Navigating Mediclaim and ESIC: Can Employees Benefit from Both or Just ESIC?

Dear All,

In our organization, we have a mediclaim policy. Later, as the number of employees started growing, we came under ESIC. My question is, can an employee take the benefit of ESIC and mediclaim both? Is it necessary to have both mediclaim and ESIC, or can we opt for only ESIC? Please guide.

Hi Rohit,

ESI benefits are designed to provide medical assistance to employees. Therefore, we may offer only one benefit out of the two options. Considering that ESI offers more benefits than any other medical insurance, it would be preferable to choose ESI.

Understanding the ESI Act and Mediclaim Policies

1. Sir, please refer to sections 53 and 61 of the ESI Act, 1948, which bar claims under any other enactments in case a person is entitled to benefits under this Act.

2. However, since mediclaim policies are a private affair and hence ESIC has no role to play, two aspects are essential to be kept in view. Firstly, compliance under the ESI Act, 1948, and rules/regulations framed thereunder is compulsory irrespective of whether any type of mediclaim policies have been taken. Secondly, the employer cannot be legally bound to incur expenses for the said mediclaim policies of the employees already covered or coverable under the said Act.

It is always advisable to have ESIC as it offers more benefits compared to any mediclaim policy and also, this falls under statutory requirement. On the other hand, you can keep both Mediclaim and ESIC depending on management decision. It's normally been seen in higher cadre employees that they prefer to go to a private clinic rather than ESIC. In this case, a Mediclaim policy will be beneficial.

Any employee who falls under the purview of ESI must be covered under ESI. For such employees, Mediclaim is optional, and if management is willing, they can plan for both.

If an employee exceeds the ESIC limit, they are not eligible for ESI. In this case, you may consider Mediclaim.

I am working in an infrastructure company. There is no ESIC, but they have a Mediclaim and WC policy. Is it right or wrong if the company doesn't provide the ESIC facility? In this case, is ESIC compulsory?