BENEFITS & ELIGIBILITY CONDITIONS DURATION & SCALE OF BENEFITS STANDARD SICKNESS BENEFIT RATES ESI SCHEME

– At a Glance as on 31.3.2007
1. SICKNESS BENEFIT
S.No. Average daily wage Slabs Standard B. Rates Coverage
(a) Sickness Benefit : Payment of contribution for 78 days in corresponding Upto 91 days in two consecutive benefit periods at 20% more than the Standard Benefit
contribution period of six months. Rate i.e. just above 60% of the wages. • No. of States/UTs covered 27
1. Below Rs. 28/- Rs. 14/-*
(b) Enhanced : Same as above. 14 days for tubectomy & 7 days for vasectomy, extendable on medical advice. Rate of 2. Rs. 28 and above but below Rs. 32 Rs. 16/- • No. of implemented centres 737

(c)
Sickness Benefit
Extended
Sickness Benefit
: For 34 specified long term diseases. Continuous
insurable employment for two years with 156 days
payment is 100% of the wages.
124 days which may be extended upto two years on medical advice during a period of
three years in insurable employment.
3.
4.
5.
Rs. 32 and above but below Rs. 36
Rs. 36 and above but below Rs. 40
Rs. 40 and above but below Rs. 48
Rs. 18/-
Rs. 20/-
Rs. 24/-
•
•
No. of Employers covered
No. of Insured persons covered
3.31
101
lakhs
lakhs
Employees'
contribution in ‘four consecutive contribution periods. Rate: 70% of wages approx. 6.
7.
Rs. 48 and above but below Rs. 56
Rs. 56 and above but below Rs. 60
Rs. 28/-
Rs. 30/-
•
•
No. of women workers covered
Total number of beneficiaries
18
394
lakhs
lakhs
State Insurance Scheme
2. DISABLEMENT BENEFIT
(a) Temporary : From day one of entering insurable As long as temporary disablement lasts.
8.
9.
Rs. 60 and above but below Rs. 64
Rs. 64 and above but below Rs. 72
Rs. 32/-
Rs. 36/- of India – An Introduction
Disablement employment & irrespective of having paid any Rate: about 75% of wages approx. 10. Rs. 72 and above but below Rs.76 Rs. 38/- Infrastructure
Benefit contribution. 11. Rs. 76 and above but below Rs. 80 Rs. 40/-
12. Rs. 80 and above but below Rs. 88 Rs. 44/-
• No. of R.Os/S.R.Os/D.Os 45
For whole life.
(b) Permanent : Same as above. • No. of Branch/Pay Offices 813
Rate: about 75% of wages depending upon loss of earning capacity. 13. Rs. 88 and above but below Rs. 96 Rs. 48/-
Disablement
Benefit 14. Rs. 96 and above but below Rs. 106 Rs. 53/- • No. of ESI Hospitals 144
15. Rs. 106 and above but below Rs. 116 Rs. 58/-
• No. of ESI Annexes 42
3. DEPENDANTS : From day one of entering insurable employment & For life to the widow or until her remarriage. To legitimate dependant children till the age 16. Rs.116 and above but below Rs. 126 Rs. 63/-
BENEFIT irrespective of having paid any contribution in case of of 18 years. To dependant parents for life. 17. Rs. 126 and above but below Rs. 136 Rs. 68/- • No. of Beds 27,668
death due to employment injury. Rate: about 75% of the wages approx. shareable in fixed proportion. 18. Rs. 136 and above but below Rs. 146 Rs. 73/- • No. of Occupational Disease Centres 5
19. Rs. 146 and above but below Rs. 156 Rs. 78/-
4. MATERNITY : Payment of contribution for 70 days 12 weeks in case of normal delivery. 6 weeks in case of mis-carriage. Extendable by 4 • No. of ESI Dispensaries 1388
20. Rs. 156 and above but below Rs. 166 Rs. 83/-
BENEFIT in two preceding contribution periods. weeks on medical advice. 21. Rs. 166 and above but below Rs. 176 Rs. 88/- • No. of Doctors/Specialists 9000
(one year) Rate: Almost full wages.
22. Rs. 176 and above but below Rs. 186 Rs. 93/- • No. of Ins. Medical Practitioners 1942
5. MEDICAL : Full medical facilities for self and 23. Rs. 186 and above but below Rs. 196 Rs. 98/-
Full medical care till disease or disablement lasts. • No. of paramedical personnel etc. 45000
BENEFIT dependants from day one of entering No ceiling or upper limit on expenditure for individual cases. 24. Rs. 196 and above but below Rs. 206 Rs. 103/-
insurable employment. Retired insured persons who have been in insurable employment for atleast five 25. Rs. 206 and above but below Rs. 216 Rs. 108/-
years before superannuation and disabled insured persons are entitled to full medical 26. Rs. 216 and above but below Rs. 226 Rs. 113/- Income & Expenditure - 2006-2007 (Rs. in Crores)
care for self and spouse only on payment of Rs. 120/- as annual contribution. 27. Rs. 226 and above but below Rs. 236 Rs. 118/-
28. Rs. 236 and above but below Rs. 250 Rs. 125/- • Total contribution income 2453.48
- Confinement An Insured woman or an I.P. in respect of his Up to two confinements only 29. Rs. 250 and above but below Rs. 260 Rs. 130/- • Expenditure on medical care 779.78
Expenses wife in case facilities for confinement are not Rate : Rs 1000/- per case 30. Rs. 260 and above but below Rs. 270 Rs. 135/-
available in ESI Institutions. • Expenditure on cash benefits 273.94
31. Rs. 270 and above but below Rs. 280 Rs. 140/-
32. Rs. 280 and above but below Rs. 290 Rs. 145/- • Administrative expenditure 221.39
- Funeral Expenses From day one of entering insurable employment For defraying expenses on the funeral of an insured person.
Rate: Actual expenses subject to a maximum of Rs. 3000/- (w.e.f. 1-12-07). 33. Rs. 290 and above but below Rs. 300 Rs. 150/- • Provision for Construction of hospitals, etc. 74.25
34. Rs. 300 and above but below Rs. 310 Rs. 155/-
- Vocational In case of physical disablement due to As long as vocational training lasts. 35. Rs. 310 and above but below Rs. 320 Rs. 160/-
Rehabilitation employment injury. Actual fee charged or Rs. 123/- a day whichever is higher. 36. Rs. 320 and above but below Rs. 330 Rs. 165/-
37. Rs. 330 and above but below Rs. 340 Rs. 170/-
- Physical In case of physical disablement due to As long as a person is admitted in an artificial limb centre. 38. Rs. 340 and above but below Rs. 350 Rs. 175/- Published by
Rehabilitation employment injury. Rate: 100% of wages. Director General
39. Rs. 350 and above but below Rs. 360 Rs. 180/-
- Unemployment In case of loss of employment due to closure Maximum six months during life time. 40. Rs. 360 and above but below Rs. 370 Rs. 185/- EMPLOYEES' STATE INSURANCE CORPORATION - INDIA
Allowance of factory, retrenchment or permanent invalidity due to Rate: 50% of the wages. 41. Rs. 370 and above but below Rs. 380 Rs. 190/- Designed by : Print Com. Services & Consultants # 26167599
non-employment injury and the contribution in respect 42. Rs. 380 and above Rs. 195/- and Printed at M/s. Mohan Printing Press
of him have been paid / payable for a minimum of five on behalf of EMPLOYEES' STATE INSURANCE CORPORATION
years prior to the loss of employment * Or full average daily wage whichever is less.
Public Relations Deptt. ESIC New Delhi, (INDIA)
 EMPLOYEES' STATE INSURANCE 3. Coverage: 5. Finances: 7. Social Security Benefits:
SCHEME OF INDIA ESI SCHEME OF INDlA

1. The Scheme :
- An Introduction
T o begin with, the ESI Scheme was
implemented at just two industrial
centres in the country in 1952, namely
Kanpur and Delhi. There was no looking back
since then in terms of its geographic reach
E SI Scheme, like most of the social security schemes the world
over, is a self financing health insurance scheme. Contributions
are raised from covered employees and their employers as a
fixed percentage of wages. As of now, covered employees contribute
1.75% of the wages, whereas, the employers contribute 4.75% of the
T he health insurance benefits offered by the scheme fall in two
broad categories; namely, the Medical Benefits and the Cash
Benefits.

(a) Medical Benefit :

..... in which

and demographic coverage. Keeping pace wages, payable to the insured persons. Employees, earning upto

T he promulgation of An insured person and

Employees’ State Insurance with the process of industrialisation, the Rs. 70/- a day are exempted from payment of their share of his/her dependants become
Act, by the Parliament, in scheme today, stands implemented at over contribution. The State Governments, as per provisions of the Act, eligible to full and free
1948, was the first major 737 centres in 27 states and union contribute 1/8th of the expenditure of medical benefit within a per medical facilities, without
legislation on comprehensive territories. The Act now applies to over 3.31 capita ceiling of any specified limit and as per
Social Security for workers in Lakhs factories and establishments across Rs. 1000/- per requirement, from day one of Employees'
independent India. The Act the country, benefitting about 10 million family units of workers in the insured person per Medicine
entering the insur able
envisages social protection of lower wage bracket. As of now, the total beneficiary population stands annum. Any employment. The benefit
workers deployed in the organised sector in conceivable at over 40 million. additional comprises out patient care, domiciliary visits, specialist and
contingencies, such as, sickness, maternity and death or disablement expenditure diagnostic services, hospitalisation, super speciality treatment, free
due to employment injury. Based on the principle of “pooling of risks 4. Administration: incurred by the supply of drugs and dressings, provision of artificial aids and
and resources”, the unique, multidimensional health insurance State Govts, over appliances, besides, immunization and family welfare services, etc.
scheme guarantees a fair deal to the covered members by providing
full medical facilities to the beneficiaries, besides, adequate cash
compensation to insured persons for loss of wages or earning capacity
in times of physical distress arising out of sickness or employment
T he comprehensive and multi-pronged social security programme
is administered by an apex corporate body called the Employees’
State Insurance Corporation. It comprises members,
representing vital interest groups that include, employees, employers,
the Central and State Govts; besides, representatives of Parliament
and above the
ceiling, and not
falling within the
shareable pool, is
The scheme also offers old age medical care to retired insured
persons, disabled workers and their spouses subject to fulfilment of
certain conditions.
injury. borne by the State Govts. concerned. (b) Cash Benefits:
and medical profession. The Corporation is headed by the Union
2. Applicability: Minister of Labour, as its Chairman, whereas, the Director General, These include benefits payable in cash, through Branch Offices of the Hospitalization
6. Infrastructure: Cash Benefit
appointed by the Central Govt. functions as its chief executive officer. Corporation, on account of loss of wages or earning capacity caused by

T he ESI Act applies to non-seasonal, power using factories

employing ten or more persons and non power using factories
and specified establishments employing twenty or more
persons. A factory or an establishment located in a geographical area
notified for implementation of the Scheme, falls under the purview of
the Act. Employees of the aforesaid categories of factories and
establishments, but drawing wages only upto Rs. 10,000/- a month,
are entitled to health
insurance cover under
the ESI Act. The wage
ceiling for purpose of
coverage is revised from
time to time, to keep
pace with rising cost of
living and subsequent
wage hikes.
The broad based corporate body is, primarily responsible for
coordinated policy planning and decision making for growth,
development and efficacy of the Scheme. A standing committee,
constituted from among the members of the Corporation, acts as an
executive body. The Medical Benefit Council, constituted by the
Central Government, is yet another statutory body that advises the
Corporation on matters related to effective delivery of medical
services to the beneficiary population.
The Corporation, with its central headquarters at New Delhi, operates
through a network of 45 regional, sub-regional and divisional offices
located in various States. The administration of medical benefit is
taken care of by the respective State Govts. except in case of Delhi and
Noida/Greater Noida area in Uttar Pradesh where, the Corporation
administers medical facilities directly. The Corporation has taken over
the administration of 21 ESI Hospitals in various states for developing
them as ESIC Model Hospitals.
E ver since its inception in 1952, the infrastructural network of the
scheme has kept expanding to meet the social security
requirements of an ever increasing worker population. ESI
Corporation has, so far, set up 144 hospitals and 42 hospital annexes
sickness, maternity, disablement or death of an insured person due to
employment injury or occupational disease. Sickness benefit,
disablement benefit, maternity benefit, etc. are payable after due
medical certification by an authorised doctor/medical board.
with about 28,000 beds for inpatient services. Primary and out- Unemployment allowance is payable for loss of employment due to
patient medical services are provided through a network of about closure of factory, retrenchment or permanent invalidity arising out of
1388 ESI dispensaries, 1942 panel clinics and over 300 diagnostic non-employment injury.
centres set up in and around the industrial centres. The Corporation
Brief description of
has also set up five occupational disease centres, one each at Pune
benefits, contributory
Every Contributor is a
(Maharastra), New Delhi, Kolkata (W. B.), Chennai (T.N.) and Indore
conditions, duration of
(M.P.) for early detection and treatment of occupational diseases
benefits and the scale of
Benefactor and
prevalent among workers employed in hazardous industries.
benefits are reproduced on
For payment of cash benefits, the Corporation operates through a the backside of this brochure.
a Beneficiary
network of over 813 Branch Offices/Pay Offices, whose functioning is
supervised by the regional/sub-regional and divisional offices.