Stuck with ESI Benefits: How Can We Access Medical Help for My Wife?

My wife is working in a company in Kolkata on Outsourced Payroll, and the employer is based in Bangalore without any setup in Kolkata. Her salary is processed from Bangalore. As she falls under the ESI ceiling, her employer has provided her with a code, but the code pertains to Bangalore, including the dispensary and doctor's name. This arrangement by her employer aims to ensure statutory compliance; however, my wife is unable to access any medical benefits from ESI.

Furthermore, due to this issue, I am unable to enroll my wife for medical benefits in my company (as a spouse) since she is technically already a member of the ESI scheme.

Please suggest what steps we should take.

Regards,
DG

Challenges with ESI Benefits for Outsourced Employees

With the introduction of an online system and the issuance of smart card ID cards, the insured is expected to receive benefits from any dispensary they prefer. However, since most local offices and dispensaries are still operating without an online system (or even a computer), the process is still in its infancy stage. Therefore, you must submit a copy of the returns filed by the employer in Bangalore to the local office in Calcutta to ensure coverage and proper remittance of ESI in her name.

These challenges often arise in contract engagements. In cases where the contractor does not have an office in Calcutta, obtaining a sub-code becomes impossible. Therefore, please request your spouse to address this with her employer in Bangalore.

Regards,
Madhu.T.K

Thank you for the reply. My wife is an IP under ESI benefits, but she is unable to get any medical benefits as she is from Kolkata, and her ESI code has been generated from Bangalore. I am serving a Govt. PSU which has some very good medical facilities for self and spouse. A spouse can be included subject to her not receiving any medical benefits from her office. In my case, although technically my wife is an insured member of ESI, in practice, she is unable to benefit from ESI while staying in Kolkata. Please suggest the best possible way.

Furthermore, as my company provides extraordinary medical benefits for self and spouse, can my wife opt for medical benefits under my company instead of choosing ESI benefits by providing any declaration?

Regards,
DG

Opting Out of ESI Scheme

Opting out of the ESI scheme is not possible. However, there is no restriction under ESI for an insured person to avail themselves of other beneficial medical schemes. Even in public sector medical schemes, I doubt if there is any provision that requires a family member to not receive medical benefits from other schemes. If not specifically stated, please include your spouse in your medical scheme.

Your spouse should take this matter up with the employer immediately. When writing a letter, mark copies to the Principal Employer (because it is their duty to ensure that the contract employee is receiving all statutory benefits and to intervene in case of any failure on the part of the contractor to provide them) and the local office of the ESI.

Regards,
Madhu.T.K