Comprehensive Guide to Employees’ State Insurance (ESI) Benefits Under the ESI Act, 1948

The Employees’ State Insurance (ESI) Scheme, implemented under the ESI Act, 1948, is a social security initiative designed to provide financial stability and healthcare to employees and their families. Here’s a detailed breakdown of the numerous benefits covered under the ESI scheme.

In this blog, we will explore the various benefits provided under the ESI scheme, which covers both employees and their dependents across India.
1. Introduction to the ESI Scheme in India

The ESI scheme aims to offer medical, financial, and social security benefits to employees in times of need. With no cap on medical treatment expenditure and a nominal contribution rate, it ensures comprehensive coverage for employees and their dependents.

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2. Medical Benefits Under the ESI Scheme

From the day an employee enters insurable employment, full medical care is extended to them and their family members. Retired or permanently disabled insured persons and their spouses can also avail of medical facilities by paying an annual premium of ₹120.

Key Features Include:

• Specialist consultations
• In-patient treatment
• Imaging services
• Artificial limbs and aids
• Reimbursement of expenses in special cases

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3. Sickness Benefits

The scheme provides a cash benefit to employees unable to work due to illness.

• Standard Sickness Benefit: 70% of wages, payable for up to 91 days per year, subject to 78 days of contributions in a six-month period.
• Extended Sickness Benefit: Available for up to two years for 34 long-term illnesses, with an enhanced rate of 80% of wages.
• Enhanced Sickness Benefit: Full wages paid for up to 7 days (Vasectomy) or 14 days (Tubectomy) for sterilization procedures.

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4. Maternity Benefits

Maternity benefits are provided for confinement, pregnancy, or miscarriage.

Key Details:

• 26 weeks of leave, extendable by one month on medical advice.
• Paid at 100% of wages.
• Requires 70 days of contributions in the previous two contribution periods.

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5. Disability Benefits

The ESI scheme covers both temporary and permanent disabilities caused by employment injuries.

• Temporary Disability Benefit (TDB): 90% of wages, paid for the entire duration of disability.
• Permanent Disability Benefit (PDB): Monthly payments at 90% of wages, adjusted to the certified loss of earning capacity.

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6. Dependents’ Benefits

In case of the death of an insured person due to employment injury or occupational hazard, 90% of wages are paid monthly to the dependents.

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7. Additional Benefits

• Funeral Expenses: ₹15,000 for performing the last rites.
• Confinement Expenses: Paid if medical facilities are unavailable under the ESI scheme.
• Vocational Rehabilitation: Support for permanently disabled persons.
• Physical Rehabilitation: Assistance after employment-related injuries.

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8. Unemployment Allowance Under ESI

Rajiv Gandhi Shramik Kalyan Yojana

Provides financial relief to employees who lose their jobs due to closure, retrenchment, or permanent disability (minimum 40%).

• 50% of wages for up to 2 years.
• Includes medical care and vocational training.

Atal Beemit Vyakti Kalyan Yojana

A welfare scheme offering unemployment relief once in a lifetime.

Highlights:

• 50% of wages for up to 90 days.
• Insured persons must have contributed for at least 78 days in the preceding 12 months.
• Online claim submission available at www.esic.gov.in.

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9. Incentives for Employers Hiring Persons with Disabilities

• Minimum wage limit for availing ESI benefits is ₹25,000.
• The Central Government pays the employer’s contribution for three years.

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10. Contribution Conditions Under the ESI Scheme

Contributions are linked to the employee’s wages, ensuring benefits are provided as per individual needs. Employers and employees both contribute a percentage of wages, ensuring the scheme’s sustainability.

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Conclusion

The ESI Scheme offers a robust framework of social security benefits, covering employees and their families during sickness, maternity, disability, death, and unemployment. By ensuring that workers have access to medical care, wage replacement, and rehabilitation, the scheme plays a vital role in safeguarding the health and livelihood of India’s workforce.

For employers and employees alike, understanding and utilizing the benefits of the ESI scheme is essential to maintaining a healthy and financially secure workforce.

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For more updates and detailed guidelines, you can visit the official ESIC website or explore our other articles on labor law compliance at ComplianceAge.