Opting Out Of Esic Benefits - Doc Download

Dear All,
I am working in a PSU and it provides very good medical facilities for myself and my wife. My wife is working in private sector and comes under the coverage of ESI benefits. I want my wife to avail the medical benefits from my company as it is far better that benefits she can avail from ESIC. So though her contributions are deducted on every month and she comes under the ESIC compliance as per statute but still can she opts out of ESIC benefits purposely by providing a self declaration to her organisation and can avail medical benefits from my organisation.
please suggest.
Rgds..
DG

Dear DG,
Your wife can opt from your organisation, but at the same time she can't claim from ESIC.
Regards
Praveen

Dear DG,
It is illegal.
you cannot apply for both at the same time.
Since in both the case original bills has to be produced for the claim. also you declare in both the case that you are not claiming the amount through different source.
Moreover she can get the maternity benefits under ESI in specified ESI dispensary/Hospital only where the Insurance medical officer signs all the form.

Is your wife able to get 84 days maternity leave from your organisation? No. That means for maternity leave she should have ESI. It is immaterial whether she takes treatment from ESI Hospital or not and therefore, she can take medical assistance from your hospital while covered by ESI. If the PSU medical facilities being given to dependents are irrespective of their dependency, why don't you chose to take the eligible leave from ESI and get her treated in the hospital of the PSU?
Regards,
Madhu.T.K

@k_shenbagarajan: I think you have misunderstood my question. I have clearly mentioned that my wife is interested to avail either of the benefits and her preference is opting out of ESIC and to go for benefit provided by my organisation. While she will only prefer to claim for only one of the two options available to her then I am unable to understand how the matter of illegality comes?
Rgds..
DG

@DG:
Your wife has no option.ESIC is compulsory whether you avail benefits or not.Almost 40% of the insured persons under ESI do not avail any benefit. If PSU has condition that your wife has to give declaration,she can not give any such declaration. What Madhu has suggested is best way,if possible under rules you are governed by

Dear DG,

You may get some clue from the following and the attachment:

Exemptions:

The provisions of the ESI Act are not applicable to factories or establishments, run by the State Governments / Central Government, whose employees are, otherwise, in receipt of social security benefits substantially similar or superior to the benefits provided under the ESI Act. The case of each such Public Sector Undertaking, is decided on merit by comparing the quality and quantity of benefits being provided to the employees by the concerned managements, with those admissible under the ESI Act.

The "Appropriate Government", may grant or renew exemption under Section 87 of the ESI Act in respect of a Factory/Establishment or class of factories or establishments in any specified area from the operation of the Act for a period not exceeding one year at a time.

Exemption Under Section 88 of the Act is granted by the "Appropriate Government" to employees, or class of employees, who remain away from their Hqrs. for more than 7 months in a year, and those employees who are posted in non-implemented areas.

No exemption, under Section 87, or Section 88 can be granted unless a reasonable opportunity has been given to the Corporation to make any representation and the same is considered by the "appropriate Government".

Exemption Under Section 90 can be granted to a factory / establishment belonging to any local authority such as a Municipality / Corporation, etc. if employees in any such factory/establishment are otherwise in receipt of benefits substantially similar or superior to the benefit. provided under the Act.

You may try by applying to your wife's office with documents having she is covered by your medical scheme. We have provided such exemptions to some of VRS employees from defence who are covered by Army hospitals.

Caution:

Think about her leave eligibility and possible catches under your medical scheme for dependents.

Regards,

kumar.s.

The exemption is meant for the units not for the individuals employees of the units covered under the Act

Dear Sir,
ESI Covered persons, cannot come out of the purview of the Act, unless their salary exceed
Rs15000/-.
D.Gurumurthy
LL.HR & IR Consultant