THE EMPLOYEES STATE INSURANCE ACT,

1948

NIVETHA CIV TERM

OBJECTIVESAIMSCOPEADMINISTRATIONFINANCEBENEFITS TO EMPLOYEESBENEFITS TO EMPLOYERSOTHER BENEFITS

ESI ACT, 1948

• It is a measure of Social Security and Health Insurance in the country.

• It provides certain cash and medical benefits to industrial employees in case of sickness, maternity and employment injury.

SCOPE

The ESI Act of 1948

All power using factories other than seasonal factories where more than 10 persons were employed.

The ESI (amendment) Act of 1975

Small factories employing more than 10 persons, irrespective of power usage.

Shops Hotels and restaurants Cinemas and theatres Road-Motor transport establishments Newspaper establishments Private medical and educational institutions employing 20 or

more in some states.

ADMINISTRATION

Chairman- Union Minister of Labour

Standing Committee- Headed By Union Labour secretary

Director General(Chief Executing Officer)

Finance Commisione

r

Medical Commisione

r

Director ESI(State Govt.)

Medical Superintendents

State Medical Commisioners

Insurance Commisione

rActuary

Beneficiaries: 602 lakhs by 31.3.11 Corporation has set up a wide spread network of service outlets.

1427 ESI dispensaries 2100 panel clinics 307 diagnostic centres. 143 ESI hospitals 43 hospital annexes with over 27,000 beds.

FINANCE

Employer• 4.75% of total wage bill.

Employee

• 1.75% of wages. ( with exception of employees getting daily wage of below Rs.70).

State Govt.

• 1/8th of total cost of medical care

BENEFITS TO EMPLOYEES

Medical Benefit

Sickness Benefit

Maternity Benefit

Disablement Benefit

Dependant’s Benefit

Funeral Expenses

Rehabilitation Benefit

Medical BenefitFull medical care including hospitalization, free of cost, to the insured persons in case of sickness, employment injury and maternity.

Out Patient Care Supply of drugs or dressings Specialist services in all branches of medicine Pathological and Radiological investigations Domiciliary services Antenatal, Natal and Post natal services Immunization services Family planning services Emergency services Ambulance Services Health education Inpatient Treatment

Mode of Delivery of Medical CareDirect

Concentration >1000• Full-time medical Care

Less than 750• ESI Dispensaries

Scattered• Mobile ESI services

Indirect

Panel System

Sickness BenefitPeriodical cash payment to an insured person in case of sickness, if his sickness is duly certified by an Insurance Medical Officer or Insurance Medical Practitioner. Payable Upto a maximum period of 91 days. EXTENDED SICKNESS BENEFIT: Incase of long term sickness,

an insured person is entitled to Extended sickness benefit for a maximum period of 2 years.

The insured person is protected from dismissal or discharge from service by the employer during the period of sickness.

SOME OF THE CHRONIC DISEASES

INFECTIOUS DISEASES

Tuberculosis, leprosy, chronic empyema, AIDS.

NEOPLASMS Malignant diseases.

ENDOCRINE, METABOLIC

Diabetes mellitus with proliferative retinopathy/diabetic foot/nephropathy.

DISORDERS OF NERVOUS SYSTEM

Monoplegia, Hemiplegia, paraplegia, Hemiparesis, Parkinson’s disease, spinal cord compression, myasthenia gravis, glaucoma, detachment of retina.

CVS CAD, CCF, Cardiac valvular diseases, Cardiomyopathies.

CHEST DISEASES Bronchiectasis, Interstitial Lung Disease, COPD with CCF.

DIGESTIVE SYSTEM Cirrhosis of liver with ascites, chronic active hepatitis.

ORTHOPAEDIC DISEASES

Dislocation of vertebra, prolapse of vertebral disc, non union or delayed union of fracture, post traumatic surgical amputation of lower extremity.

PSYCHOSIS Schizophrenia, Endogenous depression, Manic depressive psychosis, Dementia.

OTHERS More than 20% burns, Chronic renal failure, Raynaud’s disease.

Maternity Benefit

Payable by cash to an insured women for:

Confinement: 12 weeks

Miscarriage: 6 weeks

Sickness arising out of confinement: 30 days

Disablement benefitCash Payment and free medical treatment, in the event of temporary or

permanent disablement as a result of employment injury.

In case of temporary disablement: 70% of wages during the

period of disablement.

In case of total permanent disablement: Life pension worked out

on the basis of loss of earning capacity determined by the medical

board.

Dependant’s Benefit

In case of death, as a result of employment injury, the dependants of

an insured person are eligible for periodic payments.

Pension at the rate of 70% of wages is payable, shared by dependants

in a fixed ratio, on a monthly basis.

An eligible son or daughter is entitled to dependant’s benefit up to the

age of 18; the benefit is withdrawn if the daughter marries earlier.

Funeral expenses

Cash payment payable on the death of an insured

person towards the expenses on his funeral, the amount

not exceeding Rs.5000.

RehabilitationOn a daily payment of Rs.123 (w.e.f. 01.01.06), the

insured person and his family members continue to get

medical treatment after permanent disablement, or

retirement.

BENEFITS TO EMPLOYERS Exemption from the applicability of Workmen’s Compensation Act

1923.

Exemption from Maternity Benefit Act 1961

Exemption from payment of Medical allowance to employees and

their dependants or arranging for their medical care.

Rebate under the Income Tax Act on contribution deposited in the

ESI account.

Healthy work-force.

RAJIV GANDHI SHRAMIK KALYAN YOGNA New scheme provided for the employees under the ESI scheme.

Came into effect from 1st April, 2005.

This scheme provides unemployment allowance for the

employees who are rendered unemployed due to retrenchment/

closure of factory etc. after fulfilling certain eligibility conditions.

Employed under the establishment for a minimum period of 5 years.

Payable upto 6 months.

Other Benefits:

Medical Bonus

Money order facilities

Prevention of HIV/AIDS

References

Park’s textbook of Preventive and Social Medicine.

www.esic.nic.in

THANK YOU