Can an Employee Still Get ESIC Medical Benefits After a Break in Contributions?

I have an employee who is covered under ESIC since his joining in the organization. Now, the said employee is being retired, and he wants to avail medical benefits from ESI after his retirement. However, to avail medical benefits, one should have a minimum of 5 years of continuous contributions in ESIC. The issue is that in 2009, when the ESIC coverage limit was Rs. 10,000, he exceeded the limit as his salary was Rs. 12,000. Then, in 2010, when the coverage limit was extended to Rs. 15,000, he was once again covered under ESIC. This situation resulted in a one-year break in his contributions.

Question on Availing Medical Benefits

The question is, can the employee still avail of medical benefits despite the break in contributions? Please help me.

Regards,
Dinesh Kumar

Retirement Scheme Approval and ESI Provisions

For a person who is retiring from your company, any scheme that you suggest should have the approval of your management. Please check the provisions of ESI. I have just referred to the PDF file that is posted alongside this message. Unfortunately, it does not mention anything about retired employees. You may need to refer to the ESI Act.

I am aware of schemes offered by private insurance companies that extend benefits to employees even after their retirement. If it aligns with your company policy, you may explore these provisions.

Regards,
V. Raghunathan

Thank you for replying. I would like to clarify that a person can avail of medical benefits after retirement by contributing a nominal amount, i.e., Rs. 10 per month or Rs. 120 per year. However, I am not aware of the full terms and conditions for availing them.

Regards,
Dinesh Kumar

Understanding ESI Scheme and Contribution Breaks

The ESI Scheme states that one should have been in insurable employment for a minimum period of five years immediately preceding their date of superannuation. The phrase "immediately preceding" is used to encompass those who have made continuous contributions for five years just before retirement. However, in cases where an individual was in insurable employment for more than five years but experienced a break due to being out of coverage in between, the ESIC may consider the situation. Therefore, you may write to the ESIC providing details regarding the contributions, including the out-of-coverage period.

Regards,
Madhu.T.K

Thank you for replying. Sir, we have written to the ESIC official about the break, but they denied it by saying that one should have a minimum of 5 years of contribution and there should be no break in between. Sir, could you please provide me with any case regarding this matter so that we can show it to the ESIC official?

Regards,
Dinesh Kumar

Case Law and Medical Benefits for Retired Employees

There seems to be no case law because the facility is strictly for employees and not for those who are out of employment. This old age benefit is only an extension of the benefits. Therefore, courts cannot interfere and order that one should get it. As ESIC has denied it following the conditions applicable for the extension of medical benefits to retired persons, I don't think that we can get it.

Regards,
Madhu.T.K

Yes, after retirement, an employee can avail the facility of ESI Medical if he was covered under ESI continuously for 5 years during his entire service. It is not necessary that he is a member of ESI before the superannuation date. A total period of five years, whether there is a break in it, is acceptable. The only requirement is that records of deductions can be produced by your employer.

Anju