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1. What is E.S.I. Scheme ? * In addition to necessities of food, clothing, housing etc.

, man needs security in

times of physical and economic distress consequent upon sickness, disablement etc. The Employees State Insurance Scheme is an integrated measure of Social Insurance embodied in the Employees State Insurance Act and is designed to accomplish the task of protecting employees as defined in the Employees State Insurance Act against the ha!ards of sickness, maternity, disablement and death due to employment in"ury and to pro#ide medical care to insured persons and their families. The Scheme co#ers employees of non$seasonal po%er$using factories employing &' or more persons. There is, ho%e#er, a built$in pro#ision for its e(tension to other establishments or classes of establishments, industrial, commercial, agricultural or other%ise. The Scheme has been progressi#ely e(tended to co#er employees in non$po%er using factories employing )' or more persons and to commercial establishments.

2. How does the Employees State Insurance Scheme assist you? * The dependence of an indi#idual on cash income is a characteristic feature of modern economy. An interruption of money income e#en for a small period is, therefore, a hardship* a prolonged loss of income is indeed a catastrophe. +y coming for%ard to pro#ide health protection and income maintenance in a series of oft$ e(perienced contingencies like sickness, maternity, disablement and death due to employment in"ury, the Employees State Insurance Scheme tends to ameliorate your economic an(iety and to be a friend in need and distress.

3. Why is it called a Health Insurance Scheme? * The Employees State Insurance Scheme performs a dual role* by pro#iding

assistance in kind ,medical care- it tries to restore your health and %orking capacity and by assistance in cash ,cash benefit- it tries to sustain you %hen your income is interrupted. .ith a better and facile health protection, greater #itality, and assurance of income$maintenance in times of need, it makes you e#ery inch a better, a healthier, secure %orker and therefore, a happier man. The assistance comes to you not as an act of bene#olence but in #irtue of an acquired right.

4. Who administers the Employees State Insurance Scheme? * The Employees State Insurance Scheme is administered by a corporate body called

the Employees State Insurance /orporation ,ESI/-, %hich has members representing Employees, Employers, the /entral 0o#ernment, State 0o#ernments, 1edical 2rofession and the 2arliament. The 3irector 0eneral is the /hief E(ecuti#e 4fficer of the /orporation and is also an e($officio member of the /orporation. The other bodies at the national le#el are the Standing /ommittee ,a representati#e body of the /orporation- and the 1edical +enefit /ouncil, a specialised body %hich ad#ises the /orporation on administration of 1edical +enefit. At the 5egional and 6ocal le#els, the 5egional +oards and 6ocal /ommittees ha#e been constituted. There is, thus, an association of interests and interest groups at all le#els. ESI/ is the trustee of the interests of the insured persons. It discharges its obligations and duties through a net$%ork of 5egional 4ffices and 6ocal 4ffices, 7ospitals and 3ispensaries spread o#er the entire country.

5. Whom does the Scheme protect? * The Scheme protects all 8employees9 engaged on a monthly remuneration not

e(ceeding 5s. :;''<$ in a factory<establishment to %hich the Act applies. 2ersons employed for %ages on any %ork connected %ith the administration of the factory or

establishment or any part, department or branch thereof or purchase of ra% materials, or distribution or sale of the product of a factory or establishment are also co#ered. 1ines, 5ail%ay 5unning Sheds, =a#al, 1ilitary and Air >orce .orkshops and specified seasonal factories are e(cluded. The scheme also pro#ides full medical co#er to the dependants of insured persons. In the e#ent of death of an insured person due to employment in"ury dependants become eligible to cash benefit. . Where do Employees State Insurance !unds come "rom? * The Employees State Insurance >unds are primarily built out of employers

contribution and employees contribution payable monthly as a fi(ed percentage of %ages. #. How are the employees re$istered under the Scheme? * Simultaneously %ith his<her entry into employment in a co#ered factory or

establishment, an employee is required to fill in a 3eclaration >orm. The employee is then allotted a 5egistration =umber, %hich distinguishes and identifies the person for the purposes of the Scheme. A person is registered once and once only upon his entry in insurable employment. %. What is an Identity &ard? * 4n registration e#ery insured person is pro#ided %ith a 8Temporary Identification

/ertificate9 %hich is #alid ordinarily for a period of ? months but may be e(tended, if necessary, for a further period of ? months. .ithin this period, the Insured 2erson is gi#en a permanent 8family photo Identity /ard9 in e(change for the /ertificate. The Identity /ard ser#es as a means of identification and has to be produced at the time of claiming medical care at the dispensary<clinic and cash benefit at the 6ocal 4ffice of the /orporation. In the e#ent of change of employment, it should be produced before the ne% employer as e#idence of registration under the Scheme to pre#ent any duplicate registration. The Identity /ard bears the signatures<thumb impression of the insured person.

Since medical benefit is also a#ailable to the families of insured persons, the particulars of family members entitled to 1edical +enefit are also gi#en in the Identity /ard affi(ed %ith a postcard si!e family photo. If you lose your Identity /ard before it has run its normal life, a duplicate card is issued on payment as prescribed. '. What are the rates o" contri(ution? * /ontributions payable in respect of an employee comprise of employers

contribution and employees contribution prescribed in Schedule I of the Act. An employee co#ered under the scheme has to contribute &.@;A of the %ages %hereas, an employer contributes B.@;A of the %ages payable to an employee. The total contribution in respect of an employee thus %orks out to :.;'A of the %ages payable. 1). Who is e*empted "rom payment o" contri(ution? * Employees earning less than 5s B'<$ a day are e(empted from payment of

contribution. The employers share of contribution is, ho%e#er, payable. 11. How are the &ontri(utions collected? * The /ontribution is deposited by the Employer in cash or by cheque at the

designated branches of some nationalised banks. The responsibility for payment of all contributions is that of the employer %ith a right to deduct the Employees share of contributions from employees %ages relating to the period in respect of %hich the /ontribution is payable. 12. What are +&ontri(ution ,eriods and +-ene"it ,eriods? * .orkers, co#ered under the ESI Act, are required to pay contribution to%ards the

scheme on a monthly basis. A contribution period means a si($month time span from &st April to ?'th September and &st 4ctober to ?&st 1arch. Thus, in a financial year there are t%o contribution periods of si( months duration.

/ash benefits under the scheme are generally linked %ith contributions paid. The benefit period starts three months after the closure of a contribution period. The t%o types of periods are illucidated belo%CD

&ontri(ution ,eriod &orrespondin$ -ene"it period &st April to ?'th September &st Eanuary to ?'th Eune of the >ollo%ing Fear &st 4ctober to ?&st 1arch &st Euly to ?&st 3ecember

13. What is a .ocal /""ice? * A net$%ork of 6ocal 4ffices has been established by the /orporation in all

implemented areas to disburse all claims for sickness, maternity, disablement and dependents benefit. The 6ocal 4ffice also ans%ers all doubts and enquiries and assists other%ise in filling in claim forms and completing other action necessary in connection %ith the settlement of claims. These offices also interact %ith the employers of the area. The 6ocal 4ffices are managed by a 1anager and %ork under the direction and control of the 5egional 4ffices. 14. What does +Sic0ness -ene"it mean? * Sickness signifies a state of health necessitating medical treatment and attendance

and abstention from %ork on medical grounds. >inancial support e(tended by the /orporation is such a contingency is called Sickness +enefit. 15. What are the &ontri(utory &onditions? * The contribution condition required to be fulfilled for admissibility of sickness

benefit during any benefit period is that contributions should ha#e been paid in respect of an insured person in the corresponding contribution period for not less than @G days.

1 . How much is the Standard -ene"it 1ate? * The daily rate of Sickness +enefit during any benefit period is the 8standard benefit

rate9 this rate corresponds to the a#erage daily %age of an insured person during the corresponding contribution period and is roughly half of the daily %age rate. +enefit is paid for Sundays also. )G %age groups ha#e been e#ol#ed for %orking out the daily rate of Standard Sickness +enefit. Standard +enefit rates for )G %age groups are sho%n in Anne(ure A. 1#. What is the duration o" Sic0ness -ene"it? * Sickness benefit is payable for a ma(imum period of H& days in any t%o

consecuti#e benefit periods. +enefit is not paid for an initial %aiting period of ) days unless the insured person is certified sick %ithin &; days of the last spell in %hich Sickness +enefit %as paid. 1%. What is E*tended Sic0ness -ene"it? * E(tended Sickness +enefit is a /ash +enefit paid for prolonged illness due to any

of the ?B specified diseases as mentioned belo%. 2iseases &. Tuberculosis ). 6eprosy ?. /hronic Empyema B. +ronchiectasis ;. Interstitial 6ung disease :. AI3S @. 1alignant 3iseases G. 3iabetes 1ellitus$%ith proliferati#e retinopathy<diabetic foot< nephropathy.

H. 1onoplegia &'. 7emiplegia &&. 2araplegia &). 7emiparesis &?. Intracranial space occupying lesion &B. Spinal /ord /ompression &;. 2arkinsons disease &:. 1yasthenia 0ra#is<=euromuscular 3ystrophies &@. Immature /ataract %ith #ision :<:' or less &G. 3etachment of 5etina &H. 0laucoma )'. /oronary Artery 3iseases )&. /ongesti#e 7eart >ailure$6eft, 5ight )). /ardiac #al#ular 3iseases %ith failure<complications )?. /ardiomyopathies )B. 7eat disease %ith surgical inter#ention along%ith complications );. /hronic 4bstructi#e 6ong diseases ,/423- %ith congesti#e heart failure ,/or 2ulmonale):. /irrhosis of li#er %ith ascitis<chronic acti#e hepatitis ,8/A79)@. 3islocation of #ertebra<prolapse of inter#ertebral disc )G. =on union or delayed union of fracture )H. 2ost Traumatic surgical amputation of lo%er e(tremity ?'. /ompound fracture %ith chronic osteomyelitis ?&. ,a-Schi!ophrenia ,bEndogenous depression

,c-1aniac 3epressi#e 2sychosis ,132,d3ementia

?). 1ore than )'A +urns %ith infection<complication ??. /hronic 5enal >ailure ?B. 5eynauds disease<+urgers disease. In addition, e(tended sickness benefit may also be sanctioned by the prescribed authority, in case of any rare disease or special circumstances on the recommendation of the specified authority. 1'. What are the &ontri(utory &onditions? * E(cept in case of disability from administration of drugs<in"ections, the insured

person should ha#e been in continuous employment for a period of ) years and should ha#e contributed for atleast &;: days in B preceding contribution periods. 2). How much is the -ene"it rate? * The daily rate of E(tended Sickness +enefit is B'A more than the Standard

Sickness +enefit rate admissible. 21. How lon$ is the -ene"it a3aila(le? * After e(hausting Sickness +enefit payable for H& days the ES+ is payable upto a

further period of &)B<?'H days that can be e(tended upto ) years in special circumstances. Thus, together %ith the Sickness +enefit for H& days, it puts a claimant on benefit for an aggregate period B'' days for all specified diseases and ) years in chronic suitable cases on recommendation of competent authority. 22. What is Enhanced Sic0ness -ene"it? * Enhanced Sickness +enefit is cash benefit for the insured persons undergoing

sterlisation operation of #asectomy<tubectomy for family planning. 22a.What are the contri(utory conditions? * The contributory conditions are the same as for claiming sickness benefit.

22b. How much is the (ene"it rate? The daily rate of this benefit is double the standard benefit rate. Say, not less than the daily %age.

22c.How .on$ is the (ene"it a3aila(le? * The benefit is a#ailable upto @ days for #asectomy and upto &B days for tubectomy

operations. This period can ho%e#er be e(tended in cases of post operati#e complications or sickness arising out of these sterlisation operations. Its duration is not counted to%ards the total number of H& days for %hich the sickness benefit is a#ailable during any t%o consecuti#e benefit periods. 22d. How to claim Sic0ness -ene"it? * A claim for Sickness +enefit should be supported by a 1edical /ertificate issued

by an Insurance 1edical 4fficer<Insurance 1edical 2ractitioner in the appropriate >orm. 1edical /ertificates are issued at inter#als of not more than se#en days, e(cept in cases of prolonged sickness, %here Special Intermediate /ertificates may be issued at longer inter#als not e(ceeding B %eeks. 4n the back of each certificate, e(cept the Special Intermediate /ertificate, a /laim >orm is printed. The /laim >orm is essentially a declaration in regard to abstention of the claimant from %ork during the period of claim. Separate /laim >orms are also a#ailable. The /laim >orm should bear signatures<thumb impression of the claimant and should be submitted to the 6ocal 4ffice personally, by post, through a messenger or by deposit in certificate bo(es, %here#er pro#ided. All claims should preferably to submitted to the 6ocal 4ffice %ithin three days. The 5eceptionist at the 6ocal 4ffice renders all assistance in filling in the claim on your behalf. 23. What is +2isa(lement? * 3isablement is a condition resulting from employment in"ury %hich may be CD ,a-4emporary i.e. rendering an insured person incapable of %ork temporarily and necessitating medical treatment* ,b-,ermanent partial i.e. reducing the earning capacity of the insured person generally for e#ery employment*

,c-,ermanent total i.e. totally depri#ing the insured person of the po%er to do all %ork. 24. What constitutes an 5Employment In6ury?7 * Employment in"ury means a personal in"ury caused to an employee by an accident

or occupational disease arising out of and in course of his employment in a factory or establishment co#ered under the Employees State Insurance Act. The la% relating to Employment in"ury has been liberali!ed. =o%, an accident arising in the course of employment is presumed also to ha#e arisen out of his employment if there is no e#idence to the contrary. >urther, an accident brought about by %illful disobedience, negligence or breach of regulations etc. or an accident happening %hile tra#eling in a transport pro#ided by the employer or %hile meeting an emergency is accepted sub"ect to certain conditions, to ha#e arisen in the course of and out of employment. In"uries suffered %hile under the influence of drinks and drugs take a%ay the right of the employee to this benefit. 5oadside accident caused %hile commuting bet%een place of residence and %orkplace is also treated as notional e(tension of employment for purpose of death or disablement benefit. 25. What are +/ccupational 2iseases? * 4ccupational 3iseases are such diseases as are susceptible of being traced back to

their occupational origin. These are specified under Schedule III of the Employees State Insurance Act, %hich enumerates the compensable 4ccupational 3iseases and the corresponding industrial processes in#ol#ing e(posure to the diseases are thus recogni!ed %ithout any further e#idence. 2 . What are the -ene"its $ranted? * Temporary 3isablement +enefit is paid periodically in arrears as the e#idence of

incapacity ,medical certificate- is produced. 2ermanent total disablement and permanent partial disablement benefits are paid in the form of pensions. /urrent employment for %ages or engagement in any gainful acti#ities is no bar to payment of

permanent disablement benefits. An insured person suffering from an occupationed disease is also entitled to full medical care. 2#. How much is the -ene"it 1ate? * The daily benefit rate for permanent total disablement and temporary disablement is

B'A more than the Standard Sickness +enefit rate and is roughly equi#alent to about @'A of the %age rate. >or permanent partial disablement, the rate of benefit is proportionate to the percentage of loss of earning capacity. The benefit is paid for Sundays also. 2%. What are the &ontri(utory &onditions? * There are no qualifying conditions as to the length of employment or the number of

contributions paid. 2rotection accrues from the #ery moment of entry into insurable employment. 2'. What is the duration o" -ene"it? * Temporary 3isablement +enefit is paid as long as disablement lasts. There is a

%aiting period of ? days ,e(cluding the day of accident-, but if incapacity e(ceeds this period, benefit is paid from the #ery first day. The permanent disablement benefit is paid for the life$time of the beneficiary. 3). How is ,ermanent 2isa(lement assessed? * There is indeed no %ay of adequately compensating a permanently disabled

employee and yet some method of determining %hether an employment in"ury has resulted in permanent disablement and of assessing the e(tent of permanent damage caused by that employment in"ury has to be adopted for the purpose of determining the scale of compensation for the loss of earnings. This is done by e#aluating loss of earning capacity %ith reference to general disability for all %ork. The e#aluation is done by a 1edical +oard %hose decision can be appealed against to a 1edical Appeal Tribunal presided o#er by a "udicial officer, %ith a further right of appeal to Employees Insurance /ourt or directly to Employees Insurance /ourt. 2ending an appeal, payment for permanent loss of earning capacity as recommended by the 1edical +oard is made,

sub"ect to ad"ustment later. 6oss of %ages and e(penditure on con#eyance occasioned by attendance before the 1edical +oard are compensated by the /orporation in accordance %ith rates framed for the purpose. .here the assessment of loss of earning capacity by the 1edical +oard is not of a final character, the beneficiary is required to appear again before the 1edical +oard for a re#ie% of the assessment. 31. &an the decisions o" 8edical -oard or o" 8edical 9ppeal 4ri(unal (e re3iewed? * Fes. If the 1edial +oard or the 1edical Appeal Tribunal is satisfied by fresh

e#idence that a decision %as gi#en because of non$disclosure or mis$representation of a material fact, it can re#ie% its earlier decision at any time. A 1edical +oard can also re#ie% its earlier assessment of e(tent of disablement, if it is satisfied that there has been substantial and unforeseen aggra#ation of the results of the rele#ant in"ury and substantial in"ustice %ould be done by not re#ie%ing it. Such re#ie%, ho%e#er, cannot be made earlier than ; years or in the case of the pro#isional assessment, earlier than : months of the date of assessment to be re#ie%ed. 32. Is lump sum -ene"it allowed in place o" ,ension? * Fes. At the option of the beneficiary, permanent disablement pension, %here the

daily rate payable is not significant, can be commuted for a lump sum payment sub"ect to the fulfillment of the follo%ing t%o conditions CD ,i- That the permanent disablement has been assessed as final, and ,ii-The daily rate of permanent disablement does not e(ceed 5s ;<$ and the total commuted #alue does not e(ceed 5s ?','''<$ ,effecti#e from AprilD'?-. 33. How to claim +2isa(lement -ene"it? (a) Temporary Disablement:

,i- =otice of the in"ury should be gi#en either orally or in %riting personally or through an agent, to the employer<foreman<duty super#isor or particulars of

the in"ury should be entered in the Accident +ook kept in the factory, personally or through an agent. ,ii-A medical certificate of incapacity should be obtained from the Insurance 1edical 4fficer<Insurance 1edical 2ractitioner. ,iii- The claim form printed on the back of the medical certificate should be filled in and submitted promptly to 6ocal 4ffice along %ith the medical certificate. ,i#- A final certificate should be obtained from the Insurance 1edical 4fficer<Insurance 1edical 2ractitioner and submitted to the 6ocal 4ffice before resumption of duty. (b) Permanent Disablement:

,i- If suffering from permanent effects of employment in"ury, the insured person should make an application to the 5egional 4ffice of the /orporation for reference of his case to the 1edical +oard ,reference to the 1edical +oard is made other%ise also by the 5egional 4ffice-. ,ii-.here loss of earning capacity has been assessed and communicated to the insured person, he should submit a claim in the appropriate form to the 6ocal 4ffice. ,iii- After the claim has been admitted, the beneficiary should submit at si($ monthly inter#als ,%ith the claim for Eune and 3ecember e#ery year- a life certificate in appropriate form duly attested by the prescribed authority. 34. Is there any pro3ision "or physical reha(ilitation? * Fes. Insured 2ersons %ho suffer physical disablement due to employment in"ury

are pro#ided artificial appliances or other physical aids such as %heel chairs, crutches, dentures and spectacles etc. 35. What a(out 3ocational reha(ilitation? * The /orporation at its cost arranges for the #ocational rehabilitation of disabled

insured persons pro#ided the disability has been assessed at abo#e B' percent and the

beneficiary is not o#er B; years of age. The training is pro#ided at #acational rehabilitation centres run by the 0o#t. of India etc. The fee, tra#elling e(penses etc are borne by the /orporation. 3 . What is +2ependents -ene"it? * 3ependents +enefit is a monthly pension payable to the eligible dependents of an

insured person %ho dies as a result of an Employment In"ury or occupational disease. 3#. Who are the -ene"iciaries and how lon$ is the -ene"it a3aila(le? * 3ependants entitled to the benefit could be CD ,a-.ido%<.ido%s during life or until remarriageC ,b6egitimate or adopted son until age &G or if legitimate son is infirm, till

infirmity lasts* ,c-6egitimate or adopted unmarried daughter until age &G or until marriage, %hiche#er is earlier, or if infirm, till infirmity lasts and she continues to be unmarried. In the absence of any %ido% or legitimate child, the benefit is payable to a parent or grandparent for life, to any other male dependant until age &G or to an unmarried or %ido%ed female dependant until age &G. 3%. How much is the -ene"it "or each -ene"iciary? * The total di#isible benefit is equi#alent to the temporary disablement benefit rate

,roughly @'A of the %age rate-. The %ido%<%ido%s share ?<;th of the benefit and the legitimate or adopted son and daughter )<;th each of the benefit. If the total benefit so di#ided e(ceeds the full rate, there is a proportionate reduction in the respecti#e shares of the beneficiaries. 3'. How to claim +2ependants -ene"it? * To establish title to 3ependant +enefit, the follo%ing documents should be

submitted at the 6ocal 4fficeCD ,a-/laim in the appropriate form*

,b-E#idence of death being due to employment in"ury* ,c-2roof of relationship to the deceased supporting eligibility of the claimant as a 8dependant9* ,d-E#idence of age of the claimant,s- ,certified copy of official record of birth, +aptismal register, school records, original horoscope etc* ,e-/ertificate of infirmity from 1edical 5eferee or any other prescribed authority in case of legitimate infirm son or legitimate or adopted unmarried infirm daughter. After the claim to 3ependants +enefit has been admitted, the beneficiary should submit at si($monthly inter#als ,%ith the claim for Eune and 3ecember-, a declaration that he<she is ali#e and has not married<remarried, attained the prescribed age<continues to be infirm, as the case may be duly attested by the prescribed authority. 4). &an 2ependants -ene"it (e re3iewed? * Fes. 3ependants +enefit once a%arded can be re#ie%ed by the /orporation at any

time if it is satisfied on fresh e#idence that the earlier decision %as due to non$ disclosure or misrepresentation of material facts. It can also be re#ie%ed on birth, death, marriage, re$marriage and attainment of age &G, by a claimant. The benefit can be continued, increased, reduced or discontinued. 41. What is 8aternity -ene"it? * 1aternity +enefit is cash payable to an insured %oman for the specified period of

abstention from %ork for confinement or miscarriage or for sickness arising out of pregnancy, confinement, premature birth of child or miscarriage. 8/onfinement9 connotes labour resulting in the deli#ery of a li#ing child or labour after ): %eeks of pregnancy %hether the resultant issue is ali#e or dead. 81iscarriage9 means e(pulsion of the contents of a pregnant uterus at any period prior to or during ):th %eek of pregnancy. /riminal abortion or miscarriage does not, ho%e#er, entitle to benefit. 42. What are the &ontri(utory &onditions? * The contribution condition is the same as for Sickness +enefit.

43. How much is the -ene"it? * The daily benefit rate is double the Sickness +enefit rate and is thus roughly

equi#alent to the full %ages. +enefit is paid for Sundays also. 44. What is the duration o" the -ene"it? * The +enefit is paid as follo%sCD (a) For confinement:

>or a total period or &) %eeks beginning not more than : %eeks before the e(pected date of child birth. If the insured %oman dies during confinement or %ithin : %eeks thereafter, lea#ing behind the li#ing child, the benefit continues to be payable for the %hole of the period. +ut if the child also dead during that period, the benefit %ill be paid upto and including the day of death of the child. (b) For Miscarriage:

>or a period of : %eeks follo%ing the date of miscarriage. ,c)For Sickness arising out of pregnancy, confinement, and premature birt of c ild or miscarriage: >or an additional period of upto four %eek. In all the cases, the benefit is paid only if the insured %oman does not %ork for remuneration during the period for %hich benefit is claimed. There is no %aiting period. 45. How to claim 8aternity -ene"it? * .here an insured %oman %ishes to claim 1aternity +enefit after confinement or

for miscarriage, she should obtain from the Insurance 1edical 4fficer<Insurance 1edical 2ractitioner, a certificate of confinement or miscarriage and submit it to her 6ocal 4ffice personally or by post along%ith a claim for 1aternity +enefit. The claim form also contains a declaration of abstention from %ork.

If +enefit is desired before confinement, a =otice and /ertificate of 2regnancy and a /ertificate of E(pected /onfinement obtained from the Insurance medical 4fficer<Insurance 1edical 2ractitioner are also required to be submitted. >or claiming +enefit in the e#ent of death of an insured %oman lea#ing behind a child, her nominee and if there is no such nominee, her legal representati#e should submit personally or by post to the 6ocal 4ffice of the deceased insured %oman, a claim for the +enefit together %ith a certificate of death of the insured %oman. An insured %oman claiming 1aternity +enefit for Sickness arising out of pregnancy, confinement, premature birth of child or miscarriage should submit her claim in the manner as for sickness benefit. .here a claim to 1aternity +enefit is not submitted along %ith prescribed certificates referred to abo#e, the /orporation has the discretion to accept other e#idence in lieu thereof. 4 . What is 8edical -onus? * 1edical +onus is lump sum payment made to an insured %oman or the %ife of an

insured person in case she does not a#ail medical facility from an ESI hospital at the time of deli#ery of a child. This bonus of 5s. );'<$ has been increased to 5s. &'''<$ from &st April )''?. 4#. What is 8edical -ene"it? * 1edical +enefit means medical care of insured persons and their families,

%here#er co#ered for medical benefit. 4%. What does 8edical -ene"it consist o"? * The standard medical care consists of out$door treatment, in$patient treatment, all

necessary drugs and dressings, pathological and radiological specialist consultation and care, ante$natal and post natal care, emergency treatment etc.

4'. Where are +out:patient ser3ices pro3ided? * 4ut$door medical care is pro#ided at State Insurance 3ispensaries or 1obile

3ispensaries manned by full$time doctors , Ser#ice system- or at the pri#ate clinics of Insurance 1edical 2ractitioners , 2anel9 system-. The scope of medical ser#ices also includes simple ante$natal and post$natal care for %omen, family %elfare planning ser#ices and immuni!ation against the common infectious diseases. The Scheme pro#ides at the sole cost of the /orporation, artificial limbs to insured persons %ho lose their limbs due to employment in"ury or in certain circumstances other%ise also, dentures, spectacles and hearing$aids %here the loss of teeth, impairment of eye$sight or hearing respecti#ely is due to employment in"ury. 5). How and where are +in ; patient Ser3ices ,ro3ided? * ESI/ has a net%ork of &B& hospitals country%ide. 1a"ority of these hospitals are

administered by the State 0o#ts. In D patient and diagnostic ser#ices in basic specialties are a#ailable at these hospitals. State schemes ha#e also tie$up arrangements %ith a number of 1edical colleges, ma"or state hospitals, as %ell as, pri#ate hospitals for ad#anced treatment for malignant diseases and complicated surgical inter#entions. 51. What a(out ,re3enti3e health care ser3ices? * ESI Scheme pro#ides pre#enti#e health care ser#ices through the net%ork of its

dispensaries and hospitals. These include immuni!ation against some killer diseases, pulse polio #accination and family %elfare ser#ices etc. The scheme also participates in all ma"or national pre#enti#e health ser#ice campaigns. 52. How lon$ is 8edical -ene"it a3aila(le? * Insured %orker and the members of his family are eligible for medical care from

the #ery first day of the %orker coming under ESI Scheme. The medical care includes primary medical care, diagnostic ser#ices, specialist consultations and indoor medical care. .hene#er the patient is not able to tra#el by himself<herself, ambulance ser#ices

are also pro#ided. The I.2. or his family members are not required to pay for any of the ser#ices. A %orker %ho is co#ered under the Scheme for the first time is eligible for medical care for a period of three months. If he<she continues in insurable employment for three months or more the medical care is a#ailable to him<her till the start of the first benefit period. If he<she contributes at least for @G days in a contribution period the eligibility is there upto the end of the corresponding benefit period. A %orker is also eligible for e(tended sickness benefit %hen he<she is suffering from any one of the long term ?B diseases listed in the Act. This is admissible after the %orker has been under ESI co#erage for at least ) years during %hich he<she should ha#e contributed at least for &;: days. .hen these conditions are satisfied medical benefit is admissible for a ma(imum period of @?' days for the I.2. and his<her family. 53. What are !uneral e*penses? * This component consists of a lump sum payment to%ards the e(penditure on the

funeral of the deceased insured person. 54. What is the amount paya(le? * The lump sum amount of this benefit is equal to the actual e(penditure, not

e(ceeding 5s. );''<$ to%ards the funeral of the deceased insured person. 55. 9re there any &ontri(ution &onditions? * =o contribution condition is required for this +enefit. The only condition for

admissibility of this +enefit is that the deceased person should ha#e been an insured person at the time of his death. The >uneral e(penses are thus payable in respect of an insured person in receipt of 2ermanent 3isablement +enefit e#en if he may not be employed at the time of his death in a factory or establishment co#ered under the ESI Act.

5 . 4o whom are the !uneral e*penses paya(le? * The e(penses are payable to the eldest sur#i#ing member of the family of the

deceased insured person. If the insured person did not ha#e a family or if he %as not li#ing %ith his family at the time of his death, the benefit is payable to the person %ho actually incurs the e(penditure on the funeral of the deceased insured person. 5#. How to claim the !uneral e*penses? * To claim the e(penses, the claimant should submit his<her claim personally or by

post to the 6ocal 4ffice of the deceased insured person %ithin three months, together %ith the follo%ing documentsCD ,a-3eath certificate as proof of death of the insured person issued by the Insurance 1edical 4fficer<Insurance 1edical 2ractitioner or such other 1edical 4fficer of a hospital or other institution %ho attended the insured person at the time of death or e(amined the body after the death* ,3eath certificate issued by cremation<burial ground or by 1unicipal authorities or certified copy of #illage etc. death records may also be accepted as e#idence of death-* ,ba declaration of the claimant, either person and incurred e(penditure on the funeral of the deceased. or ,ii-in case the claimant is other than the eldest sur#i#ing member of the family, that the deceased insured person did not ha#e a family or %as not li#ing %ith his family at the time of his death and that the claimant actually incurred e(penditure on the funeral of the deceased insured person. The declaration should be countersigned by a competent authority.

,i- that he is the eldest sur#i#ing member of the family of the deceased insured

2is<uali"ication "or (ene"its in certain cases= A person %ho %orks and recei#es %ages on any day is not entitled to sickness benefit or maternity benefit or temporary disablement benefit in respect of that day. A recipient of sickness benefit or temporary disablement benefit must remain under medical treatment and obey the instruction gi#en by his Insurance 1edical 4fficer. 7e should not lea#e the area of treatment %ithout the permission of his medical officer and should present himself for e(amination by the medical officer or any other person authori!ed by the /orporation.

Sa"e$uardin$ the ri$ht to -ene"it= /ash benefits payable under the Employees State Insurance Act are not liable to attachment or sale in e(ecution of any court decree or order. Also, the right to recei#e any benefit is not transferable or assignable.

,rotection "rom 2ismissal> dischar$e or other ,unishments= An employee is protected against dismissal, discharge, or other punishments during the follo%ing periodsCD ,&-a period of : months in case of a recipient of disablement benefit* ,)-a period of : months in case an employee is under medical treatment for sickness or certified illness due to pregnancy or confinement* ,?-a period of &) months in case an employee is under medical treatment for T.+. 6eprosy, 1ental, 1alignant or any of the ?B specified diseases.

1emittance o" &ash -ene"it at the cost o" the &orporation= At the option of the beneficiary, cash benefits under the Employees State Insurance Act are remitted by 1oney 4rders at the cost of the /orporation, irrespecti#e of the amount in#ol#ed.

9d6udication 8achinery= To make the right of claimants effecti#e, e#ery claimant has a right of raising a dispute in the Employees Insurance /ourt. It consists of a "udicial officer appointed by the State 0o#ernment. The "urisdiction of a /i#il /ourt is barred in all such cases.

1epayment and reco3ery o" -ene"it payments= If a person recei#es any benefit to %hich he is not legally entitled, he is liable to repay the #alue of any such benefit to the /orporation.

,unishment "or "alse statement etc.= Any false statement or false representation made or caused to be made for the purpose of obtaining benefit %rongfully etc. constitutes an offence under the Employees State Insurance Act, punishable %ith imprisonment upto three months or %ith fine upto fi#e hundred rupees or both.

4reatment at outstation In case an insured %orker lea#es his station on duty or other%ise he<she is eligible for treatment at any ESI medical unit, sub"ect to production of identity card and a certificate from Employer in >orm &';.

!/1 -E44E1 9?2 @AI&BE1 SE1CI&ES 2lease 5emember Identity /ard is your #isa to social security* protect it from loss or damage. In case of loss of Identity /ard, report the matter to your 6ocal 4ffice<3ispensary. >ill in all /laim >orms properly* a#oid mistakes. /ount your money before lea#ing 6ocal 4ffice cash counter. Apply for e(amination by 1edical +oard immediately after your T3+ terminates. >ollo% referral procedures for treatment e(cept in emergencies, %hen time factor is critical. If you ha#e a grie#ance, contact 6ocal 4ffice 1anager<3ispensary incharge to %hich you are attached for quick redressal. +e courteous %ith ESI staff and e(pect courtesy and compassion from them al%ays.