The Employees’ State Insurance Scheme of India (ESIC) is a complex social security program whose goal is to protect the socioeconomic well-being of “employees” in the organized sector. The Employees’ State Insurance Corporation is a legally recognized corporate body that oversees the ESIC Scheme.
The Employees State Insurance Act, of 1948 was enacted by the Government of India through the Parliament to strengthen social security for workers in independent India.
Manufacturing industries started hiring multiple workers to speed up production processes with the industrial revolution in the 1950s. The legislation’s goal was to give these numerous workers a security system, especially in the event of health-related emergencies. Continue reading to learn about the benefits, coverage, and eligibility for the Employees State Insurance Scheme.
- It offers coverage for medical expenses for covered workers and their families, as well as protection from illness, maternity, disability, and death due to work-related injuries.
- Almost 10.28 lakh new members joined the ESIC-run social security plan in November 2021, compared to 12.39 lakh the month before, according to official data released in January 2022, giving information about the nation’s employment in the formal sector.
Who is Eligible for ESI?
- The monthly wage ceiling for coverage of an employee is Rs. 21,000 per month, per the FAQs on the ESIC website, effective as of January 1, 2017.
- The obligation to enroll qualified workers in the ESIC program falls on the employer.
- Workers receive social security benefits based on their individual needs without discrimination, despite the fact that the contributions are determined by their ability to earn as a fixed percentage of their salary.
Is the Employer’s Registration Under the Scheme Required?
Yes, the employer is required by law to register their factory or establishment under the ESI Act within 15 days of the Act’s applicability to them, as per Section 2A of the Act and Regulation 10-B.
The Act’s Section 46 provides for the following six social security benefits. There are requirements to receive these benefits, though.
Medical Benefit: An insured person and his or her family are given access to complete medical care as soon as they begin insurable employment. The amount that an insured person or a family member can spend on care is unrestricted. Medical care is additionally offered to retired and permanently disabled covered individuals, as well as their spouses, for a small annual premium of Rs 120.
Sickness Benefit (SB): Insured employees are entitled to Sickness Benefit in the form of cash compensation at the rate of 70% of salaries during periods of certified sickness for a maximum of 91 days per year. The insured worker must have paid into the plan for 78 days out of the previous six months in order to be eligible for illness benefits.
Maternity Benefit (MB): Subject to payment for 70 days in the two preceding Contribution Periods, maternity benefits are paid for twenty-six (26) weeks during confinement or pregnancy, with a one-month extension on medical advice. Following payment for 70 days in the two prior Contribution Periods, Maternity Benefit during confinement/pregnancy is payable for twenty-six (26) weeks, with a one-month extension on medical advice.
- Temporary Disablement Benefit (TDB): In the event of an employment injury, starting the day after beginning an insurable job and regardless of whether or not you have paid any contributions. As long as the disability persists, temporary disability benefits at the rate of 90% of wage are payable.
- Permanent Disability Benefit (PDB): Depending on the severity of the loss, the benefit is paid at a rate equal to 90% of the employee’s weekly or monthly salary.
What Is Covered by the State Insurance Program for Employees?
- The ESI Scheme (ESIS) was first put into effect in Kanpur and Delhi in 1952, the two major industrial hubs at the time.
- However, as the industrial revolution gathered steam, the plan began to spread across the nation.
- As of 31 March 2019, the ESIS had been put into use in more than 34 states and Union Territories due to the rise in industrialization over time.
What Does the Employees’ State Insurance Plan Not Cover?
Currently, the ESIC program does not cover workers or employees making more than Rs. 21,000 per month, and for disabled individuals, the monthly salary is Rs. 25,000.
Additionally, unlike other states or UTs where the coverage threshold is 10, Maharashtra and Chandigarh still have 20 employees.
Benefits of Employees State Insurance Scheme (ESIS):
The key components of the ESI program offered by the Employees State Insurance Corporation (ESIC) are listed below:
Medical: According to the plan, the insured’s medical costs are covered by affordable and reasonable medical facilities. Additionally, the worker or employee is protected from the start of their employment.
Maternity: In accordance with the plan, the beneficiary is entitled to 100% of their daily wages for up to 26 weeks, which may be extended by an additional month based on a doctor’s recommendation. The benefit lasts six weeks for miscarriages and twelve weeks for adoptions.
Disability: If a worker is temporarily disabled, they are entitled to a 90% monthly wage while they recover. 90% of the monthly salary may be used for the rest of one’s life in the event of a permanent disability.
Sickness: The program provides cash flow during a period of medical leave. For a total of 91 days, the employee is eligible to receive 70% of the daily wage. You may use this for two consecutive periods.
Unemployment: The plan offers up to 50% of the average monthly wage for a maximum of 24 months in the event of an injury-related permanent disability or involuntary loss of employment.
Dependents: Dependents of the insured receive financial support through the program in the event that they become ill or sustain injuries at work. In these situations, dependents are eligible for monthly payments that are split equally among the surviving dependents.
Coverage: The plan covers workers or employees starting on the first day of employment. This applies to the insured as well as their dependents.
Funeral Expenses: The ESIC provides Rs. 15,000 toward funeral expenses. This is given to the insured person’s surviving family members or the person performing his or her final rites.
Costs of confinement: The insured person or their dependent can receive confinement costs if they are confined in a place where they cannot receive the necessary medical care covered by the plan.
Vocational Rehabilitation: The plan provides this benefit based on the requirements of the insured. This also applies to injured people who need vocational rehabilitation (VR) training at VRS and who are permanently disabled.
Physical Rehabilitation: This benefit is also given in accordance with need, particularly in cases of disability brought on by workplace injuries.
What Conditions Apply to ESI Registration?
It is necessary to register for ESI if a company, organization, or business establishment employs ten or more workers, or, as in the cases of Maharashtra and Chandigarh, twenty or more. The business needs to register with the ESIC.
- When workers or employees make less than Rs. 21,000 per month or Rs. 25,000 in the case of a person with a disability, they are covered or entitled to ESI benefits.
- The employee’s contribution to the ESI scheme is 1.75 percent of their salary, and the employer’s contribution is 4.7 percent. It should be noted that these prices are occasionally updated.
- Employers are still required to make contributions to the ESI fund on behalf of employees whose daily average pay is less than Rs. 50.
ESI Online Registration Required Documents:
The list of documents needed for ESI online registration is as follows:
- the Certificate of Registration obtained under the Factories Act or the Shops and Establishments Act
- For a partnership or company, a Certificate of Registration is required.
- Articles of Association and the Company’s Memorandum of Association
- A list of every employee at the business.
- Information about each employee’s compensation.
- PAN Card information for both the business entity and each employee.
- company bank account check that was canceled.
- The company’s directors and shareholders are listed.
- a register detailing employees’ attendance information.
- The Employer’s Registration Form (Form No. 1), can be downloaded online, completed, and uploaded on the ESIC website with the aforementioned documents.
Procedure for ESI Registration:
Employers can register for ESI entirely online; no physical applications need to be submitted before or after the registration. The steps to register your business with the ESIC are as follows:
- Step 1: Click “Login” when you arrive at the ESIC Portal.
- Step 2: Go to the new page and select “Sign Up.”
- Step 3: Enter your company name, and email ID (which will be your username), along with your phone number.
- Step 4: To confirm that your business, factory, or other facility is covered by an exclusive labor contract, manpower suppliers, security companies, or contractors supplying labor categories, check the appropriate box.
- Step 5: A login email or other details will be sent after you click “Submit”.
- Step 6: You must visit the ESIC Portal to log in now that you have registered.
- Step 7: Click “Login” after entering the email-provided username and password.
- Step 8: Then select “New Employer Registration.”
- Step 9: Click on submit after selecting the unit type.
- Step 10: Enter the name of the unit, the full postal address of the factory or establishment, and the police station that has jurisdiction over your unit on the new page.
- Step 11: Click “Next” to continue after indicating whether the factory, building, or other establishment is owned or rented.
- Step 12: Click “Next” after entering the PAN information, business type, and category.
- Step 13: On the following page, enter the factory’s or establishment’s opening date as well as any license information.
- Step 14: After entering all of the information regarding the owners, click “Save” before choosing the constitution of ownership and owner details.
- Step 15: Click “Save” after entering the total number of workers in your factory or establishment as well as the total number of workers making less than Rs. 21,000.
- Step 16: On the new page, select “Employee Declaration Form” and then enter the date that the first 10/20 employees were hired.
- Step 17: Enter the IP number and the joining date if the insured person is already registered, and then click “Yes.” If your IP address is not registered, select “No” and press “Continue.”
- Step 18: Enter the IP’s name, the father’s name, the IP’s address, the gender, the marital status, the family information, and the date of joining.
- Step 19: At this point, check the box and press the “Submit” button.
- Step 20: On the new page, click “Close” after all the necessary information has been entered.
- Step 21: Choose the appropriate ESI branch office and the inspection division on the new page.
- Step 22: Next, confirm the information has been provided by checking the box, and then click “Submit.” You’ll be taken to a different page.
- Step 23: On the new page, select “Pay Initial Contribution” and then select “Submit.” For future use, a Challan Number will be given to you.
- Step 24: Select the necessary payment gateway and click “Continue” to complete the transaction.
How To Apply an ESI Card (Pehchan Card)?
The ESI Card, also referred to as the Pehchan Card, is an identification card used to access the ESI scheme’s benefits at hospitals and pharmacies with empanelled status. The beneficiary’s name, father’s name, address, and special ESI insurance number are all listed on the card.
- Step 1:Visit the ESIC Portal and log in using your username and password as the first step.
- Step 2: Select “e-Pehchan Card” from the “Employee” section on the new page.
- Step 3: Choose the unit details and then click on view.
- Step 4: You can view information about all of the employees, but you also have the option to focus your search by entering the name and insurance number of the relevant employee.
- Step 5: Choose “View Counter Foil” next to the appropriate employee on the same page where you can see all of their details. This “Counter Foil” card is known as the “e-Pehchan.”
- Step 6: Scroll down to the bottom of the new page and click “Print,” which will open a PDF file for download.
- Step 7: The printout must have the respective employee’s signature and a photo of their family or dependents attached. The employer or an ESIC official must certify and stamp this photo.
- Step 8: Make sure the e-Pehchan Card has the employer’s signature and the ESIC office’s stamp on it.
Hospitals Covered by the Employees State Insurance Scheme:
Hospitals all over the country and the Employees State Insurance Corporation have partnered.
Visit the ESIC Portal, which has a comprehensive list of ESI and tie-up hospitals, to learn the list of ESI hospitals in India.
Evolution of ESIC 2.0’s Second Generation Reforms:
The Employees State Insurance Scheme’s health reform initiatives were introduced in 2015 by the Hon. Prime Minister Shri Narendra Modi. Below are the main agenda of the initiatives:
- Electronic health records are accessible online for ESI holders.
- Healthcare Hotline
- Operation Indradhanush in VIBGYOR
- Special OPD
- Drugs and Medicines Quality Control
- Pathological and X-Ray in PPP Model
- Honorable ESIC members regularly inspect ESIC and its hospitals
- Specialties (such as CAT labs, ICUs, MRIs, and dialysis) are being developed.
- Doctors’ and paramedical staffs’ behavioral training, yoga, ayurvedic medicine, hospitals that specialize in child and mother care, queue management, “May I Help You” counters, etc.
The ESI Scheme’s Dos and Don’ts:
A beneficiary of ESI should be aware of the following significant factors:
- Make sure to give your new employer your ESI Registration Number if you change jobs.
- To use the services at ESI hospitals and dispensaries, you must have an ESI Card/Pehchan Card or an e-Pehchan Card.
- Adhere strictly to the doctor’s instructions.
- Make sure the ESI smart card doesn’t disappear. It is possible to obtain an e-Pehchan card, but doing so could be difficult. Additionally, inform the ESIC branch office or pharmacy about the card’s loss.
How Can I Claim My ESI Benefits?
Two categories of benefits are available to you as an ESI scheme beneficiary:
- Medical Benefits: To receive medical care for you or your dependents, you must go to one of the hospitals that ESI has authorized.
- Cash Benefits: Employees and workers who are eligible for the ESI program may receive cash benefits in the event of sickness, temporary or permanent disability, maternity, unemployment, support for dependents, funeral expenses, and physical and occupational rehabilitation.
How Can I Check the Status of My ESIC Claim Online?
Following are the steps to check an ESI claim’s status online:
- Step 1: If you don’t already have the UMANG App installed on your smartphone, open it now or download it.
- Step 2: Enter the ESIC Insurance Number or IP number and select “Get OTP.”
- Step 3: Type the OTP and press “Submit.”
- Step 4: Click on “Claim Status” in the services section.
- Step 5: If you have submitted claims, you can view their status or use the advanced search to find out more information.
Does the employee’s or the worker’s overtime pay count toward the ESI coverage income cap?
In order for a worker or employee to qualify for ESI benefits, overtime is currently excluded from the scheme when determining the worker’s or employee’s monthly wages.
Can an ESI beneficiary receive money from ESI if they received care in a private hospital?
Treatment must only be obtained from ESIC hospitals or dispensaries, as required by the ESI Act. However, if a private hospital provided your care in an emergency, you can submit a claim to the ESIC, pending ESIC approval.
What happens if an employee’s monthly pay exceeds Rs. 21,000?
The contribution is to be deducted from and paid on the total income earned, and the employee remains an employee until the end of the contribution period if the wages increase by more than Rs. 21,000 in a month as per the wage limit mandated by the Centre.
What penalty is imposed for late ESI contribution payment?
Each day the worker or employee contribution is not paid results in a 12% annual interest charge.