ESI is an abbreviated term for Employee State Insurance. It is regulated by the Employee State Insurance Corporation, which is a separate legal body created under the provision under the GOI, Ministry of Labour and Employment. This scheme is dedicated to the individuals of the labor class. The scheme provides ample benefits to the workers in terms of financial and medical. The release of such benefits is initiated by the employers of the company. The company holding more than ten employees (20 employees in some states) who earn not more than Rs 15000 on the monthly basis is liable to register under this scheme. ESI Registration appreciates the hardship of employees and provides an adequate cushion in unfavorable situations. Following the section will explain the primary Benefits of ESI Registration.
Read our article:How to obtain ESI Registration in India and Returns Filing Procedure
Benefits of ESI Registration
Following are the primary Benefits of ESI Registration. Those are as follows:-
Sickness Benefit
Sickness Benefit comes in the form of periodical cash payment made to the insured worker during the time of the sickness. In general, Sickness benefit is equivalent to seventy percent of the average daily wage, and it’s payable for ninety-one days during two successive benefit periods. The Forms 8, 9, 10, 11 & ESIC-Med.13 is available on the ESI website which needs to fill and submit back to the authority to claim the benefit.
Qualifying Conditions
- To claim sickness benefit, an insured person must have contributed a minimum of seventy days during the corresponding period of contribution.
- A person who enters the scheme for the first time has to wait for at least nine months before claiming such a benefit. It’s because his corresponding benefits period initiates post that interval.
- The IP cannot claim the sickness benefit for the first 2 days of the spell of sickness except in the event of a spell initiating within fifteen days closure of the preceding spell for which said benefit was paid. This two day is regarded as a waiting period.
- The IMOs/IMPs are required to understand the provision clearly as in real-world situation shows the such of insured persons who seek medical leave on faulty grounds typically come for a first and final certificate within fifteen days of the earlier spell, generally on weekly offs or unpaid holidays to avert the loss of benefits for two days due to new waiting period.
Medical Benefits
The Employees’ State Insurance Scheme renders medical coverage in terms of treatment, medical attendance, medicines and injections and hospitalization, and special consultation to the insured persons and their family members where the facilities for hospitalization and specialist consultation have been extended to the families. This is certainly the most touted benefits of ESI registration.
The said benefit has been categorized into two essential parts:-
Full Medical Care
This encloses hospitalization facilities, drug & dressing, specialist services, and diets as required for in-patients.
Expanded Medical Care
This includes the supply of special drugs and specialist consultation, X-Ray examinations, and special laboratory tests. Apart from the aforesaid benefits rendered via hospitals and dispensaries[1], the authority also renders the given benefits to the IP.
Immunization
The Corporation has initiated a program of immunization of the children of the insured persons. Under this program, preventive vaccinations are given against severe diseases such as pertussis, diphtheria, mumps, rubella, tetanus, tuberculosis, etc.
Family Welfare Services
In addition to the immunization program, the authority has been addressing activities related to the family welfare services to the beneficiaries. The corporation has also mitigated the previous cash incentive and introduced the new one with an extended limit for the IPs to endorse recognition of sterilization method by rendering sickness cash benefit equivalent to full wage for a timeline of seven days for vasectomy and 14 days for tubectomy.
The timeline for which cash benefit is acceptable is extended beyond the max limit in the case of any troubles after family planning operations. Undoubtedly, this is one of the significant benefits of ESI registration.
Supply of Special Aids
Insured persons and their family members are provided hearing aids, spinal products, artificial limbs, cardiac pacemakers, and crutches as a part of medical aid under the scheme.
Maternity Benefit
The maternity benefit rate is equivalent to a hundred percent of average daily wages. Maternity Benefit typically benefits the insured woman in the given scenarios subject to contributory stipulates:
- Confinement-payable for the timeline of eight four dates on submission of Form 21 and 23.
- Miscarriage is payable for 182 days from the date following termination of pregnancy based on Form 20 and 23.
- Sickness occurs during pregnancy, premature birth, and confinement payable for thirty days on the product of forms 8, 10, and 9.
- In case of the demise of the insured woman during confinement, maternity benefits will be rendered to the nominee based on form 24 (B).
- In the event of the death of the Insured Woman during confinement leaving behind a child, Maternity Benefit is payable to her nominee on the production of Form 24 (B).
Funeral Costs
The corporation offers an amount of fifteen thousand to cover funeral expenses. The amount is payable to the person who does the last cremation of the IP.
Confinement Costs
In the event, if the confinement takes place in the vicinity where required medical aid is not covered under the scheme, the IPs can avail of the confinement costs.
Vocational Rehabilitation (VR)
The corporate renders this benefit depending on the requirement of the IPs. This benefits those who are physically challenged or received severe injuries for VR training at VRS.
Physical Rehabilitation
Such a benefit rendered by the corporation depending on the requirement particularly in the event of disability encountered during the employment tenure.
Old Age Medical Care
Such benefits are rendered by the authority in the case of retirement of the IP or person under VRS or ERS due to permanent disability. The benefit encloses the monetary aid worth Rs 120 per annum.
Conclusion
Any individual who makes flimsy representation or statement to avail benefit under the scheme is liable to confront penalties as prescribed under the law. The aforesaid forms must be filed properly and submitted to the relevant branch officers on time to avert penal deductions of benefits under regulation 64 & 69 of ESI Regulation, 1950. For more information on Benefits of ESI Registration feel free to connect with CorpBiz’s experts.
Read our article:Documentation Required and Process for ESI Registration
