Understanding ESI Medical Benefits: Are Employees Still Covered After Contributions Stop?

Eligibility for Medical Benefits Under ESI

Is the employee eligible for medical benefits under ESI even after his contributions are stopped, as his salary is more than Rs. 15,000? Benefits like sickness and maternity are dependent on contributions paid. What about medical benefits like OPD treatment - is the employee eligible even in his later years when he is not contributing to ESI?

Regards,
Suresh

The answer is yes to your question—Is the employee eligible for medical benefits under ESI even after his contributions are stopped?

IP is eligible for medical benefits until the corresponding benefit period is over. This corresponding benefit period starts after the contribution period, i.e., after contributions are stopped.

Apart from this, IP is eligible for the following benefits even after his contributions are stopped:

1. **Old Age Medical Care:** This benefit is available to IP retiring on reaching the age of superannuation or under VRS/ERS, and persons having to leave service due to permanent disability. IP and spouse are eligible for this medical care on payment of Rs. 120/- per year.

2. **Rajiv Gandhi Shramik Kalyan Yojana:** Under this scheme, an unemployment allowance is introduced by the corporation w.e.f. 01.04.2005. IP who became unemployed after being insured for 3 or more years, due to the closure of the Factory/Establishment, retrenchment, or permanent disability, are entitled to:
- Unemployment allowance equal to 50% of wage for a maximum period up to 1 year;
- Medical care for self and family from ESI Hosp./Dispensaries during the period IP receives unemployment allowance.