Am I Eligible for Maternity Benefits if My Delivery Date Changes? Seeking Advice on ESI

In my temporary Identity Certificate, my date of appointment was on 01/12/2012. I am pregnant now, and my expected due date is 16-09-2012. Am I eligible to get the benefit if my delivery will be in September? What if my delivery unexpectedly occurs in August, will I still get the benefit?

Yes, you will get the benefits whether it is August or September. You have to get the certificate of pregnancy from any dispensary. Based on that certificate, you can apply for maternity leave of 12 weeks, i.e., 6 weeks before the due date and 6 weeks after the due date. These maternity leaves would be paid.

Afterwards, you can receive medical treatment at any ESIC dispensary. If the ESIC dispensary refers you to another hospital, you can claim reimbursement for your expenses with all the medical reports as proof.

Regards,
Pooja

It is mandatory to complete 160 days to avail medical benefits under the Maternity Benefits Act, and you are eligible for that.

Regards,
Parvathi

You can check your benefit status through the link www.esic.in and click on IP Portal. Then, enter your Insurance No and click on Log In. Afterward, click on Entitlement to benefits, and you should get your answer. In my opinion, you should receive maternity benefits totaling 84 days, divided into two parts: 42 days just before delivery and 42 days after delivery. If needed, another month can be availed by collecting a certificate from the Medical Officer of ESIC. All medical examinations and treatments must be done at ESIC hospitals.

Regards,
Debanka
HR Admin
PPMS P Ltd

Thank you for your reply. I heard that a person should complete 9 months of contributions in order to be eligible for maternity benefits. My contributions have been deducted starting from January 2012 onwards. Please let me know if you need any further information.

Thank you.

Regards

Eligibility for Maternity Benefits from ESIC

There are two conditions for getting maternity benefits from ESIC. First, the delivery should happen during the benefit period, and second, you should have worked for at least 70 days during the two contribution periods immediately preceding the date of delivery. The first benefit period of an employee will start after nine months of his/her joining the scheme. Since you have started contributing in January 2012 only, you will not get the benefits from the ESIC.

However, the employer is liable to give the maternity benefits to an employee who is not eligible to receive them from ESIC. Therefore, even if you cannot get the benefits from the ESIC, you can still receive the same benefits from the employer.

Regards,
Madhu.T.K

According to the provisions of the Maternity Benefit Act, the female employee is not covered under ESI. Under Sec. 5(2) of the Maternity Benefit Act, 1961, she will be entitled to three months of maternity benefit provided she has served not less than 70 days in a period of 12 months immediately preceding her date of delivery. In the corresponding benefit period, she will be entitled to 12 weeks of maternity benefits. If the female employee has joined while she is pregnant, then the situation will be in a dilemma, and the benevolence depends on the employer.

Regards.

You have served sufficiently to be eligible for benefits. You are correct that a person should complete 9 months of contributions to qualify for maternity benefits, but I believe you may not be aware of how these 9 months are calculated. If an employee has already contributed for one half-yearly return (as your contributions are mentioned in the half-yearly return for May 2012) plus three months, then she can avail the benefits even if she has not contributed for all 6 months in the last half-yearly return.

I am not sure if you are aware of this, but based on my calculations, you are eligible for benefits. Sometimes the information on portals may not be up to date. Therefore, I recommend that you get your pregnancy tests done at any ESIC dispensary or by a recognized doctor to confirm the details.

Additionally, if a pregnant woman fails to notify on time, it does not mean she will be ineligible for benefits. Whenever you provide the notification, you will be eligible for the benefits.

Regards,
Pooja

According to your instruction and the contribution period shown in the ESIC server, I can't understand how 116 days of contribution have been made. From 12 January 2012 to 31st March 2012, it is 80 days if counting Sundays and holidays. Perhaps you have some previous contribution from your previous employer's end. But you should get benefits as it is written "Subject to confinement/miscarriage" just beside your entitlement status. You should immediately go to any service dispensary of ESIC and get your treatment from there. When the delivery time comes, you will surely get maternity benefits as the contribution period comes near 9 months. You should also request your present employer to give you full attendance, then the attendance figure will come to the point where you can easily avail benefits.

Lastly, I want to tell you that "ESI rules have been set for the I.P.'s and also to help I.P.'s." I.P. means "Insured Person." Go to your ESIC branch office that is printed on your Temporary Identity certificate, contact the Branch Manager, and I am sure he/she will do everything to help you.

In our company, I have also faced the same problem you are facing. We have done everything to help our employee as instructed by our branch office, and she received such benefits from ESIC.

Best of Luck.

With Regards,

Debanka

(H.R. Admin, PPMS (P) Ltd.)

Dear Pooja,

Is this 9-month contribution requirement applicable for receiving hospital benefits? Or is a 1-month contribution sufficient?

Medical Benefits Eligibility for New Employees

Benefit period requirements, such as 9 months from the date of joining or 70 days of work during the two contribution periods preceding the date of delivery, will not apply for medical benefits. An employee (and their family) is entitled to medical benefits from day one of joining the scheme. The contributory conditions of 70 days of contribution (78 days for sickness benefits other than maternity benefits) will not apply to medical benefits.

Regards,
Madhu.T.K

Mr. Madhu is right. She will get the benefit under Section 5B of the Maternity Benefit Act if she has worked in the present establishment for 80 days in the 12-month period preceding the date of delivery.

Regards,
Varghese Mathew
[Phone Number Removed For Privacy Reasons]

Could you please provide me with the correct date of appointment? You mentioned that the tentative date of appointment was 01.12.2012. Thank you.