Is My Wife Eligible for ESIC Maternity Benefits While Using a Private Hospital?

Hi Santosh, here. My wife works in HR, and as per the new rules, she has contributions towards ESIC from April 2017 and was registered in May 2017. Her due date is January 20th, 2018. Her current salary is ₹21,000. We are receiving treatment at a private hospital and plan to continue with the same hospital for the delivery as well.

Eligibility for Maternity Benefits under ESIC

In this case, will she be eligible for maternity benefits under ESIC? If yes, how much will they reimburse per month for medical claims? Additionally, is it only 26 weeks of leave provided, and if so, how much can be claimed?

Regards,
Santosh

For maternity benefits, an employee must make a payment of contributions for 70 days in the immediately preceding one or two consecutive contribution periods. Therefore, since your wife is covered from April 2017, she will definitely be entitled to the benefit of maternity leave for 26 weeks with 100% of her daily average wages. Please take her to the ESI hospital with the card she received for ESI registration and begin her treatment. The doctor will prescribe when the leave will be required and issue her the entitlement slip.

Maternity benefit is expressed as maternity leave and medical bonus put together. Now, if you seek treatment in a private hospital without the intimation or permission of ESI authorities, you will not receive any money for hospitalization expenses.

You need to inform the ESIC local branch. Based on the ESIC guidelines, they can refer you to a panel hospital.