Is Medical Coverage Mandatory for Employees Earning Above 15K Not Covered by ESIC?

Dear All,

Please clarify:

1. Is it mandatory to cover employees under medical coverage who are not covered under ESIC, i.e., above 15K?

2. If so, where can the statute stating the same be referred to?

Please suggest.

Regards,
Jaykant Rathod

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No, it is not mandatory for the employer to take medical coverage from an insurance policy. However, it is compulsory to pay compensation as per the Workmen's Compensation Act of 1923 for accidents that occur "Arising out of and in the course of employment."

Consideration of Insurance Policy

It is always advisable to opt for an insurance policy considering the risks involved in accidents as mentioned above.

Regards,
Arun J.

If any company has more than 25 employees, it's mandatory to provide the following statutory benefits:
- PF
- Medical
- Gratuity

ESIC is for employees with a salary less than ₹15,000 per month. If the salary is higher, the company can choose from various TPA and other GPA and Mediclaim companies. However, providing these benefits is compulsory.

Hope this information helps.

I do not agree with you. Which law states that it's mandatory? If they are not covered under ESIC, then they will be covered under the Workmen's Compensation Act.

Could you please inform me under which statutory notifications or circulars it is mandatory? Kindly provide the relevant information so that I can present it to my management.

Thanks & regards

You are wrong. For the application of EPF, it is 20 or more persons; for gratuity, it is 10 or more; and for ESI, it is 10 or more for factories and 20 or more for other establishments (10 in some states). Where did you get this "25"?

Further, there is no law that states medical insurance is mandatory, regardless of the number of employees.

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Accident Coverage for Employees

In case of accidents while on duty or off duty, the ESI coverage will provide shelter to the covered employees.

For the non-covered employees of ESI, the employer has to obtain a workmen's compensation policy from LIC. This will take care of other employees in case of unforeseen consequences and reduce the burden on the employer.

Taking a W.C. policy is not mandatory; it is voluntary. The employer can pay for or incur expenses in case of accidents, etc., happening to the uncovered employees if he has not taken a WC policy.

Dear all,

Questions on Employee Medical Coverage

1. Is it mandatory to cover employees under medical coverage who are not covered under ESIC, i.e., those earning above 15K?

2. If so, where can the statute stating the same be referred to?

Please note that obtaining any insurance policy for employees drawing a salary/wages beyond the ceiling limits is not mandatory. It is optional but recommendable to have WC/Group Insurance from any general insurance/LIC to divert the financial burden in case of any mishap occurring and falling under the WC Act.

Regards,
P K Sharma

Dear Jaykant,

Greetings for the day. It would be advisable to recommend to your employer to cover employees who are not beneficiaries of ESIC through Employers' liability policy by New India Insurance. In the policy, the following should be covered:

Table-A: Indemnity against Legal Liability for Accidents to Employees

- Workmen's Compensation Act 1993
- Fatal Accident Act 1855
- Common Law

Table-B: Indemnity against Legal Liability

- Fatal Accident Act 1855
- Common Law

Please review the details.

Thanks & Regards,

Sumit Kumar Saxena

The advice of Mr. Saxena is quite reasonable. Insurance policies to cover workman's compensation acts are also available from other general insurance companies.

Regards,
P. K. Sharma