ESIC Scheme 2023: Employees’ State Insurance Eligibility, Benefits

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The Employees’ State Insurance Scheme (ESI Scheme) is a comprehensive social insurance measure designed to protect ’employees’ as defined in the Employees’ State Insurance Act, 1948, against sickness, maternity, disablement, and employment injury-related incidents.

It applies to establishments employing 10 or more people, and workers earning up to Rs. 15,000 per month are entitled to social security cover.

Since its start in 1952, the ESI Scheme has expanded to over 830 centers in 31 states and Union Territories, benefiting more than 2.03 crores of insured persons/family units and over 7.89 crores of total beneficiaries.

It offers various benefits, including Sickness, Maternity, and Medical.

In today’s post, we will walk you through the complete details about it, eligibility, benefits and claiming process. Read till the very end…

Employees’ State Insurance ESI Scheme 2023

ESI Scheme

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The Employees’ State Insurance Scheme is a social insurance measure aimed at protecting employees from sickness, maternity, disablement, and death resulting from employment injuries.

It also provides medical care to covered individuals and their families.

Coverage and Applicability

The ESI Scheme applies to industries and companies with 10 or more employees, including road transport, hotels, restaurants, cinemas, newspapers, shops, and educational/medical institutions.

Some states have a coverage threshold of 20 employees for certain establishments.

Eligibility and Contributions

Salary RangeSocial Security Coverage EligibilityEmployer ContributionEmployee Contribution
Up to Rs. 15,000 per monthCovered under ESI Act4.75% of employee’s wages1.75% of employee’s wages (except if earning < Rs. 100/day)
Less than Rs. 100/dayExempted from Employee Contribution4.75% of employee’s wagesExempted from Contribution

Employees earning up to Rs. 15,000 per month in the covered factories and establishments are eligible for social security coverage under the ESI Act.

The scheme is funded through contributions from both employers and employees. Employers contribute 4.75% of employee’s wages, while employees contribute 1.75%.

Employees earning less than Rs. 100 per day are exempted from their contribution.

Expansion and Geographic Reach

The ESI Scheme, initially introduced in 1952 in Kanpur and Delhi, has since expanded its reach across 830 centers in 31 States and Union Territories.

It covers more than 7.23 lakh factories and establishments, benefiting around 2.03 crores of insured individuals and family units, with a total beneficiary count exceeding 7.89 crores.

Infrastructure and Facilities

To meet the social security needs of the growing worker population, the ESI Corporation has established 151 hospitals and 42 hospital annexes for inpatient services.

Approximately 1418/140 ESI dispensaries/AYUSH units and 1017 panel clinics provide primary and outpatient medical services.

Additionally, five Occupational Disease Centers address occupational diseases prevalent among workers in hazardous industries.

Cash Benefits and Other Benefits

The primary benefits offered under the ESI Scheme include Sickness, Disablement, Dependants, Maternity, and Medical Benefits.

Beneficiaries also receive Confinement Expenses, Funeral Expenses, Vocational Rehabilitation, Physical Rehabilitation, Unemployment Allowance (RGSKY), and Skill Upgrading Training.

ESI Scheme Benefit List 2023

Main benefits under ESI Scheme:

  • Sickness
  • Disablement
  • Dependants’
  • Maternity
  • Medical

Additional benefits for beneficiaries:

  • Confinement Expenses
  • Funeral Expenses
  • Vocational Rehabilitation
  • Physical Rehabilitation
  • Unemployment Allowance (RGSKY)
  • Skill Upgradation Training

Sickness Benefits

BenefitsContributory ConditionDurationRate
Sickness BenefitPayment of contribution for 78 days in the relevant contribution period.Up to 91 days in two consecutive periods.70% of average daily wages.
Enhanced Sickness BenefitSame as AboveTubectomy: 14 days
Vasectomy: 7 days (extendable on medical grounds)
100% of average daily wages.
Extended Sickness BenefitTo qualify for coverage of 34 long-term diseases: 2 years of continuous employment with 156 days’ contribution in four consecutive periods.Up to 124 days in 2 years, extendable with medical advice.80% of average daily wages.

ESI Disablement Benefits

BenefitsContributory ConditionDurationRate
Temporary Disablement BenefitImmediate coverage for disablement due to employment injury.During temporary disablement.Approx. 90% of daily wages.
Permanent Disablement BenefitDisability coverage from day one of employment injury.For whole life90% of average daily wages.
Proportional to loss of earning capacity determined by the medical board.

Dependants’ Benefit

Immediate coverage for death due to employment injury.Widow’s benefits until remarriage. Dependent children’s benefits until age 25. Dependent parents’ benefits included90% of average daily wages shared among dependants.

Maternity Benefit

Payment of 70 days in two preceding periods.12 weeks for confinement, 6 weeks for miscarriage, extendable by 1 month on medical advice for related sickness.100% average daily wages.

Medical Benefit

Immediate medical facilities for self and family upon joining insurable employment.Medical care during insurable employment.

Other Benefits

BenefitsContributory ConditionDurationRate
Confinement ExpensesEligible for coverage if no ESI medical facilities available during confinement.Maximum two confinements.Rs. 5,000/- per case.
Funeral ExpensesUpon entering insurable employment.Funeral expenses for insured person.Funeral expenses for the insured person.
Vocational TrainingPhysical disablement due to employment injury.During vocational training.Rs. 123/- or higher per day.
Physical RehabilitationPhysical disablement due to employment injury.Artificial limb center admission only.100% average daily wages.
Unemployment Allowance (RGSKY)ESI Scheme covers job loss, factory closure, or permanent invalidity after 3 years.Maximum 12 months lifetime.50% average daily wages.
Skill Up gradation TrainingSame as aboveMaximum 6 months duration.

Company Eligibility For ESI Scheme Registration

CriteriaESIC Registration Requirement
Number of Employees10 or more (in Maharashtra & Chandigarh), more than 20 (in other locations)
Monthly Earnings of WorkersLess than Rs. 21,000 (Rs. 25,000 for persons with disabilities)
Worker’s Contribution to ESI1.75% of their salary
Employer’s Contribution to ESI4.75% of the worker’s salary
Exemption for Workers with Daily Average WageUp to Rs. 50 or Rs. 100
Exemption for Workers’ Contribution to ESIApplicable for workers with daily average wage up to Rs. 50; employers continue to contribute for these workers.

Note that contribution rates may change over time.

Documents Necessary For ESI Scheme Online Registration

Required documents for employer registration:

  • Registration Certificate under the Shops and Establishment Act or Factories Act.
  • Certificate of Registration for partnership or company.
  • Articles of Association and Memorandum of Association of the company.
  • List of all employees with their compensation details.
  • PAN Card details of the Business Entity and employees.
  • Cancelled bank cheque of the company’s account.
  • List of shareholders and directors of the company.
  • Attendance register of employees.
  • Employer’s Registration Form (Form No.1) filled and uploaded on the ESIC website with the above documents.

How To ESI Scheme Registration @www.esic.gov.in

  • Visit the ESIC Portal and click on ‘Login’.
  • Click on ‘Sign Up’ and provide company details, employer name, state, region, email ID, and phone number.
  • Confirm your establishment’s category.
  • Click ‘Submit’ and receive login credentials via email.
  • Log in to the ESIC Portal using the provided username and password.
  • Click on ‘New Employer Registration’ and select the type of unit.
  • Enter unit details, postal address, and police station jurisdiction.
  • Provide building/establishment ownership details and nature of business.
  • Enter PAN details and other information, then proceed to the next step.
  • Fill in the constitution of ownership and owner details.
  • Enter the number of employees and those earning less than Rs. 21,000.
  • Provide the date of employment for the first 10/20 employees and complete the Employee Declaration Form.
  • Fill in details for insured persons (IP), whether registered or not.
  • Enter IP details, address, family information, and date of joining.
  • Review the information, check the checkbox, and submit.
  • Select the ESI branch office and inspection division.
  • Declare the accuracy of the information and click ‘Submit’.
  • Proceed to pay the initial contribution using the provided Challan Number.
  • Complete the payment through the required payment gateway.
  • After successful payment, receive the ESI Registration Letter (C-11) via email.

Apply For ESIC Card (ESI Scheme Pehchan Card)

ESI Pehchan Card (e-Pehchan Card) Download Process:

  • Login to the ESIC Portal using your username and password.
  • Under the ‘Employee’ section, click on ‘e-Pehchan Card’.
  • Select the unit details and click ‘View’.
  • You can view details of all employees or narrow down the search by entering the respective employee’s insurance number and name.
  • Click ‘View Counter Foil’ against the respective employee to access the ‘e-Pehchan’ card.
  • Scroll down on the new page and click ‘Print’ to download the card as a PDF document.
  • The respective employee must sign the printout and affix family or dependents’ photographs.
  • The photo on the card must be attested and stamped by the employer or the ESIC official.
  • Ensure to get either the signature and stamp of the employer or the ESIC office on the e-Pehchan Card.

Claiming ESI Benefits and Checking Claim Status Online

Medical Benefits: Visit any ESI Empanelled hospital with your dependents to avail your medical care.

Cash Benefits: Employees or workers who are beneficiaries of the ESI scheme can avail cash benefits for various situations.

Checking ESI Claim Status Online

  • Open the UMANG App or download it on your smartphone if you haven’t already.
  • Enter the IP number or ESIC Insurance Number and click on ‘Get OTP’.
  • Enter the received OTP and click ‘Submit’.
  • Select ‘Claim Status’ under the services menu.
  • You can view the status of your raised claims or use the advanced search option to find specific details.

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