Can Our Employee on Maternity Leave Access ESIC Benefits After the Salary Limit Change?

Our employee who paid ESIC for the last 2 years stopped contributing from April 2016 due to receiving a salary above 15000. Now, following the new amendment in the ESIC Act, the salary limit has increased from 15000 to 21000. Consequently, she falls within the ESIC limit again, and deductions will resume from January 2017.

She is currently on maternity leave starting from 1st February 2017 and is receiving treatment at a private hospital. Can she avail of maternity benefits under ESIC? If so, how can she take advantage of this benefit?

She is not eligible to avail Maternity Benefit (Payment) of 26 weeks from ESIC since she has become a member from 01/01/2017. In the previous 2 contribution periods, she should have contributed for a minimum of 70 days in each contribution period. She is eligible to avail Medical Benefit, i.e., treatment. Maternity benefit of 12 weeks payment to be paid by the employer under The Maternity Benefit Act, 1961.

Contribution Period:
Oct 2015 to March 2016
April 2016 to Sep 2016

If she had contributed for more than 70 days during the contribution period ending 3/16, she must be eligible for maternity benefit. Regulation 56 states that to be eligible for maternity benefit, a minimum of 70 days contribution in two consecutive contribution periods will be sufficient. 70 days contribution in each contribution period is not required. It is advisable to verify with the ESI branch office.

Dear member,

In respect of the case as mentioned above, as confirmed by the seniors and experts, the insured woman is entitled only to medical treatment from ESIC. She will not be entitled to Maternity Benefit (cash benefit of leaves) under the ESI Act, 1948. However, she can claim the said benefit from her employer under the Maternity Benefit Act, 1961 if she fulfills the contributory conditions under the said Act.

If ESIC maternity leave falls in two benefit periods, how is it calculated...?

Sickness Benefit Under ESI Rules

Sir, as per Rule 55 of ESI (Central) Rules, 1950, an insured person, if entitled by virtue of his contribution, can claim sickness benefit for a maximum of 91 days in any two consecutive benefit periods. Therefore, there is no problem if the sickness falls under two consecutive benefit periods. In sickness cases, a ceiling of 91 days is observed. If the sickness starts from 1st December, the benefit will cease after the employee has received 91 days of benefit. It is also taken into consideration whether the insured person had obtained any sickness benefit during the preceding benefit period before 1st December; if so, the benefit days will be adjusted accordingly.

Ceilings for Other Benefits

Furthermore, there are separate ceilings for maximum benefits concerning maternity benefit, long-term disease cases (ESB), and, I believe, in the case of accidents, there is no limit on benefit days. Once the insured person is declared fit by the competent authority/doctor, the payment of such benefits ceases.

Calculation of Benefits

All such calculations are carried out at the level of the Branch Office Manager of ESIC to which the insured person is affiliated.

Hi Experts, I need your valuable knowledge and guidance regarding my wife's Maternity Benefits under the ESIC Act.

Background Information

As per the record:
Registration Date: 10/08/2014
First Date Of Appointment: 28/10/2013
She has been working for the same organization and also contributed to ESIC for multiple years until her salary exceeded 15K. There has been no change in the work organization and no gap in employment in between.

ESIC Contributions Resumed

Due to the change in the ESIC salary slab from January 2017, ESIC contributions started again as below:

Current Date of Appointment: 01/01/2017
Wage Period Total Monthly Wages Number of Days wages paid/payable Employee Contribution (Oct to March-2017)
January-2017 XXXX.00 31 XXXX.00
February-2017 XXXX.00 28 XXXX.00
March-2017 XXXX.00 24 XXXX.00

Wage Period Total Monthly Wages Number of Days wages paid/payable Employee Contribution (April to Sept 2017)
April-2017 XXXX.00 26 XXXX.00
May-2017 XXXX.00 31 XXXX.00
June-2017 XXXX.00 30 XXXX.00
July-2017 XXXX.00 31 XXXX.00
August-2017 XXXX.00 31 XXXX.00
September-2017 0.00 0 0.00 - Under Maternity Leave for delivery - Leave started...

Maternity Leave and Benefits

We had our first baby on 7th September 2017 and have availed the newly amended/approved 26 weeks Maternity leave benefit. We were advised to visit the concerned ESIC branch office after completing the 26 weeks leave. However, we were informed that we cannot avail of the Maternity benefit as the ESIC contributions are not for 9 months.

Request for Clarification

Can you experts clarify my query? Why is my wife not eligible under the ESIC amended act for the benefits? How is the 9 months ESIC contributions calculated in this case? Are we going to receive benefits from the current organization for 6 months of salary? What are the correct steps that need to be taken in this case?

Please guide.

Thanks to all.

Dear Thingbaijam,

Please log in to the ESI IP Portal with your ESI Insurance number to determine eligibility for Maternity leave. Share the details with your current employer. If an ESI-covered employee is not eligible for Maternity Benefit under the ESI Act, the employer will be required to provide benefits to the female employee under The Maternity Benefit Act, 1961.

There is no need to worry; the employer will pay the last drawn gross salary as Maternity Benefit for 26 weeks.

Thank you.