Is Extra Mediclaim Coverage Worth It for Employees Already Under ESI Scheme?

Is it necessary to have a mediclaim policy if employees are covered under ESI scheme?

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The use of "mediclaim" policy can be redundant for employees covered under the ESI scheme, as ESI provides health insurance and medical benefits to employees. However, some organizations may still choose to offer additional mediclaim coverage to supplement the benefits provided by ESI. It ultimately depends on the specific needs and preferences of the employer and employees.

I am working with an insurance company. The company has offered medical coverage as well as ESI. Is it necessary to have medical and ESI simultaneously?

Not necessarily. If you are offering mediclaim to employees who are eligible for ESI (i.e. drawing < Rs. 15,000), you can apply for ESI exemption.

Our company offers mediclaim policy to our employees as well as dependents. The insured value is Rs. 1 lakh. In this case, please let me know if it is mandatory to deduct ESI for below Rs. 15,000 salary. Alternatively, can we apply for ESI exemption and what is the procedure for applying for this exemption.

Thanks in advance.

To get ESI exemption is neither easy nor feasible if your company falls within 18 Kms of any ESI dispensary. You have to satisfy ESI authorities that you will be providing better facilities and compensation than ESI.

Hi All,

Let me try to clarify the concept. ESI is deducted for those who earn less than Rs 15,000 per month. Employees share 1.75% of the Gross, and Employers share 4.75% of the gross. Mediclaim is a benefit given to employees who earn Rs 15,001 or more. The company bears the premium amount. This amount is not highlighted in your salary slip. If the company tries to provide both benefits, it results in a loss for them.

For example, if Mr. A earns Rs 15,001 as gross, then ESI would be Rs 712 per month and the premium would be Rs 100 per month. In this case, the company bears Rs 1,200 annually for a single employee. If the company pays for 100 employees, then it incurs a loss of Rs 1,20,000. Therefore, only one benefit is given to an employee. Additionally, when claiming, original copies must be submitted to the ESI/Insurance company. The claim amount will only be provided by one payer (ESI/Insurance Co).

Hence, a company will never provide two benefits to an employee as it is not useful and results in a loss for the company.

Hi All,

I have understood the concept of ESI and Mediclaim. As the deduction percentage or monthly contribution for ESI is 4.75% and 1.75% from the employer and employee, I want to know if there is any fixed percentage to calculate mediclaim deduction like ESI?

Regards,
Subrata Deka