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Employees State Insurance Scheme (ESIS)

Employee's State Insurance Scheme (ESIS) is a multidimensional and an integrated social security system customized
to offer ‘protection’ to the employees. This was introduced as per the ‘Employees State Insurance Act, 1948’.
According to this Act, the ESIS will provide help in case of sickness, death due to employment, injury, maternity,
temporary or permanent disablement etc.

ESIS offers complete medical care for the insured person as well as the dependents. This insurance comes into force
right from the beginning of the employment. This scheme offers cash benefit in case of any uncertainty resulting in a
loss of income or disablement or confinement for women. Besides, the Employee's State Insurance Scheme (ESIS) also
offers variety of cash benefits in the form of pension popularly known as dependents benefit. This is offered to the
family members dependent on the insured, in case of death due to accidents caused due to workplace (industries) or
any injury suffered during working or someone who faced hazardous situation while on duty.
 Features of Employees’ State Insurance Scheme

Includes medical care facilities for the insured individual as well as the dependent members of his/her family
from the first day of insurable employment.
Includes medical coverage during certain illnesses, as specified in the document of the scheme, which includes
cash benefit during medical leave. This extends up to a maximum of 70% of the employee’ wages till 91 days. In
order to qualify for this benefit the insured worker is required to contribute for 78 days in a contribution
period of 6 months.
Includes Maternity Benefit up to 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, ranging to
100% of the average daily wages of employees in cash. This benefit is also applicable for miscarriages or
medical termination of pregnancy of employees up to 6 weeks.
Benefit for dependents include financial security during illnesses and injuries while at work, financially
securing your dependents during emergencies arising from sudden loss of income. In such unfortunate
situations, the dependents are eligible for payments in the form of monthly instalments.
The unemployed are eligible for being insured for at least three years, provided they disclose details regarding
their previous place of work and retrenchment or permanent invalidity. In such cases, employees can avail a
monthly payment of 50% of their wage in cash for a maximum of 2 years.
Instances of temporary disablement of employees make them eligible for a monthly payment of 90% of their
wage till the time of their recovery. Employees who are permanently disabled can avail monthly payments of
90% of their wage for their entire life.

Benefits Offered by Employees State Insurance Scheme

(ESIS)

The Below Mentioned Benefits are Offered by ESIS:

Medical Benefits: ESIS offers complete medical care for the insured person as well as the dependent family
members from the first day of insurable employment. In short, ESIS helps you by taking care of your medical
needs.

Medical coverage during certain illnesses, as mentioned in the document of the Employees’ State Insurance
Scheme, is offered in the form of cash. This benefit extends up to a maximum of 70% of the employee’ wages till
a term of 91 days. In order to qualify for this benefit the insured worker is required to contribute for 78 days in
a contribution period of 6 months.
Sickness Benefit: ESIS offers cash benefit at the time of medical leave up to 70% of the wages. This benefit is
provided up to 91 days.

Maternity Benefit: up to a span of 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 ranges to
100% of the average daily wages of employees in cash. This benefit is also applicable for miscarriages or
medical termination of pregnancy of employees up to a maximum of 6 weeks.

Benefit for Dependents: In case you suffer any health hazards or injuries whilst at work, your dependents do
not have to worry about the financial crisis that may arise due to the sudden loss of income. ESIS offers
payments in monthly installments to your dependents.

Benefit for Unemployment: Incase you become unemployed after being insured for three or more years, on
account of closure of factory/establishment, retrenchment or permanent invalidity, a monthly payment equal
to 50% of wage in cash is offered by ESIS for a maximum of 2 years.

Benefit for Disablement: In case of temporary disablement, ESIS offers payment each month at the rate of
90% of wage for temporary disablement till the time the injury is healed. In case of permanent disablement,
ESIS offers monthly payments at the rate of 90% of wage continuously for the entire life (whole life).

Offers Funeral Expenses of Rs. 10,000.

Other benefits include vocational and physical rehabilitation, and old age medical care.

Things to Keep in Mind

A new employer has to be informed of the ESI Registration Number after the insured switches from one
company to another. This will make him/her eligible for utilizing the same benefits, if and when needed.
Pehchan Card serves as a channel towards social security. Hence, the cardholder has to prevent it damage or
loss.
The insured and the dependent family members who are covered under the scheme have to immediately
report a lost card to their Branch Office or Dispensary.
Recommended processes for referrals should be strictly followed.
In case an employee plans to relocate for professional reasons, he/she has to get the Form 105 signed by their
existing employer to remain eligible for the benefits of the ESI scheme in another location.
The insured has to closely abide by doctors’ medications and prescribed treatments.
 What is Covered in Employees’ State Insurance Scheme
(ESIS)?

The Employees’ State Insurance Scheme was inforced only in two Indian cities, Delhi and Kanpur, when it was initially
implemented in 1952. Since then, the scheme has spread in leaps and bounds across the country. Currently, it is
accessible in more than 843 centers in 33 States and Union Territories. The ESI Act has now been adopted by more
than 7.83 lakh factories and establishments and has a reach of over 2.13 crore insured individuals and families. It
holds a record of over 8.28 crore beneficiaries.

According to notification by the government, according to Section 1(5) of the ESI Act, shops and restaurants or hotels
that are involved in sales are covered by the Employees’ State Insurance Scheme

Infrastructure of Employees State Insurance Scheme

(ESIS)

The progress in the infrastructure of ESIS is commendable since its introduction in 1952. It has been growing rapidly
in order to fulfill the social security needs of the increasing population of the employees.

So far, ESIS has made available 151 hospitals and 42 hospital annexes to take care of inpatient services. It also has set-
up 954 panel clinics, 1450/188 ESI dispensaries or AYUSH units.

ESIS has also set-up 5 occupational disease centers each in Mumbai, New Delhi, Chennai, Kolkata and Indore to rule
out occupational diseases at the beginning of the employment who are engaged in hazardous industries.

In order to make the monthly payouts, ESIS has set-up a network of more than 628/185 branch offices/ pay offices.
The functioning of this department is further inspected or managed by 62 regional/ sub-regional and divisional
offices.

What is Rajiv Gandhi Shramik Kalyan Yojana?

Rajiv Gandhi Shramik Kalyan Yojana is especially designed for the unemployed. It is an allowance that was first
implemented on 1st April, 2005. An insured individual who has signed up for this scheme is eligible for making the
most of its benefits in case of his/her unfortunate unemployment after being insured for a minimum of three years
due to specific reasons like closure of factory or business entity, retrenchment or permanent invalidity. Benefits
offered under this scheme are:

Unemployment Allowance is equivalent to 50% of his/her individual wage for a maximum term of 2 years.
Medical care for the insured individual and his/her dependent family members can avail medical benefits at
authorized hospitals and dispensaries
Expenditure towards Vocational Training organized for the unemployed for upgrading skills, along with
traveling charges

When is ESIS Registration Required?

When a company employs 10 or more employees, it is mandatory for that company or any other entity to register
with the ESIC. An employee who earns less than Rs.21,000 per month contributes 1.75% of his/her salary towards
the ESI whereas the employer pays 4.75% towards the ESI making a total of 6.5%. The company or establishment can
apply for an ESI registration within 15 days from the time the ESI Act becomes applicable to that company or
establishment.

Procedure for ESIS Registration

Download the PDF version of Form No. 1(Employers Registration Form) and fill up the required details
accurately.
Submit it online along with the required documents, as mentioned above.

Documents Required for ESIS Registration

Registration Certificate received under the Factories Act or Shops and Establishment Act
Articles of Association of the Company and Memorandum of Association
Certificate of Registration for a company/ Partnership deed for a Partnership entity
An exhaustive list of all employees working in an organization
PAN Card of the company as well as that of the employees working in the same company
Details regarding annual income of all the employees
 Cancelled cheque of the Bank Account of the Company
Exhaustive list of the names of Directors of the Company
List of all the shareholders of the Company
Detailed account of the attendance of all the employees

Employees' State Insurance Act, 1948

Employees' State Insurance Scheme is an initiative towards offering Social Insurance to individuals, as per the
provisions of the Employees' State Insurance Act. Its objective is to financially secure employed individuals and
dependent members in their families, as per the Employees' State Insurance Act, 1948, from unforeseen incidents of
illness, temporary and personal disablement, maternity, and death and physical injury caused while being gainfully
employed. The Employees' State Insurance Scheme offers medical care to insured individuals and their dependent
family members under such circumstances.

The ESI Scheme is applicable to employees of factories, shops, restaurants and hotels and other business entities like
road transport, newspaper, cinemas, and educational institutions that employ at least 10 people who earn a monthly
wage of a minimum of Rs. 15,000. For some states, these benefits are extended only to establishments that employ no
more than 20 individuals. The ESI Corporation has decided to increase the capping on monthly wage from Rs. 15,000
to Rs. 21,000. The benefits have been extended to employees of construction sites located in areas mentioned under
the ESI Scheme since 1st August, 2015.

Both the employer and employee contribute towards the Employees' State Insurance Scheme. While the employer
contributes 4.75% of an employee’s wage towards the scheme, the same employee has to make a contribution of
1.75% of his/her wages. However, employees who receive less than Rs. 137 as their daily wages have been exempted
from contributing towards the scheme. Only their employers are liable to make the required contributions.

Employees' State Insurance Scheme and its Application

The statutory corporate authority, named Employees’ State Insurance Corporation (ESIC), established by the
Employees’ State Insurance Act 1948, is been conferred with the responsibility of ensuring smooth administration of
the Scheme. The ESI scheme is a self-financed comprehensive social security initiative introduced to ensure financial
security of employees insured under the scheme. It offers medical benefits to the insured and his/her dependent
family members against certain specific illnesses, death due to physical injuries at the workplace, and temporary and
permanent disabilities.
The ESIC is headquartered at New Delhi and has an extensive network across India. Currently, 151 hospital and 42
hospital annexes for inpatient services. Primary and out-patient medical services are provided through a network of
about 1450/188 ESI dispensaries/AYUSH units, and 954 panel clinics.. Additionally, there is also a Medical Benefit
Council that is established to offer their expert guidance to the ESIC regarding its administrative duties.

Public Healpline No. & Address

Cilck Here to download the PDF version of Employees' State Insurance Corporation (ESIC) Helpline No & Center
Addresses.

Composition of Employees' State Insurance Scheme

Director General, Employees' State Insurance Scheme

Chairman, as appointed by the Government of India
Vice President, as appointed by the Government of India
Up to 5 individuals nominated by the Government of India
1 representative for each state of India, as appointed by the Government of India
1 representative for each Union Territory of India, as nominated by the Government of India
10 representatives of employers, as nominated by the Government of India
10 representatives of employees, as nominated by the Government of India
2 representatives from the medical field, nominated by the Government of India
3 MPs (Members of Parliament) – 2 from Lok Sabha and 1 from Rajya Sabha

Improvement in ESIC Hospitals

Electronic Health Record

VIBGYOR - Operation Indradhanush
Medical Helpline
Special OPD
Pathological & X-Ray in PPP Model
Quality Control on Medicine & Drugs
Regular Inspection of H'ble Member of ESIC to ESIC/ESIS Hospitals
Queue management, Behavioral Training of Doctor & Paramedical Staff, Ayush, Yoga, Special Child & Mother
care hospital, May I help You etc.
 Specialties being Created - ICU, CT, MRI, Dialysis, Cat-labs

Employees’ State Insurance Scheme Reviews

“An accident left me temporarily disabled last year. The financial benefits for the disabled offered by the ESIS helped
me pay for my hospital and treatment expenses. Without this scheme, I have no idea how I would have met the huge
medical expenses.” – Akhil Kumar

“The nature of my factory job leaves me to the risk of accidents. That’s how I got severely injured. I’m glad that my
employer had already initiated me to the Employees’ State Insurance Scheme, which requires me as well as my
employer to make a certain contribution. The accumulated contribution funded my journey to complete recovery.” –
Pankaj Tripathi

“As an employer, it is my responsibility to ensure the welfare of my employees. The Employees’ State Insurance
Scheme helps me do just that.”

Frequently Asked Questions On ESIS

+ What is the procedure for the registration of an employer?

+ Is it mandatory for employers to register under the Employees’ State Insurance Scheme?

+ What is the ESI Code number?

+ What are the records that are to be maintained for the purpose of the ESI scheme?

+ What are the establishments that are covered under ESI?

+ How much salary is eligible for ESI?

 + What is Employee State Insurance Act?

+ How does ESI scheme work?

+ Can we withdraw ESI amount?

+ How do I make a claim against ESIS?

+ What is the age limit for ESIS coverage?

+ Is ESI contribution refundable?

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