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Confidential Copyright 2009 Wipro Ltd
ESIC
Pragati (Insurance)
Revenue
December 12, 2013 1
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Introduction- Revenue
Revenue mainly comprises of
Monthly Contribution & Live List
Action on Defaulters
Inspection & Survey
Pre-Implemention Survey & Implementation
Other processes which are also captured are
BIFR
Write Off Process
Winding-up process
Specific interface with other modules are mentioned in the respective
processes. However, HRMS would be a common interface across Insurance
Module.
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Introduction
Employers have to remit the contributions on a monthly basis to ESIC. This
includes 1.75 % of Employeesand 4.75% of Employersshare adding up to 6.5 %
of the monthly wage of the Employee.
The Employer upon accessing Form 6 online, selects the month for which payment
is being made. Upon doing so, the details of the Employees are furnished (based
on Form 3). Thereafter the Employer has to only fill up the wage details of eachEmployee. This form may also be used in lieu of CCP.
Contribution details are calculated based on the number of days worked and total
wages paid.
Upon submission of the details in Form 6, a challan may be generated for the
total/partial amount of contribution. On submission of the challan, a unique challan
number is generated. A facility to print the challan is also provided. Using this procedure monthly contributions can be tracked on a monthly basis and
the process of submission of RC shall not be required after IT roll-out.
On the basis of the Contributions received, Live List will be generated
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Entry Triggers
Employer is registered with ESIC
Submission of Form 6
Monthly contribution becomes due
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Workflow
Employee details are
populated
Employer Logs in
the portal
Selects the month for which
contribution payable
Employer fills details of no. of days
worked & wages
Total Contribution
amt determinedChallan generated
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The Process
Employer Login
Logs in using the User
Id and Password
Monthly Contribution
Form 6 format is available online
Offline filing of Monthly Contribution details is also
possible (e-formswhich can be downloaded, filled offline
& then uploaded )
OR upload of contribution data using CSV format
Generate the challan based on Form 6
Deposit the challan with the BankGenerate Live List
Employer selectsthe month
Employer
Live List
Checks if IP is
Eligible for Medical
Benefit
HIS
Challan Updation
Updates challan deposited date.Updates corresponding Challanwith Challan credited date andamount.Receipt Voucher will be generatedand considered in books of account.
Receives
Challan & Bank
statement
F&A
Reconciliation and Realization
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Exit Triggers
Inspection of the Employers defaulting on payment of contribution as well as
those paying on time is scheduled.
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When the Employer is exempted, he is not required to remit Monthly
Contribution
IPs making contributions under rule 60 & 61
Medical benefits are provided to insured person who ceases to be in an
insurable employment on account of permanent disablement on payment ofRs.120 per annum.
Medical benefits to retired insured person on payment of Rs.120 per
annum.
Exception Process
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Process related Reports
Live List
List of ESB/TDB Cases
List of IPs under Rule 60/61
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Screens
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Interface
This module will have interface with
F&A
When the challan is submitted, a unique challan number will be generated.
This number will be used while remittance.
In case of cheque bounce, F&A will intimate the details of the bounced cheque
for Actionon defaulter/ Recovery.
HIS
All the IPs eligible for Medical Benefit will be provided through the LiveList.
While availing the Medical Benefit, HIS will be able to check eligibility for Cash
Benefit.
In case of Super Speciality benefit, eligibility criteria can be checked.
Portal
Employer should be able to login using Internet
Access to Form 6 & Challan should be available for the Employer.
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MIS Reports
Following MIS Reports can be generated
Monthly Contribution received
Region-wise contribution received
No. of Defaulters
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Every month the defaulting Employers are identified. Employer who fails to make
complete contribution for the month before 21stof next month is treated as defaulter.
If an Employer makes payment for defaulted period, then the employer is removed from
the Defaulter list. Interest and Damages will be charged to the employer as per the
case.
Employers will be marked to Initial Defaulter list if Employer defaults up to 3 months. 1st
, 2ndand 3rddefault notice letters are sent to the employer for 1, 2, 3 months default
respectively.
If Employer continues to default and has defaulted for 4 months, then Employer will bemarked as Main Defaulter. Once Employer is identified as Main Defaulter following
actions are undertaken simultaneously:
C-18 ad hoc or C-18 Actual is issued (C-18 Adhoc is issued if Monthly Contribution Details are not
available for defaulting periods else C-18 Actual is issued)
The Employer is marked for Inspection.
SCN against the employer is sent to JD(I/c)/RD for approval.
If C-18 Adhoc is issued Employer is called for Personal Hearing(PH)
Revenue Branch if receives the Inspection report(IR) then issue C-18 Actual if IR is conclusive.
Employer will be issued C-18 Actual/Speaking Order/Exparte Order as per outcome of PH.
Recovery certificates are created if Employer defaults to clear dues within 15 days of
issue of C-18 Actual, Speaking Order or Exparte order.
Employer Defaults in Self-certificate submission, then employer is marked for
inspection.
Introduction
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Entry Triggers
Monthly contribution is not paid/partially paid
Self Certificate is not submitted on time
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Simultaneously
Personal Hearing
Workflow
Main Defaulter List
Inspection Show CauseNotice
C-18Adhoc/Actual
Employer defaults monthly
Contribution payment
Initial Defaulter list
C-18 (Adhoc)
Only for C-18Adhoc
C-18 ActualSpeaking
OrderEx-parte
Order
Default Notices
DefaultedMore than 3 months
Employer defaults Self-
Certification
Sanction Memoto Legal Dept
if no validexplanation from
employer
Recovery Certificates
if payment not done within 5 days of issue
If Employer didntco-operate during
Inspection
As per InspectionReport findings
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The Process
Inspection
Inspection Report is available for the Inspector to
submit Report
Intimation to Inspection Division sent
Employer
Recovery
Recovery Certificates are available to the Recovery
Officer in-charge for the area
Intimation to Recovery Officer
Employer
Revenue Branch
Officer
Inspector
Recovery Officer
Revenue Branch
Generation of Default letter (notices) /C-18 Adhoc/C-18
Actual/Speaking Order/Exparte Order/C-18(i)/D-18 ,Recovery Certificates
User to edit and save the notice/letter in the system.
Above notices/letters are also sent via email if Employer
email-ID is available in the system.
Recovery Certificates are sent to Recovery off icer for
further action.
Initiate action as per Inspection Report.
Issues Default Notice LetterIssues C-18 Adhoc
Issues C-18 Actual
Issues Speaking Order
Issues Ex-parte Order
Issues C-18(i)
Issues D-18
Issues C-19, C-19(i), D-19 (Recovery Certificates)
Employer defaults in Monthly
contribution
Employer defaults self-certification
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Exit Triggers
Employer remits the arrears of Contribution and Interest and Damages and
employer is removed from Defaulters list.
Sanction Memo is issued against the Employer and sent to the Legal Branch
for Legal Proceedings against the employer OR Sanction Memo is dropped
against the Employer.
Recovery Certificates are issued against the employer
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Process related Reports
C-18 Adhoc Report
C-18 Actual Report
Speaking Order/Exparte Order Report
C-18(i) and D-18 Report
Initial Defaulters Report
Main Defaulters Report
SCN issued Report
Sanction Memo Report
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Interface
This module will have interface with
Legal
Upon issue of a Sanction Order, the same will be sent to Legal Branch for Legal
proceedings
F&A
Payments towards arrears
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Screens
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Screens (contd)
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Inspection ensures proper compliance of the provisions given in the ESI Act. The
inspection of factories and establishments is one of the most important activity inESIC and is carried out by Insurance Inspectors.
When an investigation of a Unit takes place after the successful registration of the
Unit under ESIC, it is called Inspection.
When an investigation is conducted to determine if the Unit is coverable under ESIC,it is termed Survey.
Short Inspections are inspections conducted to determine the contribution details and
to check if all the Employees eligible under ESIC are covered
Test Inspections are inspections conducted on an already Inspected Unit and servesas a quality check on Inspections. It is usually done by Test Inspecting Officers
appointed by the RD or JD I/C.
Introduction
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Entry Triggers
Survey is conducted upon a 3rd party reference or by an Inspectors own
initiative
The reasons for Inspection are:New Employer registrations
Closure of Units
Non-payment of Contribution
Random checks on complying Employers
Employers identified in Periodical Survey RegisterExamination of complaints received
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Workflow
Inspection conducted by Inspector
Inspection
Observation Note
Inspection Report
Scrutiny of Inspection Report by DA
of Revenue Branch
Action taken based on IR
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Report Scrutiny
Same Report Screen is available for the DA to
Scrutinize the IR
If the DA finds discrepancy in report requests
clarification from II.
If the DA approves the report and discrepancies found
with Employer necessary action is taken.
Verifying and validating the Report
The Process
Insurance Inspector
Sends intimation to the Employers about
the date of Inspection
Prepares list of
Inspections to be
conducted
Inspection of Unit
Insurance Inspector conducts the inspection
Prepares Inspection Observation Note and submits to
employer
Submits re-captures Observation Note and Inspection
Report online
If Inspection could not be performed on specified date,revises date /issues Annexure A, B or C
Employer provides
documents needed
for Inspection(manual)
Inspector
Dealing Assistant
Employer
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Exit Triggers
After approval of Survey Report, Employer code is generated and requested
to submit Form 01 online if found coverable
Upon update of FDC, C-18 ad hoc may be issued to recover contributions
as per the revised dates
C-18 actual is issued and rest of the action on defaulters is initiated
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Process related Reports
Inspections conducted by Insurance Inspector
Pending at the beginning of the month
Added during the month
Dealt during the month
Pending at the end of the month
Inspection reports received & dealt by DA
Pending at the beginning of the month
Added during the month
Dealt during the month
Pending at the end of the month
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Inspection & Survey - Interface
Legal
Upon issue of a Sanction Order, the same will be sent to Legal Branch
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Inspection & Survey - Screens
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Inspection & Survey - Screens
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Pre Implementation survey is the survey done to assess an area for implementationof the ESI scheme.
Based on the initial information gathered, a survey is conducted to gather the details
of the coverable Employers, Employees and the nature of Industries in a particular
center.
The Head Quarters office, P&D branch prepares and circulates the phased program
annually on the basis of proposals received from the RD/State Government.
Based on the survey report medical arrangements and arrangements for banking,
cash disbursement and registration are finalized.
Once approval from Ministry of Labour is received and draft notification is published
in the Gazette, Employer Registration is initiated from the date of Implementation
Introduction
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Entry Triggers
Regional Office gathers information of areas where there is a concentration
of industries.
Decision to conduct pre-implementation survey (PIS) is made on the basis of
information gathered by the Regional Office.
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Workflow
Registrationof Employers
begin
Areas identified as
not covered
PIS conducted; proposal requested for from
identified State Governments
Annual phase program is prepared; State Govt..
Requested to make arrangements for medical facilities
Draft Notification & Confirmation of facilities received
at HQ; Cost estimate requested from Actuarial
Approved by IC and
forwarded to Ministry
of Labour
Notification in
Gazette
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Actuarial
Details of the basis of the financial implication arrived
by the Actuarial Branch and sent to Head of Planning &
Development
Analyses the viability
The Process
Regional Office
Identifies Area for Survey
and assigns tasks to Insurance
Inspector
Interacts with State Government to
get proposal for medical
arrangement
Makes arrangement for cash,
banking & registration. Prepares
Draft Notification
P&D branch Head Quarters
Compile Annual Phased Program for Implementation
Requests State Governments to send proposals for
Medical arrangements
Request for Cost Implications from Actuarial Dept.
Forward recommendations to IC for approval along with
Draft Notification and details of arrangement made
Coordinates with State Govt. Regional
Offices & Actuarial Dept to consolidate
arrangements for Implementation
Regional OfficeCoordn .branch Officer
P&D Head Quarters Officers
Actuarial Officers
Insurance Commissioner
Approves an area for
Implementation
Forwards to Ministry of Labour for
Govt. approval and publication in
gazette
Insurance Commissioner
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Exit Triggers
Employer & Employee registration
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Process related Reports
Notification Register
Pre-Implementation Survey Report
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Interface
Actuarial
Financial Implication is calculated for Proposed Implementation
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MIS Reports
Following MIS Reports are generated
Target Vs Actual Implementation
Pre-Implementation Survey &
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Pre Implementation Survey &
Implementation- Screens
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Thank You