EMPLOYEE STATE INSURANCE ACT 1948

Presented by Dr .vinaya Sangai (MPH)JAWAHARLAL NEHARU MEDICAL COLLAGE DEPARTMENT –COMMUNITY OF MEDICINE .WARDHA…

DEFINITIONS

Employee: employee refers to any person employed on wages in connection with the work of a factory or establishment to which this act applies.

Includes technical, manual, clerical and supervisory functionory employees or technical and non-technical,

Covers admin staff

Does not include railways ,defence, and mines .

Introduction

Employ The ESI Act, 1948 - Social welfare legislation with

object of providing benefits to employees for sickness, maternity and employment of factories or establishments, but drawing wages only up to Rs 6,500 /mth entitled to health insurance cover under ESI act

Past ceiling of Rs 6,500 has been effective from 1 January 1997 but nowCorrection with effect from 1/05/2010 act covers all employs manual clerical supervisionory and technical getting up to 15000 RS /month .

The employees’ state insurance act – 1948•HISTROY

•Pioneering measure in social insurance in India.

•Health insurance first discussed in 1927 by Indian legislature.

•Originally called “workmen’s state insurance bill” 1946.

•Came into force on 19th April 1948.

most of the state governments have extended the ESI act to certain specific classes of establishments, like……

(Except railway ,mines and defense) shops,, Hotels restaurant cinemas transport motor vehicle employing 10 or more persons. Using power This scheme is extended for medical and

educational institution .employing more than 20 worker

Extended to agricultural and commercial establishments

News paper industry

With effect from 01/05/2010 act covers all employees manual ,clerical ,supervisory and technical; getting up to 15,000 RS .

The act is extended to agricultural and commercial institution .Head office –DelhiCorporation has 23 regional office26 sub regional office at 2 divisional offices and 611Branch office Huge no of benificiaris about 344lkh Network1427- ESI dispensaries2100- panel clinic307- diagnostic centre143 - ESI hospitals43-hospital annexes over 2700 beds.

administrationIt is having autonomous body called ESI commission Union minister of labor is chairman and secretory to government is vice chairman.It consist of a member of central and state govt.Employer and employs organization medical and parliament There is a standing committee which acts as executive Body for administration of schemeChief executive is director general of health.Assisted by four officers1) INSURANCE COMMISSIONER2) MEDICAL COMMISSIONER3) FINANCIAL COMMISSIONER4) ACTUARY COMMISSIONE (बि�मांबि�त अधि��ारी)

Registration

•Registration of a factory/establishment with the employees’ state insurance corporation (esi) is a statutory responsibility of the employer under section 2-a and 10-b.

•Declaration of registration in form 01 to be furnished to the appropriate regional office within 15 days of the act becoming applicable.

•Employer should get the declaration form filled in by every employee covered under the scheme.

MEDICAL BENEFIT

Insured persons and their families entitled to free, full and comprehensive medical care.

Extended up to two years for chronic and long-term diseases.

Treatment continues even if person goes out of coverage, till sickness ends.

Package covers all aspects of health care from primary to super-specialist facilities, such as:

1) Out-patient treatment2) Domiciliary treatment3) Specialist consultation and diagnostic facilities

MEDICAL BENEFIT (CONTD.)

1) I)out patient care2) 2)supply of drugs and dressing3) 3)specialist services in all branches of 4) Medicines5) 4) pathological and radiological investigation.6) 5)domiciliary services7) 6)antenatal and postnatal care services8) 7)immunization services9) 8)family planning services10) 9)emergency medical services.11) 10)ambulance services12) 11)health education13) 12)in patient if any complication arrived.

SICKNESS AND EXTENDED SICKNESS BENEFIT

Sickness benefit represent cash payment made to insurance person during period of sickness occurring in benefit period.

QUALIFING CONDITION 1) To become eligible insurance person should paid

contribution for not less than 78 days .

2) Person has to wait for at least 9 mth to get sickness benefit.

3)sickness benefit are payble for first two days of spell of sickness except In case a spell commencing within 15 days.this period of 2 days are called waiting period.

Extendended sickness benefit (ESB)

Addition to 91 days sickness benefit ensure person who suffer from long term illness are entitle to be sickness benefit for maximum period of 2 yrs.

34 diseases are for which ESB is payable

I Infectious Diseases Tuberculosis , Leprosy Chronic Empyema AIDS

II Neoplasms Malignant Diseases  

III Endocrine, Nutritional and Metabolic Disorders Diabetes Mellitus-with proliferative retinopathy/diabetic

foot/nephropathy.

IV Disorders of Nervous System Monoplegia, Hemiplegia, Paraplegia, Hemiparesis Intracranial Space Occupying Lesion, Spinal Cord

Compression, Parkinson’s disease, Myasthenia Gravis/Neuromuscular

Dystrophies

V Disease of Eye Immature Cataract with vision 6/60 or less Detachment of Retina Glaucoma VI Diseases of Cardiovascular System Coronary Artery Disease:-

Unstable Angina Myocardial infraction with ejection less than 45% Congestive Heart Failure- Left , Right Cardiac Valvular Diseases with failure/complications Cardiomyopathies Heart disease with surgical intervention along with

complications

VII Chest Diseases Bronchiectasis Interstitial Lung Disease Chronic Obstructive Lung Diseases (COPD) with

congestive heart failure (Cor Pulmonale)

VIII Diseases of the Digestive System Cirrhosis of liver with ascites/chronic active hepatitis

IX Orthopaedic Diseases

Dislocation of vertebra/prolapse of intervertebral disc Non union or delayed union of fracture

Post Traumatic Surgical amputation of lower extremity Compound fracture with chronic osteomyelitis

X Psychoses Sub-group under this head are listed for clarification

Schizophrenia Endogenous depression Manic Depressive Psychosis (MDP) Dementia

XI Others More than 20% burns with infection/complication Chronic Renal Failure Reynaud’s disease/Burger’s disease.

DISABLEMENT BENEFIT

In case of temporary disability arising out of employment injury, this benefit is admissable for the entire period certified by an insurance medical officer/practitioner for which the insured person does not work for wages.

Rate payable not less than 70% of daily wages; minimum 3 days of incapacity required.

In case injury results in permanent, partial or total loss of earning capacity, periodical payments to be made for life. One-time lumpsum is permissible in certain cases.

Permanent Disablement Benefit (PDB)

PDB is payable to an IP who suffers permanent residual disablement due to and results in loss of earning capacity.

The proper authority for assessing loss of earning capacity for injuries is the Medical Board and for Occupational Diseases.

DEPENDANTS’ BENEFIT

Periodical pension paid to dependants of deceased where death occurs out of employment injury or disease.

Widows: 3/5th of benefit rate for life or until remarriage Children: 2/5th of benefit rate until 18 Total amount distributed not to exceed ceiling of

disablement benefit. Benefit not paid to married daughters. In case there is no widow or child, benefit can be paid

to other dependants including parents. Amount paid is reviewed and increases granted from

time to time to compensate for erosion in real value and cost of living.

Maternity Benefits

Maternity Benefit is payable to an Insured Woman in the following cases subject to contributory conditions:-

Confinement-payable for a period of 12 weeks (84 days)

Miscarriage or Medical Termination of Pregnancy (MTP)-payable for 6 weeks (42 days) from the date following miscarriage

(100%)wages

Enhance sickness benefits

It is introduced for the person undergoing Tubectomy and vasectomy insured person

is eligible ordinary sickness benefit at 100%of full wages

7days in case of vasectomy 14 days in case of tubectomy Period may be extended if there any

complication After operation……

Funeral Benefits On death of IP cash payment of max. Rs.2500/- towards

his funeral expenses

Sickness Absenteeism 15-20 %, 8-10 days a year Causes- Economic, Social, Medical , Non-occupational

causes Prevention-good management, pre-placement

examination, good human relations, ergonomics

In the ESI Scheme the contributions are related to the paying capacity as a fixed percentage of the workers wages, while, they are provided social security benefits according to individual needs without distinction.

Cash Benefits are disbursed by the Corporation through its Local Offices LOs/ Mini Local Offices (MLOs)/Sub Local Offices SLOs)/pay offices, subject to certain contributory conditions.

SUMMARY

(a) Medical Benefit(b) Sickness Benefit(SB)

Extended sickness Benefit(ESB) Enhanced Sickness Benefit

(c) Maternity Benefit(MB)(d) Disablement Benefit

Temporary disablement benefit(TDB) Permanent disablement benefit(PDB)

(e) Dependants’ Benefit(DB)(f) Funeral Expenses

Employee State Insurance Act,1948

THANK YOU