Employee State Insurance Corporation (ESIC) - Administrative and Operational Benefits of ESIC Act

The ESIC is instrumental in delivery of benefits for wage-earners/employees of factories and commercial organizations across India by ensuring that:

• The quality and quantity of benefits is based on the norms and standards as laid down by the ESI Corporation for the purpose.
• The benefits are made readily available within the given time frame to insured persons and beneficiaries under this scheme.
• No harassment is caused to the beneficiaries of this scheme across the counter at the grass root level by way of word or deed.
• All requisite information, procedural norms and guidance etc. are made available to the beneficiaries for availing benefits.

• All types of forms etc. are made available to the beneficiaries of ESIC scheme which is free of cost as such forms may be required by such individuals for filing their medical claims
• No beneficiary is exploited at any level in the process of delivery of benefits.
• As notified for ESIC/ESIS establishments, office hours are strictly adhered to by the staff. This is indeed essential in order to avoid any inconvenience being caused to the beneficiaries of ESIC scheme for the purpose of smooth flow of benefit process.
• Drugs, injections, dressings, etc. as prescribed by the authorised doctors are made available in a timely manner.

Role of ESIC in Servicing Employers

ESIC plays an important role in servicing the employers of factories, commercial establishments, shops etc. This is done with a view to reduce the employer’s responsibility pertaining to the healthcare issues concerning their organizational employees and in turn the issues regarding employees’ welfare is assumed by ESIC.

• To develop a purposive, responsive and productive relationship with the employers.
• Seek their active involvement in the improvement of the scheme as a confidence building measure.
• Provide the employers necessary guidance in fulfilling their lawful obligations under the ESIC Act.
• Make available to them all the requisite Forms and proformae free from all hassles as may be required by them from time to time.

• To ensure that any lax medical certification on part of ESIC does not bring down the productivity of a factory or commercial establishment.
• To ensure that in case of any doubt, difficulty or misunderstanding the employer is given an opportunity to be heard at an appropriate level.
• To ensure that all the correspondences emanating from the employer is responded to in a timely manner and objectively.
• To ensure that an employer is not being unnecessarily harassed by any official of the ESIC who have been authorized to inspect the commercial premises or the records.
• To ensure that any grievances received from employers are looked into promptly and pointedly for speedy disposal of cases.

Medical Benefits – For Retired & Disabled Persons (Rules 60 & 61 of ESI Central Rules, 1950)

Insured Persons who cease to be in insurable employment on account of permanent physical disablement due to employment injury or those who leave the insurable employment on attaining the age of superannuation are eligible to receive medical benefits for themselves and their spouses (or dependants). The benefit is provided on payment of contribution in lump sum for one year at the rate of Rs. 10/- monthly in advance.

Scale of Medical Benefits

Superannuated or disabled insured workers are entitled to the same scale of Medical Benefits and to the same package of medical/healthcare facilities that are admissible to an insured person and spouse.