Frustrated with ESIC Services? Exploring Private Insurance Alternatives for Better Employee Benefits

We are paying monthly 3 lakhs as a contribution for ESIC, but we are not getting proper facility from the ESIC Department for our employees. Please let us know if there is any way to come out of it. Is there any alternate option by switching to private insurance instead of paying to ESIC.

Exemption from ESI Scheme

There is no option to opt out of the ESI Scheme per se. However, if you have facilities to provide medical benefits to your employees and their families in a manner where the facilities available in the hospital are better than those offered by ESIC, then the ESIC will exempt your establishment from the operation of the ESI Act. In order to get an exemption, the facility should be superior to the one available at an ESI hospital. Additionally, the employer should provide all accident compensation, leave with wages for the same duration as paid by the ESI, and post-retirement medical benefits.

Limitations of Private Medical Insurance

I don't think that any private medical insurance will cover a family member of the employee who is aged 70 or 80 years. I doubt if any private insurance company will extend coverage to an employee who already has a pre-existing disease. Furthermore, I don't believe that any insurance company will compensate for a leave of absence for a period of up to 90 days!

Dear Anamika,

You can address the issue in writing with the ESI Dispensary/Hospital/ESI Local Office, highlighting deficient Service 7 for the redressal of your genuine grievance. Please correspond regularly with the concerned party.

Thank you.