company's burden, but the only rule is that any period for which the company has paid any amount during that period, cash benefits will not be provided by ESI.

Hello everybody,

I am an ex-serviceman and employed in a private company. Currently, I am receiving a salary of Rs. 25,000/- per month in cash vouchers, in addition to my pension. I have requested my company not to deduct any EPF/ESI or TDS as I am a member of the Ex-serviceman Contributory Health Scheme (compulsory for all ex-servicemen) and I am also receiving my pension/family pension. Can anybody help me determine whether this practice is correct or not? If it is correct, please assist me in preparing a salary sheet to avoid tax deductions.

Components to include in the salary sheet:
- Basic
- HRA
- Medical Allowance
- Children's Education Allowance
- Conveyance
- Telephone
- Etc.

Thank you,
lxrath

Kind Attn: Mr. Prasad sir,

Please clarify that you have mentioned in the sickness benefit that 60% of wages will be awarded apart from his medical leave. I had read it is 50% of wages; hence, I am bringing this to your kind notice. Please let me know.

Regards,

Dear all,

I would like to add a corollary to what Mr. Prasad has already deliberated.

Under mediclaim, NO OUT-PATIENT TREATMENT IS ALLOWED BY ALMOST ALL OF THE COMPANIES. THE CLAIM AMOUNT IS RESTRICTED TO THE VALUE OF THE SUM-INSURED (E.G., A PERSON HAS TAKEN A POLICY OF 1 LAKH. SUPPOSE HE UNDERGOES A HEART BYPASS SURGERY, WHICH COSTS AROUND 2.5 LAKH. THEN MEDICLAIM ALLOWS YOU AROUND 90,000 OR IN AN IDEAL CASE 1 LAKH. NOT MORE THAN THAT. BUT ESI HAS NO UPPER LIMIT ON THE CLAIM. IN CASES SUCH AS RENAL TRANSPLANTS, THE BILL MAY SHOOT UP TO 20 LAKHS EVEN THEN THE AMOUNT IS RELEASED.

The most important highlight of the ESI scheme is that "THE ABOVE-SAID BENEFIT IS NOT RESTRICTED TO THE EMPLOYEE ALONE. BUT THE SAME BENEFIT IS PAYABLE TO HIS SPOUSE, CHILDREN, AND DEPENDENT FATHER & MOTHER WITHOUT ANY SUB-LIMIT. Whether it is possible for a private/commercial player to give such benefits. Then how can the benefits be superior to ESI at the same costs to the company. Hence the question of getting an exemption would probably not arise.

Best wishes, Ramesh

Hi, sir,

I have a doubt. If an employee crosses the ESI, whether he is eligible for any medical treatment or wages from the ESI. I hope the validity will be for 6 months from the period he crosses the ESI. Is it correct?

Regards,
Janaki

He is entitled to medical and cash benefits until the completion of the benefit period concerned with the Contribution period during which he resigned. Shortly, until 9 months from the contribution period during which he resigned...

Thank you, sir, for the reply. One more question: As soon as an employee joins, does he get benefits from the ESI? Or does he have to wait for some period (3, 6, or 9 months)?

Hi Sir,

Can medical allowance be included in the pay structure when an employee falls under the ESI slab?

Regards,
Balaji.R

Hi Sir,

Can there be a medical allowance in the pay structure if an employee falls under the ESI slab?

Regards,
Balaji.R

Dear Janaki,

As soon as the employee starts working for wages in a covered Unit/Estt., the employee and his family will receive medical benefits. However, cash benefits will only begin after 9 months, provided the Insured Person fulfills the terms and conditions related to such benefits.