ESIC

The section 46 of the Act envisages following six social security benefits :-
(a) Medical Benefit : Full medical care is provided to an Insured person and his family members from
the day he enters insurable employment. There is no ceiling on expenditure on the treatment of an
Insured Person or his family member. Medical care is also provided to retired and permanently
disabled insured persons and their spouses on payment of a token annual premium of Rs.120/- .

1. System of Treatment
2. Scale of Medical Benefit
3. Benefits to Retired IPs
4. Administration of Medical Benefit in a State
5. Specialist consultation
6. In-Patient treatment
7. Imaging Services
8. Artificial Limbs & Aids
9. Special Provisions
10. Reimbursement

(b) Sickness Benefit(SB) : Sickness Benefit in the form of cash compensation at the rate of 70 percent of wages is payable to insured workers during the periods of certified sickness for a maximum of 91 days in a year. In order to qualify for sickness benefit the Insured Person is required to contribute for 78 days in a contribution period of 6 months.

1. Extended Sickness Benefit(ESB) : SB extendable upto two years in the case of 34 malignant and
long-term diseases at an enhanced rate of 80 per cent of wages.

2. Enhanced Sickness Benefit : Enhanced Sickness Benefit equal to full wage is payable to insured
persons undergoing sterilization for family planning upto 7 days/14 days for Vasectomy and
Tubectomy respectively.

(c) Maternity Benefit (MB) : Maternity Benefit for confinement/pregnancy is payable for Twenty Six
(26) weeks, which is extendable by further one month on medical advice at the rate of full wage
subject to contribution for 70 days in the preceding Two Contribution Periods.

(d) Disablement Benefit

1. Temporary disablement benefit (TDB) : From day one of entering insurable employment &
irrespective of having paid any contribution in case of employment injury. Temporary Disablement
Benefit at the rate of 90% of wage is payable so long as disability continues.

2. Permanent disablement benefit (PDB) : The benefit is paid at the rate of 90% of wage in the form
of monthly payment depending upon the extent of loss of earning capacity as certified by a
Medical Board

(e) Dependants Benefit(DB) : DB paid at the rate of 90% of wage in the form of monthly payment to
the dependants of a deceased Insured person in cases where death occurs due to employment injury
or occupational hazards.

(f) Other Benefits :

1. Funeral Expenses : An amount of Rs.15,000/- is payable to the dependents or to the person who
performs last rites from day one of entering insurable employment.
2. Confinement Expenses : An Insured Women or an I.P.in respect of his wife in case confinement
occurs at a place where necessary medical facilities under ESI Scheme are not available.

In addition, the scheme also provides some other need based benefits to
insured workers.

1. Vocational Rehabilitation :To permanently disabled Insured Person for undergoing VR Training
at VRS.
2. Physical Rehabilitation : In case of physical disablement due to employment injury.

Rajiv Gandhi Shramik Kalyan Yojana :
This scheme of Unemployment allowance was introduced w.e.f. 01-04-2005. An Insured Person who
become unemployed after being insured two or more years, due to closure of factory/establishment,
retrenchment or permanent invalidity not less than 40% arising out of non-employment injury are
entitled to :-

Unemployment Allowance equal to 50% of wage for a maximum period of upto Two Years during
the life time.

Medical care for self and family from ESI Hospitals/Dispensaries during the period IP receives
unemployment allowance.

Vocational Training provided for upgrading skills – Expenditure on fee/travelling allowance borne
by ESIC.

Atal Beemit Vyakti Kalyan Yojana (ABVKY) :
This scheme is a welfare measure for employees covered under Section 2(9) of ESI Act, 1948, in the
form of relief payment upto 90 days, once in a lifetime. The Scheme was introduced w.e.f. 01-07-2018
on pilot basis for a period of two years initially. It has also been decided to enhance the rate of
unemployment relief under the scheme to 50% of wages from earlier rate of 25% along with relaxation
in eligibility conditions, provided the Insured Person should have been in insurable employment for a
minimum period of one year immediately before her/his unemployment and should have contributed
for not less than 78 days in the completed contribution period in 12 months immediately prior to
unemployment. In a significant relaxation, relief shall become due for payment after 30 days from date
of unemployment and claim can be submitted directly to the designated ESIC Branch Office / DCBO
by the worker. Claims to get the relief can be made online at website www.esic.gov.in along with
submission of the physical claim with an affidavit, photocopy of Aadhaar Card and Bank Account
details to the designated ESIC Branch Office / DCBO by post or in person.

Incentive to employers in the Private Sector for providing regular employment
to the persons with disability :

Minimum wage limit for Physically Disabled Persons for availing ESIC Benefits is 25,000/-.

Employerss’ contribution is paid by the Central Government for 3 years.

Benefits & Contributory Conditions :
An interesting feature of the ESI Scheme is that the contributions are related to the paying capacity as
a fixed percentage of the workers wages, whereas, they are provided social security benefits
according to individual needs without distinction.
Cash Benefits are disbursed by the Corporation through its Branch Offices (BOs) / Pay Offices (POs),
subject to certain contributory conditions