Confused About Maternity Benefits Under ESI? Seeking Expert Advice on Section 56

Section 56 under ESI Central Rules 1950 mentions, "An IW shall be qualified to claim maternity benefits for a confinement occurring or expected to occur in a benefit period if the contributions in respect of her were payable for not less than 70 days in the immediately preceding two consecutive contribution periods."

Some of our women employees did not get their maternity benefit. On inquiry, we were pointed to this section. Can anyone explain and give me expert advice on this?

Regards,
Vini

Hi Vini,

This is Rabi Panda here.

As per your queries, I think the below may give clear info:

A female employee who has made contributions for 70 days in one or two consecutive periods (i.e., either from April-Sept or Oct-Mar contribution period) is eligible for ESI maternity benefits.

Only the Insured Woman (IW) is entitled to receive maternity benefits for confinement for a period of 12 weeks (of which not more than 6 weeks can precede the expected date of confinement) for all the days on which she does not work for remuneration.

No payment will be made for the days on which she worked for remuneration. But the said days will be counted for the purpose of arriving at the total range of 12 weeks / 84 days.

An insured woman and an insured person in respect of his wife shall be paid a sum of rupees one thousand per case as "confinement expenses" (earlier termed as medical bonus), provided that the confinement occurs at a place where necessary medical facilities under the ESI Scheme are not available. i.e., where the facility for confinement is not available in the ESI institutions at the place of confinement. Also, confinement expenses shall be payable for two confinements only.

Thanks,

The normal contribution periods are April to Sept and Oct to March following. There are two corresponding benefit periods also, viz, January to June and July to Dec. Any employee who becomes a member of ESI is eligible for benefits after around nine months of his admission.

If the date of delivery is in the month of July, she should have paid contributions for at least 70 days in the two consecutive contribution periods, i.e., the previous year's Oct to March period and April to Sept period. A woman employee who has recently joined will not be eligible for maternity benefits.

Regards, Madhu.T.K

Dear Professional,

I have another doubt regarding ESIC, specifically regarding sickness benefits. If a newly joined employee is covered under ESI, when is he entitled to claim sickness benefits? Is it after 78 days or after 9 months?

Kindly reply.

Regards,
Anirban Biswas
Email: hr_anirban@yahoo.com

The responsibility for payment of maternity benefit in respect of an ESI-covered employee lies with the ESIC, whereas it rests with the employer for an employee who is not covered by the ESI Act. For details, please refer to the Employees' State Insurance Act.

Regards,
Madhu.T.K

If someone joins on 1st Feb '14 and delivers on 16th Oct '14, the conditions of 70 days are met since there are 56 days in the first contribution period and 180 in the second period. Will maternity benefit be paid in such a case by ESIC?

There are two conditions, namely, 70 days of working in two consecutive contribution periods immediately preceding the date of or expected date of delivery, and delivery happening in the benefit period. In this case, delivery has happened before the benefit period has started. The first benefit period will be after 9 months of joining in all cases. That means the benefit period for an employee who joined in February should be from 1st November and not earlier than that; hence she may not be entitled to maternity benefits from ESIC. However, she can get maternity leave and a medical bonus from the employer since she is not in receipt of such benefits from ESIC.

Regards,
Madhu.T.K

Thanks, Mr. Madhu. Our advocate says that she has just completed 8 months with us. Although she has worked for not less than 80 days in the preceding 12 months, she should complete the first 12 months of work. Then, in the second 12 months, this condition of 80 days is to be considered. What is your view on the same?

He says if someone joins on 1st Feb and delivers on 1st May, how can maternity benefits be paid just because 80 days are completed? The employee worked for just 80 days and got the benefit of 84 days. Doesn't it look irrational?

Dear member, the eligibility for various benefits, including maternity, is determined based on satisfying the contributory conditions as laid down under the ESI Act, 1948, and the rules/regulations framed thereunder. The Branch Office of ESIC is the appropriate office to decide the eligibility and payment of benefits.

Since each case may have different facts, I suggest you visit the Branch Office of ESIC to which you or the insured woman is attached. Discuss the matter to clear your doubts. However, Sh. Madhu T.K., a senior expert, has clearly explained the position in his remarks on the previous page.

The interpretation by your lawyer is genuine. However, working 80 days in a 12-month period does not automatically mean she will be entitled to maternity leave once she completes 12 months of service with the company. If she is already pregnant, the question arises as to why she was appointed in the first place. If she has been given an appointment, she should also be entitled to leave.

Madhu.T.K

Dear Sir,

I am working in a government factory on a contract basis since September 2014. My ESI subscription has been deducted since October 2014, and I am currently nine months pregnant. Our employer is stating that I cannot avail leave benefits from ESI because I have not completed nine months of ESI subscription.

Please guide me on this issue.

Since you have not completed two contribution periods, you will not receive maternity benefits from the ESI Corporation. However, if you have worked for 80 days immediately preceding the date of (or expected date of) delivery, you are entitled to maternity leave and a medical bonus from your employer.

Maternity Benefits Under the Maternity Benefits Act

Section 5A of the Maternity Benefits Act clearly states that a woman employee not qualified to get maternity benefits from the ESI Corporation shall receive them from the employer. Therefore, you are entitled to 84 days of paid leave and Rs 5000 as a medical bonus as maternity benefits from the factory employer.

Regards,
Madhu.T.K

The medical bonus payable to an employee under the Maternity Benefit Act, if the employee is not provided any prenatal or postnatal care by the employer, is not Rs 5000 but is Rs 3500. Thanks to Harsh Kumar Mehta for pointing out the mistake.

Regards, Madhu.T.K

Maternity benefits under ESI are applicable for all women employees (permanent employees as well as probationers) who have contributed at least 70 days for 2 consecutive contribution periods. All employers are liable to obey and provide maternity benefits for such women employees. They can avail benefits as per the provisions of the Act.

Hi, this is Neelam here, and I'm 8 months pregnant. My doctor has suggested complete bed rest. Can I avail the benefits of maternity leave before and after delivery?

Maternity leave is for 12 weeks, of which a maximum of 6 weeks can be taken before childbirth.

Madhu.T.K

I am 8 months pregnant and planning to go on leave from Sept. I have been working with my company for the last 22 months and am insured under ESIC. Now, I want to avail the maternity benefit but have no idea where to start.

Can anyone help me with a step-by-step procedure on what needs to be done?

Dear member, It would be better if you could visit your ESI dispensary, consult the doctor, obtain a medical certificate, and submit it to the appropriate Branch Office of ESIC to which you are attached. Please ensure that you have your Pehchan Card issued by the said Branch Office since it will be required by both the ESI Dispensary and ESIC branch to assess your eligibility for the benefits, etc.

From the Branch Office or ESI insurance medical officer, you can ascertain further procedures to claim maternity benefits under ESIS.

The treatment and certification are provided by the concerned ESI dispensary, and the certificates are required to be submitted to the Branch Office of ESIC in order to claim the cash benefit, i.e., maternity benefit. I hope you will comply with the procedure and not face any difficulties.