TheEmpl

oyees’
Stat
eInsur
anceAct
,1948

Obj
ect
iveoftheAct:
Topr ov
idef orcer
tai
nbenefi
tstoEmploy
eesincaseofSickness,Mat
erni
tyand
Empl
oymentInjuryandtomakeprov
isi
onsf
orRel
atedMat
ter
s.

TheESISchemei sanintegr
atedmeasur eof“ Soci
alI
nsur
ance”comet ot heli
fe
throught heEmploy ees'St
ateInsuranceAct-1948,andi sdesi
gnedt ocompletethe
taskofpr ot
ecti
ng“Empl oyees”asdefinedi nt
heESIAct–1948,againstt
hehazardsof
Sickness,Materni
ty,Disabl
ementorDeat hduetoEmploymenti
njur
yandt opr
ovideful
l
Medi calcar
etoinsur edper
sonsandt heirfamil
i
es.

Cover
ageinIndi
a:
No.ofSt
ates/UTscov
ered:-29
No.ofi
mplementedcenter
s:-787

I
nfr
astr
uct urei
nIndia:
No.ofRegional/
Sub-Regional
/Divl
.Off
ices:
-52
No.ofBranch/Payof f
ices:
-798
No.ofESIHospi t
als:
-148
No.ofHospi t
alAnnexes:-42
Atan av eragetheESICor por
ation makes40 lacsindi
vi
dualpay
mentseach year
amounti
ngt oaboutRs.300cr oresthr
oughitswi
despreadnetwor
kofbr
anchOff
icesin
i
mplement edareas.

Appl
i
cabi
l
ityoft
heAct
:

 UnderSecti
on2( 12)TheActisappl
icabl
etothe“Fact
ori
es”empl
oyi
ng10( Ten)
ormor e persons i
rr
espect
ive ofwhetherpoweris used i
nthe pr
ocess of
manufact
uringornot.

 UnderSect i
on1(
5)oftheAct,t
heSchemehasbeenextendedtoShops,Hotel
s,
Restaurant
s, Ci
nemas incl
udi
ng previ
ew Theat
re, Road motor tr
ansport
undertaki
ngsand Newspaperest
abl
ishmentempl
oyi
ng 20 (Twent
y)ormor e
persons.

 Fur
ther,u/s1(5)oft
heAct ,t
heSchemehasbeenext
endedtoPr
ivat
eMedical
I
nsti
tuti
onandEducationalI
nsti
tut
ionsempl
oyi
ng20(
Twenty
)ormoreper
sons
i
ncertainStat
es.

 Theexist
ingwage-
li
mitf
orcoverageundertheAct,i
sRs.15,
000/
-permont
h
(excl
udi
ngremuner
ati
onf
orover
ti
me)w.e.f:-May01,2010.

 AREASCOVERED:TheESIActi
sappl
i
cabl
eacr
osst
hel
engt
handbr
eadt
hoft
he
I
ndia.
  An empl oyer
/establi
shmentcoverundert
he ESIActi
s exemptf
rom t
he
pr
ovisi
onsof:
a.Mat erni
tyBenefi
tAct,
1961
b.Empl oyees’Compensati
onAct
,1923

ESICont ri
but i
onShar e:
Empl oyee’sESICont ribut ion( 1.75%OfGr ossSal ary)+Empl oy er’
sESICont ri
buti
on
(4.
75%OfGr ossSal ary )=Tot alESICont r
ibut ion( 6.5%OfGr ossSal ary
)
Contri
but i
onDeposi t&DueDat es:
 The amountofcont ri
but i
on (Empl oy ee’s and Empl oyer’s share)i st o be
deposi ted wit ht he aut horized bank ( St ate Bank OfI ndia)t hrough Onl i
ne
Gener atedChal l
an,onorbef ore21stdayoft heSucceedi ngmont h,ofmont h
foll
owi ngt hecalendarmont h.
 Cont r
ibut i
oncanal sobesubmi t
tedOnl ine,bysel ecti
ngOnl i
nePay mentOpt i
on
duringPay mentoft hecont ri
buti
on,thepr ocesswi l
ltakey out hePay mentpage
ofSBIcor poratebanki ngl ogintocompl etet hepay ment.
 I ftheempl oyeeisdr awingupt oRs. 70/ -asdai l
yav eragewage,hei sexempt
from thepay mentofhi sshar eofcont r i
but i
on.Theempl oy erishowev ertopay
empl oy er'
sshar eof4. 75%oft hesalaryr ecei vedbyt heempl oyee.
 TheSt at eGov t.bear sone- eightshareofexpendi t
ureonmedi calbenef itswit
hin
thepercapi t
acei lingofRs.1200/ -perI .P.f amilyperannum &al laddit
ional
expendi turebey ondt hecei li
ng.

Contr
ibuti
on&Benef i
tPeriod:
Employerscover
edundert heAct,ar
erequi
redt oPaytheContr
ibut
iont
owar
dsthe
schemeonaMont hlybasis.Ther
ear
et wocont
ributi
onperi
odseachofSixmont
hsand
twocorrespondi
ngbenefitperi
odsal
soofSixmont hsdur
ati
onasunder.

Cont
ri
but
ionPer
iod Benef
itPer
iod

1stApr
ilt
o30t
hSep. 1stJant
o30t
hJune(
oft
hef
oll
owi
ngy
ear)

1stOctt
o31stMar
ch 1stJul
yto31stDec.

**Atanaver
agetheESICorpor
ati
onmakes40l acsi
ndi
vi
dualpay
ment
seachy
ear
amount
ingt
oaboutRs.300cr
oresascashbenef
it
s.

Soci
alSecur
it
yBenef
it
sofESI
C:

Thef
oll
owi
ngbenef
it
sar
epr
ovi
dedundersect
ion46.

1.Medi
calbenef
it
:
TheESISchemeprov
idesful
lrangeofMedicalCaretoallI
nsur
edperson
andt
heirf
amil
y,thr
oughanetwor
kofESIDispensar
ies,Hospi
tal
s&PanelCl
inics,
 DiagnosticCenters&SuperSpeci al
ity
.
Super-
Specialit
yt r
eatmentsuchas: -OpenHear tSurger y
,Neur o-
Surgery
,
BoneMar row Transplant,Ki
dneyTr ansplantorspecial
izedi nvesti
gati
onslike
CATscan, MRI,Angiographyetc.
El
igibi
l
ityforMB: -Anempl oyeewhoi scov er
edundert heSchemef orthe
fi
rstti
mei seli
gibl
ef ormedicalcaref oraper i
odofthreemont hs.Ifemployee
contri
butesatleastfor78day sinacont r
ibuti
onperi
odtheeligibi
lit
yisthereupto
theendoft hecor r
espondingbenefitperi
od.
Claimform underESIAct :
-Form -09

2.Sicknessbenef i
t:
Si
cknessBenef it
sr epresentper i
odicalcashpaymentsmadet o anI P
duringt heper iodofcer ti
fiedsi cknessoccurri
ngi nabenefi
tperi
odwhenI P
requires medi calt r
eatmentand at t
endance wit
h abst
enti
on f
rom wor k on
medi calgrounds.
El
igibi
li
tyforSB:-Minimum 78day scontri
buti
oni
nonecontr
ibut
ionperi
od.
Thedai lyrateofSicknessBenef itis50%oft hedail
ywages.
Max.Dur at
ion:-Maxi mum per iod of91 daysin anytwo consecut
ive
benef i
tperiods .
Clai
mf orm underESIAct :-Form -09

ExtendedSi cknessBenefi
t:ExtendedSicknessBenefi
tisaCashBenef i
t
paidforpr ol
ongedi l
l
nessduet oanyoft he34specifi
eddiseasesasper
(Annexure–A) .El
igi
bil
i
tyforExtendedSB:-Conti
nuousemploymentf ora
periodof2y earsandshouldhav econtr
ibutedforatl
east156day sin4
preceding contri
buti
on peri
ods.The dai l
yr at
e ofExtended Sickness
Benefitis40%mor ethanSBr at
e.

Maximum Durati
onofESB: -I
ncludi
ngSi cknessBenefi
tpayabl
ef or91
daystheESB ispayableupt
oaf ur
therperi
odof124/ 309day sthatcanbe
ext
ended upto2y ear
si n speci
alcircumstances on recommendati
on of
competentaut
hor
it
y.

3.Mat ernitybenef i
t:
Mat ernit
y Benef i
tconsi sts ofper iodicalcash pay ment si n case of
confinementormi scarr
iageorsi cknessar i
singoutofpr egnancy ,confinement,
premat urebi r
thofchi ldormi scarr
iage,toani nsuredwomanascer ti
fi
edbya
dulyappoi ntedmedi caloffi
cerormi dwi f
e.
Eli
gi bi
li
tyforMB: -Thecont ri
butioncondi ti
onisthesameasf orSickness
Benef i
t.Thedai lybenef itrateisdoubl etheSi cknessBenef i
trateandi st hus
roughlyequi val
entt othefullwages.Benef i
tispaidforSundaysalso.
TheBenef i
tispaidasf oll
ows:-
(a)ForChi ldDel i
very:-Forat otalperiodof12weeksbegi nningnotmor e
than6weeksbef oretheexpect eddat eofchi l
dbi r
th.
(b)ForMi scarri
age:-Fora per i
od of6 weeks f ol
lowing t he date of
mi scarri
age.( c)ForSi ckness ar i
sing outofpr egnancy ,conf inement,
 pr
ematurebi
rt
hofchi
l
dormi
scar
ri
age:
-Foranaddi
ti
onalper
iodofupt
o
04weeks.

Cl
aimf
orm underESIAct
:-For
m –09&19(
Not
iceofWor
k)

MedicalBonus:
-MedicalBonusi
slumpsum pay
mentmadetoaninsur
ed
womanort hewi feofaninsuredpersonincaseshedoesnotavai
lmedical
faci
l
ityfrom anESIhospi
talatthetimeofdel
i
very
.TheamountofBonusi
sRs.
2500/-.

4.DisablementBenef it:
DisablementBenef i
tisadmissi
blefordisabl
ementcausedbyempl oyment
i
njury.Att hef ir
stinstance,temporarydisabl
ementbenef i
tispay ableaslongas
thet empor arydi sabili
tylasts.Iftheempl oy mentinjur
yr esult
si n parti
alor
total
/permanentdi sabi
lit
y,permanentdi sablementbenef i
ti spay abl
et il
lthe
deathoft hei nsuredper son.
The Dai l
ybenef i
tr ateforPermanentand Tempor aryDi sabl
ementi s
roughlyequi v al
entt o about100% oft he wage rate.Forper manentpar t
ial
disablement ,ther ateofbenef i
tisproporti
onatetot heper cent
ageofl ossof
earningcapaci ty.Thebenef iti
spaidforSunday sal
so.

Cl
aimf
orm underESIAct
:ForTemporaryDi
sabl
ement
:-For
m –09
ForPer
manentDi
sabl
ement
:-For
m –14

5.DependentsBenef i
t:
Dependent sbenef i
ti spai dasf amilypensi ont ot hedependantsofa
deceasedi nsuredper soni nt heev entofdeat hduet oempl oy
menti nj
uryor
occupati
onal diseaseandi sequivalenttoabout70%oft hewages.
El
igi
bleMember s:
 Awi dowcanr eceiv
et hisbenefitonmont hlybasisforl
ifeorti
llher
Re-Mar r
iage.A sonordaught ercanr eceivet hi
sbenef i
tti
l
l( 25)
twentyfiveyearsofage.
 Ot herdependant slikeparentsincludingawi dowedmot heret
c.can
alsoreceivethisbenefitundercertaincondi t
ions.

The f
ir
stinst
all
mentis pay
abl
e wi
thi
n a maxi
mum ofthr
ee mont
hs
fol
lowingthedeathofaninsur
edpersonandther
efor
e,onar
egul
armonthl
y
basis.

Cl
aimf
orm underESIAct
:-For
m –15&16

6.FuneralExpenses:
Funeralexpensesareinthenatur
eofalumpsum paymentofRs.10000/-
(rev
isedfrom @ 5000/ -w.
e.f
:-Apri
l2011)madetodefr
aytheexpendi
tur
eont he
funeralofdeceasedi nsuredperson.Theamounti spai
deithertotheeldest
survi
v i
ngmemberoft hefamil
yor ,i
nhisabsence,t
othepersonwhoact uall
y
 i
ncur
stheexpendi
tur
eont
hef
uner
al.

Cl
aimf
orm underESIAct
:-For
m –22.

7.OthersBenefi
ts:
Rehabi
l
itat
ion All
owance:
-Rehabi
li
tat
ion i
n case ofdisabl
ed i
nsur
ed
personsunder45y ear
sofagewith40per
centormoredisabl
ement.

Free Suppl
y:
-Fr ee Supply ofphysi
calaids and appl
i
ances such as
cr
utches,wheel
chai
rs,
dentures,spect
acl
esandothersuchphysi
calai
ds.

Ol
dAgeMedi calCare:
-OldageMedi calcar
eforsel
fandspouseata
nomi
nalcont
ri
but
ionofRs.120/-perannum.

Raj
ivGandhi ShramikKaly
anYojana:
-UnemploymentAl
lowancei
spayabl
e
tothosewor ker
sf acinginvol
untar
yunemploymentduetoclosureoff
actor
yor
non-employmentinjury.Benef
itrat
ewhichisjustabove50%ofthedail
ywages
formax01y ear.

Obl
i
gat
ionoft
heEmpl
oyer
s:

Compl et
etheRegi
str
ati
onprocesswithin15daysaft
ertheActbecomes
appli
cable.SubmitFor
m -Generat
edt heTIC01totheRegi
onaloff
iceorappl
y
thr
oughOnl inetogett
heuni
queRegistr
ati
onNo.underthi
sAct.

Fol
l
owi
ngResponsibili
tyare:
-
 Gener atet heTI
C&handov ert
oempl oyeeforSmar tCard.
 Mai ntainanAcci dentBookinForm -11(underRegulati
on66) .
 Submi tan Acci dentReportin Form – 16 wi thin 24 hours of
Accident.
 Gr antl eav etoi nsured employ
ees on t he basis ofsi ckness
cert
ifi
cates.

Recor
dsMai
ntenance:-
 RegisterofEmployeesinForm- 6(underRegulat
ion32)
 AccidentBookinFor m -11(underRegulati
on66)
 I
nspect i
onBook( underRegulati
on102A)
 Fil
eforcopiesofreturnofdeclarat
ionforms.
 Fil
eforcopiesofRet urnofContri
buti
on,Chall
ans,et
c.
 Fil
eforgeneralcorrespondence&copiesofAccidentRepor
ts.

Saf
eguar
dsf
orI
nsur
edEmpl
oyees:

 Righttor ecei
ve Paymentofany benef
itunderthe Actthatshal
lnotbe
“Transf
erabl
eorAssignabl
e”.
 CashBenef i
tspayableundertheActarenotli
abl
etoat t
achmentorsal
ein
 execut i
onofanydecr eeoror derofanycour t
.
 Empl oy ershallnotdismiss,dischargeorreducet hewagesorot herwi
sepunisha
cover edempl oyeeduri
ngt heper i
odhe/shei sinrecei
ptofSicknessBenefitor
Mat ernityBenef i
tetc.
 Byr easonofhi sli
abil
i
tyt opayhi sshareofcont ri
buti
onundert heESIAct ,no
empl oyershal ldir
ectl
yorindirectl
yreducet hewagesofacov eredempl oyee.
 Rightt or egist
ert hei
rgr ievances /compl ai
nts atanyl ev
elf orimmedi ate
Redr essal&Judgement .
 Rightt oappr oachEICour tagainstanyaction/decisi
onofthemedi calBoardet c.

I
nter
est&DamagesasPenal
ty:

UnderSect i
on39( 5)(
a)oftheESIact ,r eadwi t
hRegulati
on31( A)oft heESI
(General
)Regulations1950,theemployerisli
abl etopaysimpleinter
est@ 15per cent
perannum i nrespectofeachdayofdef aultordel ayinpay mentcont r
ibut
ions.In
addit
ion,underthePr ov
isi
onofRegulati
on31-CofESI( General
)Regulati
ons,1950,read
withsection85( B)(
i)oftheESIAct,theCorporationi
sempower edt orecoverdamage
asunder:
Periodofdelayin RateofDamages
pay mentofCont ri
buti
on ontheamountdue

i
) Upt
olessthan2mont
hs 5%
i
i
)2mont hsandabov
ebutl
esst
han4mont
hs 10%
i
i
i)4monthsandabov
ebutl
esst
han6mont
hs 15%
i
v)6monthsandabov
e 25%