Esi Benefits

PROJECT REPORT ON
AWARENESS AND EFFECTIVE UTILIZATION OF ESI

BENEFITS
UNDER THE GUIDANCE OF

PROF. Pius Moras
SUBMITTED BY
Mr. Ankit Krishna Patkar
ROLL NO. 321
MASTER IN HUMAN RESOURCE DEVELOPMENT

MANAGEMENT
UNIVERSITY OF MUMBAI
(2014-2017)
N.L. DALMIA INSTITUTE OF MANAGEMENT STUDIES

AND RESEARCH
Awareness and Effective Utilization of ESI Benefits 1

CERTIFICATE
I, Prof. Pius Moras hereby certify that Mr. Ankit Krishna Patkar of N.L. Dalmia Institute
of Management Studies and Research, MHRDM, 5th Semester, has completed a
project on Awareness and effective utilization of ESI benefits in the academic Year of
2014-2017.This information submitted is true and original to the best of my knowledge.
Signature of Director of the Signature

College/Institution Project Guide
____________________ ___________________
Prof. Dr. Gulab Mohite Prof. Pius Moras
Director Incharge

ACKNOWLEDGEMENT
This project on Awareness and effective utilization of ESI benefits is the result
of co-operation, hard work and good wishes of many people. I, student of N.L. Dalmia
Institute of Management Studies and Research, would like to thank my project guide
Prof. Pius Moras for his involvement in my project work and timely assessment that
provided me inspiration and valued guidance throughout my study.
I owe my debt to Prof. Dr. Gulab Mohite Director Incharge, N. L. Dalmia Institute of
Management Studies and Research, for giving me this opportunity to present a creative
outcome in the form of a project work. I would also like to thank Mr. Shailendra
Dhamdhere HR Director of Human Resource in Johnson and Johnson Private Limited
and all Executives working Johnson and Johnson Private Limited for parting with the
relevant information for my project work and helping me in the completion of the same.
I would also like to take this opportunity to express my gratitude to the faculty and staff
for their friendly guidance and constant encouragement. I also express my heart felt
gratitude to my institute friends and family members whose efforts and creativity has
helped me in giving the final shape and structure to this project work.
I am also thankful to those seen and unseen hands and heads, which has been of
direct or indirect help in the completion of this project work.

DECLARATION
I, Mr. Ankit Krishna Patkar of N. L. Dalmia Institute of Management Studies and

Research of MHRDM (SEM V), hereby declare that I have completed this project on
Study on Awareness and effective utilization of ESI benefits in the academic year
2014-2017. The information submitted is true and original to the best of my knowledge.
Signature of Student
____________________
(Mr. Ankit Krishna Patkar)

EXECUTIVE SUMMARY
One of the main objectives of a health system is to reduce the monetary cost of
accessing health services, thereby enabling individuals with substantial unmet needs to
access otherwise unaffordable care.
Health insurance protects households against the financial burden of illness, especially
large out-of-pocket (OOP) expenses resulting from catastrophic illnesses, while at the
same time raising additional resources for the public sector.
The purpose of this study is to analyze the health service utilization of those enrolled in
the Employees State Insurance Scheme (ESIS) and its role in protecting against
catastrophic health payments in a low-income country setting. The study uses primary
data collected through a semi structured questionnaire which sought detailed
information on healthcare utilization and spending and on other key individual and
household factors.
ESIS is not found to provide financial protection against the risk of catastrophic
payments, as the majority of the beneficiaries are seeking care outside the insurance
plan from private facilities at a relatively high personal cost. This under use of ESIS
services is due to; perceived low quality drugs, long waiting periods, impolite personnel,
long delays in reimbursement of money spent on treatment from covered providers, and
lack of or low interest of employers and low awareness of Employees State Insurance
(ESI) procedures.

Contents
Certificate ........................................................................................................................ 2
Introduction ..................................................................................................................... 7
Social security ................................................................................................................. 9
Social security laws in india........................................................................................... 13
Employees' state insurance (esi)................................................................................... 14
Employees' state insurance corporation (esic) .............................................................. 16
Employees' state insurance act, 1948 ........................................................................... 17
Coverage areas, organizations and employees20 ..................................................... 21
ESI scheme at a glance -- maharashtra ........................................................................ 24
Benefits for employees .................................................................................................. 25
Need based benefits ..................................................................................................... 44
New initiatives - awareness ........................................................................................... 49
Esic 2.0: reform initiatives of esic ............................................................................... 53
Recent news ................................................................................................................. 56
Achievements/initiatives of esic..................................................................................... 64
Fetal medicine unit at esic super specialty hospital ....................................................... 68
Esic grievance redressal ............................................................................................... 71
Medical appeal tribunals................................................................................................ 73
Employees' insurance (ei) courts .................................................................................. 74
Employees and employers, retired and disabled persons ............................................. 75
Frequently asked questions .......................................................................................... 78

INTRODUCTION
An equitable health system must ensure that utilization conforms to need (impartiality in
delivery) and that payment conforms to the ability to pay (impartiality in financing). A
failure to separate utilization from payments will have a negative financial impact on the
poor who suffer from ill health. The poor lack financial resources to pay for health
services. Ill health, through the loss of productive labour, can also undermine their
ability to cope financially; thereby strengthening further the nexus between poverty and
poor health. Hence, the purpose of health financing is to use the appropriate funding
instruments to set the right financial incentives for providers, and to ensure that all
individuals have access to effective public health and affordable personal healthcare.
In recent years, India, like several other low-income countries, has established different
types of national health insurance scheme. The ESIS is one such scheme. One of its
main objectives is to reduce the monetary cost of accessing health services; thereby
enabling individuals with substantial unmet needs to access otherwise unaffordable
care. Health insurance also protects households against the financial burden of illness,
especially large OOP expenses resulting from catastrophic illnesses, while at the same
time raising additional resources for the public sector. This helps reduce or eliminate the
possibility that an individual will be unable to pay for such care, or will be impoverished
trying to do so. Catastrophic health payments have been found to be significant in both
rich and poor countries.
For example, results from a recent study of healthcare payments in India indicate that
around 70% of total health expenditure is made of OOP payments and around 30% of
households spend more than 10% of their income on health.
In Indonesia also, the rich are found to be at risk of experiencing catastrophic health
payments defined as exceeding 10% of income and in the United States certain
vulnerable groups are more affected by such payments than other groups. A recent
global review of household catastrophic health payments emphasized the role of health

insurance as a key instrument in reducing the risk of such payments. Given that one of
the key purposes of health insurance is to provide protection against particularly high
healthcare costs, this study aims to test this proposition empirically in a low-income
country setting. The health insurance is an important policy tool for providing financial
health protection is well grounded in both theory and experience.
The highly heterogeneous array of health financing arrangements justifies the

systematic analysis of individual cases to provide evidence on the practical effects of
health insurance programmes. Furthermore, access to the potential benefits of health
insurance may be curtailed if indirect financial and non-financial barriers (such as travel
and lodging expenses, lost income, and a lack of knowledge of what providers offer)
impede the insured from seeking care. Even when care is actually sought, the insured
may still face a wide range of hurdles before actually receiving health insurance
benefits.
Some of these hurdles include the tedious paperwork, the limited portability of the
insurance schemes, or the unwelcoming attitude of health staff towards insured
patients. Although much has been written on the barriers to access that prevent
individuals from seeking appropriate care, comparatively little is known about the factors
influencing the insured person's decision to access their insurance benefits when care is
actually sought.
This study was undertaken with the following objectives:

1. To analyze overall trends in utilization and number of beneficiaries of ESIS over a
period of time in Maharashtra;
2. To assess the effectiveness of the scheme as perceived by beneficiaries, and from
utilization level of ESI facilities, in Maharashtra; and
3. Analyze the development of ESI policy in the state and factors influencing its
implementation.

SOCIAL SECURITY
India has a very basic social security system catering to a fairly small percentage of the
countrys workforce. Traditionally, Indians relied on their extended families for support in
the event of illness or other misfortunes. However, due to migration, urbanization, and
higher social mobility, family bonds are less tight and family units much smaller than
they used to be. So far, neither the state nor private insurance companies have quite
stepped up to fill this gap.
There are two major social security plans in India, the Employees Provident Fund
Organization (EPFO) and the Employees State Insurance Corporation (ESIC). The
EPFO runs a provident fund, also known as a pension scheme, and an insurance
scheme. All of these are supposed to grant EPFO members and their families benefits
for old age, disability, and support in case the primary breadwinner dies.
The ESIC, on the other hand, covers low-earning employees providing them with basic
healthcare and social security schemes. Originally aimed at factory workers, the
coverage is being gradually extended to include greater parts of the population, e.g.
employees in hospitals or educational institutions.
What is Social Security?

any of the measures established by legislation to maintain individual or family
income or to provide income when some or all sources of income are disrupted
or terminated or when exceptionally heavy expenditures have to be incurred
(e.g., in bringing up children or paying for health care).
social security may provide cash benefits to persons faced with sickness and
disability, unemployment, crop failure, loss of the marital partner, maternity,
responsibility for the care of young children, or retirement from work.

Social security benefits may be provided in cash or kind for medical need,
rehabilitation, domestic help during illness at home, legal aid, or funeral expense.
It acts as a facilitator it helps people to plan their own future through insurance
and assistance.
History of Social security

Germany was the first country to introduce Social security scheme (1883)
each member of a particular trade (blacksmiths, painters, weavers etc) was

required to contribute at regular intervals;
Money from this fund was used for food,lodging, hospital and feneral expenses of
aged and disabled members.
In USA, Social Security Act came into existence in 1935. (years not important,
this is only fodder material for Essay.)
Social Security in India

India has always had a Joint Family system that took care of the social security
needs.
However, with rise of migration, urbanization, nuclear families and demographic

changes, Joint family system has declined. Hence we need a formal system of
social security.

Difference between Organized and Unorganized Sectors
Organized sector
includes primarily those establishments which are covered by the Factories Act,
1948, the Shops and Commercial Establishments Acts of State Governments,
the Industrial Employment Standing Orders Act, 1946 etc.
This sector already has social security benefits under above laws.
Examples: employees of union and state Government, army, navy, airforce,

Multinational companies, Infosys, TCS and so on.
Unorganized sector
Unorganized sector doesnt have labour law coverage. These are seasonal and
temporary nature of occupations.
Casual nature of work, labour mobility is high hence bargaining power is low.

Examples of Unorganized sector
Rural Areas Urban Areas
1. landless agricultural labourers

2. small and marginal farmers
3. share croppers 1. street vendors
4. persons engaged in 2. hawkers
a. animal husbandry 3. head load workers
b. fishing 4. cobblers
c. horticulture 5. tin smiths
d. bee-keeping 6. garment makers
e. toddy tapping 7. Construction workers
5. forest workers
6. rural artisans

SOCIAL SECURITY LAWS IN INDIA
Employees State Insurance Act, 1948 (ESI Act)

covers factories and establishments with 10 or more employees
Provides medical care to employees and their families.
Provides Cash benefits during sickness and maternity
Monthly pension after death or permanent disability.
Employees Provident Funds Act, 1952

applies to specific scheduled factories and establishments employing 20 or more
employees and ensures terminal benefits to provident fund, superannuation
pension, and family pension in case of death during service.
Workmens Compensation Act, 1923 (WC Act)

Requires payment of compensation to the workman or his family in cases of
employment related injuries resulting in death or disability.
Maternity Benefit Act, 1961 (M.B. Act)

provides for 12 weeks wages during maternity as well as paid leave in certain
other related contingencies.
Payment of Gratuity Act, 1972 (P.G. Act)

provides 15 days wages for each year of service to employees who have worked
for five years or more in establishments having a minimum of 10 workers.

EMPLOYEES' STATE INSURANCE (ESI)
Employees' State Insurance (abbreviated as ESI) is a self-financing social security

and health insurance scheme for Indian workers. It is a comprehensive Social Security
Scheme designed to accomplish the task of socially protecting the 'employees' in the
organized sector against the events of sickness, maternity, disablement and death due
to employment injury and to provide medical care to the insured employees and their
families. The ESI Scheme is administered by a corporate body called the 'Employees'
State Insurance Corporation' (ESIC), according to rules and regulations stipulated there
in the ESI Act 1948.
ESIC is an autonomous corporation by a statutory creation under Ministry of Labour and

Employment, Government of India. Employees State Insurance Scheme of India is an
integrated social security scheme tailored to provide social protection to workers in the
organized sector and their dependants in contingencies, such as, sickness, maternity or
death and disablement due to an employment injury or occupational disease. The
scheme tailored to suit health insurance requirements of workers provides full medical
facilities to insured persons and their dependants, as well as, cash benefits to
compensate for loss of wages or earning capacity in different contingencies.
In March 1923, B. P. Adarkar was appointed by Government of India to create a report

on health insurance scheme for industrial workers. The report became the basis for the
Employment State Insurance (ESI) Act of 1948. The ESI Act was enacted in 1948 and
came into effect from 24 February 1952. The act was initially intended for factory
workers but later became applicable to all establishments having 10 or more workers.
As of 2011-12, the total beneficiaries are 65.5 million.
The scheme was inaugurated in Kanpur on 24th February 1952 (ESIC Day) by then
Prime Minister Pandit Jawahar Lal Nehru. The venue was the Brijender Swarup Park,
Kanpur and Panditji addressed a 70,000 strong gathering in Hindi in the presence of
Pt.Gobind Ballabh Pant, Chief Minister Uttar Pradesh; Babu Jagjivan Ram, Union

Labour Minister; Raj Kumari Amrit Kaur, Union Health Minister; Sh.Chandrabhan Gupt,
Union Food Minister and Dr.C.L.Katial, the first Director General of ESIC.
The scheme was simultaneously launched at Delhi as well and the initial coverage for
both the centres was 1,20,000 employees. Our first prime Minister was the first
honorary insured person of the Scheme and the declaration form bearing his signature
is a prized possession of the Corporation.
It is important to mention here that it blossomed as the first social security scheme in
1944, when the Government was still British. The first document on social insurance
was "Report on Health Insurance" submitted to the Tripartite Labour Conference,
headed by Prof. B.P.Adarkar, an eminent scholar and visionary.
The Report was acclaimed as a worthy document and forerunner of the social security
scheme in India and Prof. Adarkar was acknowledged as "Chhota Beveridge" by none
other than Sardar Vallabhbhai Patel. Sir, William Beveridge, as all know, was one of the
high priests of social insurance.
The report was accepted and Prof. Adarkar continued to be actively associated with it till
1946. On his disassociation, he strongly advocated management of the Scheme by an
expert from ILO. In 1948 Dr. C.L.Katial, an eminent Indian doctor from London took over
as the 1st Director General of ESIC and he steered the affairs of the fledgling Scheme
till 1953. Since the red-letter day of 24th February in the annals of social security in
India, there has been no looking back.

EMPLOYEES' STATE INSURANCE CORPORATION (ESIC)
Employees' State Insurance Corporation (ESIC), established by ESI Act, is an

autonomous corporation under Ministry of Labour and Employment, Government of
India. As it is a legal entity, the corporation can raise loans and take measures for
discharging such loans with prior sanction of the central government and it can acquire
both movable and immovable property and all incomes from the property shall vest with
the corporations. The corporation can set up hospitals either independently or in
collaboration with state government or other private entities, but most of the
dispensaries and hospitals are run by concerned state
governments.
ESIC LOGO
A lighted lamp which is the logo of ESIC truly symbolizes the
spirit of the Scheme, lighting up lives of innumerable families
of workers by replacing despair with hope and providing help in times of distress, both in
physical and financial terms.
During the 61 years of its existence, ESIC has grown from strength to strength and the
Corporation owes it, most of all, to the commitment, dedication and perseverance of
persons like Prof. Adarkar and Dr. Katial.

EMPLOYEES' STATE INSURANCE ACT, 1948
The promulgation of Employees' State Insurance Act, 1948 envisaged an integrated

need based social insurance scheme that would protect the interest of workers in
contingencies such as sickness, maternity, temporary or permanent physical
disablement, death due to employment injury resulting in loss of wages or earning
capacity. the Act also guarantees reasonably good medical care to workers and their
immediate dependants.
Following the promulgation of the ESI Act the Central Govt. set up the ESI Corporation
to administer the Scheme. The Scheme, thereafter was first implemented at Kanpur and
Delhi on 24th February 1952. The Act further absolved the employers of their
obligations under the Maternity Benefit Act, 1961 and Workmen's Compensation Act
1923. The benefit provided to the employees under the Act are also in conformity with
ILO conventions.
APPLICABILITY OF THE ESI ACT
The ESI Act, (1948) applies to the following categories of factories and establishments
in the implemented areas: -
Non-seasonal factories using power and employing ten (10) or more persons
Non-seasonal and non-power using factories and establishments employing
twenty (20) or more persons.
The appropriate Government State or Central is empowered to extend the provisions

of the ESI Act to various classes of establishments, industrial, commercial, agricultural
or otherwise in nature. Under Section 1(5) of the Act the Scheme has been extended to
certain specific classes of establishments, such as, shops, hotels, restaurants, cinemas,
preview theatres, motors transport undertakings and newspaper and advertising
establishments etc., employing 20 or more persons.

ORGANISATION
As provided under the ESI Act, the scheme is administered by a duly constituted
corporate body called the Employees State Insurance Corporation (ESIC). It comprises
members representing Central and State Governments. Employers, Employees,
Parliament and the medical profession. Union Minister of Labour functions as Chairman
of the Corporation whereas Director General as chief executive discharges the duty of
running the day-to-day administration.
A Standing Committee representing all stake holders is elected from the body corporate
for managing the affairs of the scheme and monitoring the progress of implementation
of various decisions and policies etc. from time to time. The Medical Benefit Council, a
statutory body advises the Corporation on matters related to administration of medical
benefit under the ESI scheme.
INFRASTRUCTURE
The central headquarters of the Corporation is located at New Delhi. For purpose of
coverage, revenue collection, extension of the scheme to new classes of
establishments, implementation of the scheme in new areas, co-ordination with the
State Governments and general administration the Corporation has established
Regional and sub-Regional Offices across the country mostly located in State capitals.
Given the huge number of beneficiaries about 340 lakhs now the Corporation has
set up a wide spread network of service outlets for prompt delivery of benefits in cash
and kind that includes full medical care.
Medical facilities are provided through a network of 1452 ESI Dispensaries, about 3000
Panel Clinics, 307 diagnostic centres besides 140 ESI hospitals and 43 hospital
annexes with over 26000 beds. For providing super specialist medical care the

Corporation has tie up arrangements with advanced medical institutions in the country,
both in public and private sector.
The medical benefit is administered with the active co-operation of State Governments.
The payment of cash benefits is made at the grass roots level through as many as 800
Branch Offices and Cash Offices that function under the direct control of the
Corporation.
NEW AMENDMENT
The Employees State Insurance Corporation (ESIC) raised the monthly wage limit to
Rs 21,000, from the existing Rs 15,000, for coverage with effect from October, 2016
Labour Minister Bandaru Dattatreya added that the move of raising the threshold will
help bring in an additional 50 lakh members to ESIC. Labour Minister is the Chairman of
the ESIC Board.
At present, ESIC has 2.6 crore insured persons, which covers over 10 crore people,
assuming four members of a family. The minister also said there is a plan to increase
the wage threshold for retirement fund body EPFO subscribers and it may be
considered in the next meeting of the Central Board of Trustees (CBT).
At present, the wage threshold is Rs 15,000 per month for coverage under its social
security scheme.

COVERAGE AREAS, ORGANIZATIONS AND EMPLOYEES
COVERAGE
The ESIC Scheme is being implemented in various phases area-wise across India. The
Scheme has already been implemented in different areas in various States/Union
Territories across India except in states like Arunachal Pradesh, Manipur, Mizoram,
Nagaland, Tripura and Sikkim.
UNION TERRITORIES
Delhi and Chandigarh
Coverage(As on 31st March, 2015)
No. of Insured Person family units 2.03 Crores
No. of Employees 1.79 Crores
Total No. of Beneficiaries 7.89 Crores
No. of Insured women 3.36 Lacs
No. of Employers, etc. 7.23 Lacs
COVERAGE OF FACTORIES
The Act is applicable to all non-seasonal factories that utilize power providing
employment to 10 or more individuals as well as factories not utilizing power employing
20 or more individuals for wages on any day in areas wherein ESIC Act has been
implemented.
There is an amendment to the Act under Section 1(5) to extend the benefits to other
classes of establishment agricultural, commercial, industrial or otherwise. The
provisions of this Act have been extended by majority of the State Governments in India
to the following class of establishments such as shops, hotels, restaurants, cinemas

road-motor transport agencies, newspaper agencies, workshops, establishments
employing 20 or more individuals.
In case, at any stage or in due course of time, if the number of employees working with
an establishment or factory covered under the ambit of this Act falls short of the
stipulated number of 10 or 20 employees as specified, ceases to be a beneficiary of
ESIC Act without any aid of power. However, this Act is not applicable to workers
engaged in mining operations, railway running sheds and certain seasonal/temporary
factories operating for less than 7 months in a calendar year. The employees of
establishments or factories run with the aid of Central or State Governments who are in
receipt of social security benefits that are substantially similar or superior as compared
to those provided under this Act can be exempted from coverage.
COVERAGE OF EMPLOYEES
The Central Government of India has issued guidelines pertaining to monthly wage limit
that has been prescribed for the purpose of coverage of employees/workers of the
factories or establishments covered under this Act.
Under Section 2(9) of this Act, an employee has been defined as any individual
employed for wages in connection with the work related to a factory or establishment
which is a beneficiary under ESIC Act. The wage ceiling is revised from time to time.
The existing wage ceiling effective from 1.10.2006 is Rs. 10,000/- per month.
ADMINISTRATION
The 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, including, employees, employers, the
Central and State Government, representatives of Parliament and medical profession.
The Corporation is headed by the Union Minister of Labour, as its Chairman, whereas
the Director General, appointed by the Central Government functions as its Chief
Executive Officer. 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 52 Regional, Sub- Regional and Divisional Offices located in various States.
The administration of Medical Benefit is taken care of by the respective State
Government 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 23 ESI Hospitals in various States for developing them as
ESIC Model Hospitals.
FINANCE
ESI 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 wages, payable to their employees. Employees earning upto
Rs.100/- a day are exempted from payment of their share of contribution. The State
Governments, as per provisions of the Act, contribute 1/8th of the expenditure of
medical benefit within a per capita ceiling of Rs. 1500/- per Insured Person per annum.
Any additional expenditure incurred by the State Governments, over and above the
ceiling and not falling within the shareable pool, is borne by the State Governments
concerned.
CONTRIBUTION

E.S.I. Scheme being contributory in nature, all the employees in the factories or
establishments to which the Act applies shall be insured in a manner provided by the
Act. The contribution payable to the Corporation in respect of an employee shall
comprise of employer's contribution and employee's contribution at a specified rate. The
rates are revised from time to time. Currently, the employee's contribution rate (w.e.f.
1.1.97) is 1.75% of the wages and that of employer's is 4.75% of the wages
paid/payable in respect of the employees in every wage period. Employees in receipt of
a daily average wage upto Rs.100/- are exempted from payment of contribution.
Employers will however contribute their own share in respect of these employees.
Collection of Contribution
An employer is liable to pay his contribution in respect of every employee and deduct
employees contribution from wages bill and shall pay these contributions at the above
specified rates to the Corporation within 21 days of the last day of the Calendar month
in which the contributions fall due. The Corporation has authorized designated branches
of the State Bank of India and some other banks to receive the payments on its behalf.
Contribution Period and Benefit Period

There are two contribution periods each of six months duration and two corresponding
benefit periods also of six months duration as under.

Contribution period Corresponding Cash Benefit period
Contribution Period Cash Benefit Period
1st April to 30th Sept. 1st Jan of the following year to 30th
June
1st Oct to 31st March of the year 1st July to 31st December.
following.
ESI SCHEME AT A GLANCE -- MAHARASHTRA
REGIONAL OFFICE 1
SUB REGIONAL OFFICES 5
NUMBER OF EMPLOYEES 11,67,712
NUMBER OF INSURED PERSONS 13,09,235
NUMBER OF HOSPITALS 14
NUMBER OF DISPENSARIES 72
NUMBER OF INSURANCE MEDICAL PRATICTIONERS 1063

BENEFITS FOR EMPLOYEES
Benefits
Under Section 46 of ESIC Act, totally six social security benefits have been conferred
on employees working with various organizations across India. These six social security
benefits for the welfare of the employees are enlisted as follows:
(a) Medical Benefit
(b) Sickness Benefit (SB)
(c) Maternity Benefit (MB)
(d) Disablement Benefit
(e) Dependants' Benefit (DB)
(f) Retirement Benefit
And some Other Benefits
(a) Medical Benefit:
In ESIC, comprehensive medical care ranging from OPD, medical attendance,

treatment, drugs, specialist consultation, hospitalization of insured persons (IPs) and
their family members to super-speciality treatment, are provided under the Scheme.
Medical Benefit is available to the Insured Person (IP) and his family member from the
day one he enters the insurable employment. What makes this Scheme unique is that,
medical care is provided to ESI Beneficiaries as per need. There is no ceiling on
expenditure on individual medical care. Besides this, Medical Care as available in ESI
Dispensaries/Hospitals is also provided to retired and permanently disabled insured
persons and their spouses on payment of a token annual premium of `120/-.
Full medical care is provided to an Insured person and his family members from the day
he enters insurable employment. There is no ceiling on expenditure on the treatment of
an Insured Person or his family member. Medical care is also provided to retired and

permanently disabled insured persons and their spouses on payment of a token annual
premium of Rs.120/- Section 56 (1) of ESI Act, 1948 provides, an Insured Person or
(where such medical benefit is extended to his family) a member of his family whose
condition requires medical treatment and attendance shall be entitled to receive medical
benefit.
Eligibility for Medical Benefit:

An insured person (IP) and his/her family member become eligible for primary &
secondary medical benefit under the ESI Scheme from day one of entering insurable
employment. Section 56 (3) of ESI Act, 1948 provides, A person shall be entitled to
medical benefit during any period for which contributions are payable in respect of him
or in which he is qualified to claim sickness benefit or maternity benefit (or is in receipt
of such disablement benefit as does not disentitle him to medical benefit under the
regulations).
Duration and Scale of Medical Benefit:

The insured person/family member of an insured person can avail the medical treatment
under this Scheme till the insured person is in insurable employment. Full medical care
(all facilities including hospitalization) for insured person and their family members is
provided.
Delivery of Medical Benefit:

As per the provisions of ESI Act, 1948, the State Governments are responsible for
providing the medical benefits through the network of ESI Dispensaries (for primary
medical services) and ESI Hospitals (for secondary medical services). However, the ESI
Corporation provides medical care directly, in Delhi and Noida area. Besides these two
areas, the Corporation is also running 34 ESIC Hospitals directly which includes ESIC
Model Hospitals, at least one in each State. The beneficiaries are provided OPD
services, in-patient services, diagnostic facilities, free drugs and dressings etc. in all ESI
medical delivery institutions. ESIC has developed its own pharmacopeia for drugs.

All drugs and dressing (including vaccine & sera), which is considered necessary and
generally in accordance with pharmacopeia, are supplied to all patients free of charge.
In the case of critical patients, incidental expenditure on transport, stoppage charges at
the centre, traveling expenses for attendants (if required) are also being paid by ESIC.
Medical Infrastructure of ESI Scheme:

The ESI Scheme has the largest medical infrastructure under one umbrella, in India.
Medical Care is provided through its huge network of 150 ESI Hospitals, 1372/91 ESI
Dispensaries/ISM Units, 1380 Panel Clinics and 7340 IMOs. The ESI Scheme is also
the largest employer of Medical and Para-Medical personnel of the country. It includes:
1. System of Treatment
2. Scale of Medical Benefit
3. Benefits to Retired IPs
4. Administration of Medical Benefit in a State
5. Domiciliary treatment
6. Specialist consultation
7. In-Patient treatment
8. Imaging Services
9. Artificial Limbs & Aids
10. Special Provisions
11. Reimbursement

System of Treatment
Generally, the allopathic system of medicine is used for providing Medical Benefit.
However, where a substantial number of workers demand treatment by Indian system of
medicine and Homoeopathy (ISM & H) other than Allopathy and where the State
Government has recognized the qualifications in such system, treatment facilities may
be provided under the ISM & H as well. The various ISM &H systems of treatment in
vogue are: Ayurveda, Unani, Siddha, Yoga therapy and Homeopathy.
Certificates required for the purpose of Cash Benefits in respect of persons treated by
ISM &H should be issued by IMO /IMP having recognized qualifications in such system
and duly appointed by the State Government. The issue of certificates under ISM &H is
possible only where dispensaries in systems other than allopathic medicine are
functioning independently with IPs and their family units attached to them and not
functioning merely as referral units. In places where ISM &H units function only as
referral centres, certificates will have to be issued by the Allopathic dispensary to which
the IP is attached.
Scale of Medical Benefit
The scale of Medical Benefit under section 57 of Act to be provided to the IPs and
members of their families is to be prescribed by State Government in consultation with
the Corporation under Section 58(1 & 3) of Act under State Medical Benefit Rules.
An IP and/or a member of his family does not have the right to claim Medical Services
over and above those which have been so prescribed. The beneficiaries are entitled to
reasonable medical, surgical and obstetric treatment.

a. To Insured Persons: - IPs are entitled to avail treatment in ESI
Dispensary/Hospital/Diagnostic Centre and recognized institutions, to which he is
attached such as: -
Outpatient treatment
Domiciliary treatment by visits at their residences.
Specialists Consultation.
In-patient treatment(Hospitalisation)
Free supply of drugs dressings and artificial limbs, aids and appliances.
Making and laboratory services.
Integrated family welfare, immunisation and MCH Programme and other national
health programme etc.
Ambulance service or re-imbursement of conveyance charges for going to
hospitals, diagnostic centres etc.
Medical Certification and
Special provisions.
b. To Family Members of Insured Persons:- While in all implemented areas, IPs are
entitled to medical care as detailed above, members of a family of an IP are entitled
to one or other of the following scales of Medical Benefits:-
"FULL" Medical Care i.e., all facilities as for IPs including hospitalization.
"EXPANDED" Medical Care i.e., all facilities as for IPs except hospitalization. A
small number of IPs in the States of Gujarat and Bihar fall under this category.
The Corporation aims at providing uniform scale of Medical Care to the Family
members in all implemented areas as the rates of the contribution paid by the
employees and the employers are the same throughout the country.

Benefits to Retired Insured Persons (IPs)
Medical Benefit to Retired Insured Persons and Permanent Disabled Insured Persons:-
On payment of Rs.10/- P.M. in lump sum for one year in advance, Medical Benefit can
be provided (under Section 56 of the Act) to:
i. An Insured Person and his or her spouse who leaves insurable employment on
attaining the age of superannuation after being insured for not less than five years,
till the period for which contribution is paid.
ii. An Insured Person and his/her spouse who ceases to be in insurable employment
on account of permanent disablement due to employment injury shall be entitled to
medical benefit.
Administration of Medical Benefit in a State
The administration of Medical Benefit under the ESI Scheme is the statutory
responsibility of the State Government except in the Union Territory of Delhi where the
ESIC has taken over direct responsibility to administer the same with effect from
1.4.1962.
The Corporation has also taken the responsibility of directly administering the existing
Occupational Disease Centres at Delhi. Mumbai, Calcutta, Chennai and Nagda as well
as the Scheme in the Industrial pocket of Uttar Pradesh i.e., Noida and Greater Noida.
Domiciliary Treatment
An Insured Person and his family members are entitled to free medical attendance by
IMO/IMP at their residence when the condition of the patient is such that he/she cannot
reasonably be expected to attend the dispensary/clinic.

Conveyance allowance for Domiciliary visit
i. For the domiciliary visit, the IMO's are paid conveyance allowance. The quantum of
this allowance is decided by the State Government in consultation with the
Corporation.
ii. The IMPs are not paid any domiciliary conveyance allowance. In their case, it is
included in the capitation fee upto a distance of 5 km. between the Clinic of IMP and
IP's residence.
The IMOs/IMPs are required to maintain record of domiciliary visits in a register month-
wise. The columns in this register are given under the Chapter "Sickness Absenteeism
and Recording".
Specialists Consultation
The standard of Medical Care under the E.S.I. Scheme provides for specialist
consultation to IP in all cases and to members of their families in areas with "Expanded"
and "Full" Medical Care.
Arrangements for specialist consultation may be provided at Specialist/Diagnostic
Centres, E.S.I. Hospitals or at such other institutions by appointing Specialists/Super
Specialists on full time/part-time basis where suitable arrangements exist.
Such consultation is provided in the following specialities: -
1 General Medicine 15 Cardiology
2 General Surgery 16 Neurology
3 Pulmonary Medicine (Tuberculosis and 17 Urology and Nephrology

Chest Diseases)
18 Gastro-enterology
4 Obstetrics and Gynaecology
19 Endocrinology
5 Pathology
20 Oncology

6 Paediatrics 21 Burns and Plastic Surgery
7 Eye 22 Cardio Thoracic Surgery
8 Ear, Nose and Throat Diseases 23 Neurosurgery
9 Skin and STD 24 Occupational Medicine
10 Radiology 25 Laboratory Services
11 Orthopaedics Rehabilitation Services 26 Blood Transfusion Services

(Physiotherapy and Occupational
28 Haematological Services
Therapy)
29 Anaesthesiology
12 Dental
13 Psychiatry
14 Critical Care Services
It may not be necessary to appoint specialists in all specialities at all centres. However,
specialists in the first 13 specialities mentioned above may be made available in each
diagnostic Centre and emergency centres as far as possible. The other specialities may
be provided as per disease profile of the area/as per requirement.
In-Patient Treatment
Under the E.S.I. Scheme, IPs in all areas and their family members in areas with "Full"
medical care facility are entitled to hospitalization. In-patient treatment is provided at
hospitals constructed by E.S.I.C or by reservation of beds in the hospitals owned by the
State Government, local Fund Organization or Private Bodies or by constructing
annexes to such institutions. The E.S.I. Scheme pays for these beds on the basis of
occupied bed days.
The Corporation has framed standard plans for construction of different sizes of
hospitals/annexes mainly with a view to achieving uniformity and standardization all

over the country. The Corporation has also laid down norms for equipment and staff for
hospitals of different bed strengths.
Drugs and Dressing

All drugs and dressings (including vaccines and sera) that may be considered
necessary and generally in accordance with the E.S.I.C drug formulary are supplied free
of charge. There are two parts in E.S.I.C Drug Formulary, 1998 as follows:-
Part-I: - List of medicines for emergency kit for

a. dispensary
b. hospital
Part II: -List of medicines to be supplied by dispensaries in Service Areas or by

approved chemists or depots on prescription in panel areas.
Imaging Services
Imaging Services and Laboratory Investigations
Imaging and investigations including CT Scan, MRI, Echocardiography and laboratory
facilities are provided free of cost to IPs and their families at state level speciality
hospitals or other institutions having tie up with E.S.I. Scheme.
Artificial Limbs & Aids

Artificial Limbs, Aids and Appliances
Insured Persons and their family members are provided following artificial limbs, aids
and appliances as part of medical care under the E.S.I. Scheme.:-
Artificial limbs
Hearing Aids
Spectacles (Frame costing not more than Rs.100/- and replacement of
frames not to be made earlier than 5 years) (To insured persons only)
Artificial Dentures, teeth (To insured persons only)

Artificial Eye (To insured persons only)
Wigs (replacement not earlier than 5 years) to female beneficiaries only
Cardiac pacemaker
Wheel Chair/tricycle
Spinal supports (jackets, braces etc.)
Cervical collars
Walking callipers, surgical boots etc.
Crutches
Hip prosthesis, total hip
Intra ocular lens (IOL)
Any other aid or appliances prescribed by the specialist as part of treatment.
The expenditure on artificial limbs, aids and appliances is met from the shareable pool
of expenditure on medical care.
Special Provisions
Benefits received by Insured Person- Not assigned or attachable Sec 60
Bar on benefits under other enactments Sec 61
No reduction of wages during sickness Sec 72
No termination/Dismissal/Discharge/ Reduction during sickness Sec 73
Medical Board- Medical appeal tribunal employees' Insurance Court Sec 54-A
Appeal can be filed within 3 months but this period can be extended.
Members of medical appeal tribunal

Judicial member
Doctor of concerned speciality
Labour Leader
Medical Board- Medical appeal tribunal employees' Insurance Court

Other Provisions of ESI Act
Punishment for false statement by Insured Person Sec 84
Establishment of E.I. Court Sec 74
Submission of Return of Contribution Sec 44
Provision for Prosecution for Non-submission Sec 85
RETURN OF CONTRIBUTION IS REQUIRED TO BE SUBMITTED BY THE

EMPLOYER EVERY 6 MONTHS.
FOR HALF YEAR ENDING 31ST MARCH 12 MAY
FOR HALF YEAR ENDING 30TH SEPTEMBER 11 NOV
Liability of Transferee - Joint & Severally Sec 93-A
Restricted to the value of Assets
Repayment of Benefits improperly received Sec 70
Recovery of Employees' share of contribution by Reduction from his Sec 40

wage and not otherwise- Shall relate to the period or part of the period
in respect of which contribution is payable - AND Shall not be in
excess of the sum representing the Employees' Contribution for the
period
Power of Central Govt. to give directions Sec 92
Provision for Prosecution Sec 85, 85-A &

For non/delayed payment of contribution, non-submission of 86
returns/records
No contribution by employee if wages less than Rs. 50/- per day

Reimbursement
Under Regulation 69, every employer has to arrange for First-aid Medical care and
transport of accident cases till the injured IP is seen by the IMO/IMP and such employer
is entitled to reimbursement of expenses incurred in this regard upto the maximum of
scale prescribed from time to time. However, reimbursement is not permissible, if the
employer is required to provide such medical aid free of charge under any other
enactment.
The cost of provision of such emergency treatment would be reimbursed to the

employer by the Director/AMO (ESI Scheme) of the respective State and, therefore, all
claims duly supported by relevant receipts and vouchers should be sent to him for
verification and payment.
Reimbursement of expenses incurred in respect of medical treatment under

regulation-96 A.
Regulation-96 A reads as follows: - Claims for reimbursement of expenses incurred in

respect of medical treatment of IP and his family may be accepted in circumstances and
subject to such conditions as the Corporation may by general or special order specify.
The following conditions have been laid down under this Regulation: -
1. Full authority is vested with the State Government concerned to reimburse

expenditure in respect of medical treatment of IP and his family.
2. It may be left to the discretion of the State Government to decide the Authority
within their machinery who will approve the expenditure in question; and
3. Time limit for submission of the claims for reimbursement is one year

The State Government has to keep in view the following points while considering the
cases of reimbursement of expenditure on Medical Care:-
1. Whether such facilities for which reimbursement is recommended are not

available with the State.
2. Whether the hospital where the IP was sent or proposed to be sent was/is the
nearest hospital having required facilities/services.
A List of Types of cases for which reimbursement is permitted is given below: -
1. Reimbursement is permissible in case of failure of the mobile dispensary van due to

technical defects or otherwise to adhere to its schedule timings or where IP attached
to such a dispensary sustained serious injuries or suffered from serious illness
during off hours of the dispensary.
2. IPs and their family members had to resort to private treatment during the off hours
of ESI dispensary/Emergency Centre due to unavoidable circumstances.
3. Medicines prescribed by IMO/Specialist were out of stock in the ESI

Dispensary/Approved Chemist thereby compelling the IPs to make purchases from
the market.
4. Medicines prescribed by Specialist and not provided by the IMO/IMP and where
specialist considered such special Medicines absolutely necessary for the treatment
of the beneficiaries as no substitute medicine was considered equally efficacious
whether as an outpatient or in patient.
5. Special appliances prescribed by Specialist such as Spinal supports, Cervical

Collars, Walking Callipers, and Crutches, etc. if considered necessary as part of the
treatment.

6. Where an IMO/IMP failed to make domiciliary visit requested by an IP thereby
compelling the IP to make private arrangement for treatment. Under the panel
system such cost is recoverable from the IMP if recommended after investigation by
the Medical Service Committee.
7. Serious cases of accident or illness admitted directly into recognized hospitals where
owing to the clinical condition of the patient, being unconscious or otherwise, it was
not possible to reveal his identity as an ESI patient and the hospital authorities
recovered hospital expenses directly from the patient or the employer.
8. Serious cases of accident/illness where a beneficiaries was admitted directly at a

private hospital or in a non-recognized hospital where admission in a hospital
recognized under the scheme would have seriously jeopardized his health like
sudden heart attacks, fracture of the spine, cerebral haemorrhage, etc.
9. Expenditure incurred on investigation for blood transfusion.
10. Mental cases that may have incurred expenditure either as an outpatient on
specialized Therapy such as ECT etc.
11. Serious cases of accident and illness admitted to recognized hospitals where all the
reserved ESI beds were occupied.

Reimbursement of conveyance charges incurred by IP where ambulance or any
other transport under the scheme is not available owing to some reason or the other
and where in the opinion of the IMO/IMP such a patient was non-ambulatory.
In respect of Specialized examination, laboratory test, X-ray, other imaging services

etc., recommended by specialist, but where the IP either due to the break down in
the machinery or where the nature of the examination of the Laboratory Tests was
such that it was beyond the scope of the facilities available in the recognized
laboratory/hospital.
In addition to above types of cases, reimbursement may also be allowed in other

cases depending upon the merits of each case and the circumstances under which
expenditure was incurred.
Reimbursement of Conveyance Charges
In the absence of availability of an ambulance and where needed in an emergency, any

other quick form of transport may be used and amount so spent subject to the maximum
rate prescribed by the Government/Transport authority (both ways) is reimbursed to IPs.
To avoid hardship to IP and his family who have to go to any hospital or medical
institution for admission, specialist consultation or investigation, but whose condition is
not such as to need an ambulance, provision has been made for the payment of
conveyance charges, if hospital/medical institution to which the case is referred to, is at
an out-station or is at a distance of more than 8 kms from the ESI Dispensary or the
clinic of the panel doctor. The charges are restricted to actual IInd class railway fare or
cost of a single seat in public conveyance both ways whichever is feasible.
If the beneficiary is not in a fit condition to travel without escort for reasons to be
recorded and so certified by IMO/IMP, the conveyance charges are also allowed for an

escort. The IMO/IMP should keep a separate account of such payments in the
prescribed Register and send a quarterly statement of this expenditure to the
Director/AMO by the 15th of the month following the quarter ending in March, June,
Sept. and December. The returns received from different areas in the State may be
consolidated area-wise by the Director/ AMO and quarterly statement sent to the
Corporation. The expenditure on conveyance charges forms part of the Medical Care
under the E.S.I. Scheme and hence shareable between the Corporation and the State
Government in the usual ratio within ceiling prescribed.
(b) Sickness Benefit (SB) :
Sickness Benefit in the form of cash compensation at the rate of 70 per cent of wages is
payable to insured workers during the periods of certified sickness for a maximum of 91
days in a year. In order to qualify for sickness, benefit the insured worker is required to
contribute for 78 days in a contribution period of 6 months.
1. Extended Sickness Benefit(ESB) : SB extendable upto two years in the case of 34

malignant and long-term diseases at an enhanced rate of 80 per cent of wages.
2. Enhanced Sickness Benefit : Enhanced Sickness Benefit equal to full wage is payable
to insured persons undergoing sterilization for 7 days/14 days for male and female
workers respectively.
(c) Maternity Benefit (MB) :
Maternity Benefit for confinement/pregnancy is payable for three months, which is

extendable by further one month on medical advice at the rate of full wage subject to
contribution for 70 days in the preceding year. The Maternity Benefit is paid at the rate
of 100% of the average daily wages up to 12 weeks in case of confinement, up to 6
weeks in case of miscarriage.

This can be extended by one month on medical advice in case of sickness arising out of
pregnancy, confinement and miscarriage. The total Expenditure incurred during 2013-
14 on cash benefit payments is Rs.598.69 crores from which one can assess the huge
support extended by ESIC to its IPs at the time of distress, which otherwise should have
put extra burden on the low-income bracket of the workforce of the country
Maternity Benefit is payable to an Insured Woman in the following cases subject to

contributory conditions: -
Confinement-payable for a period of 12 weeks (84 days) on production of Form

21 and 23.
Miscarriage or Medical Termination of Pregnancy (MTP)-payable for 6 weeks (42

days) from the date following miscarriage-on the basis of Form 20 and 23.
Sickness arising out of Pregnancy, Confinement, Premature birth-payable for a

period not exceeding one month-on the basis of Forms 8, 10 and 9.
In the event of the death of the Insured Woman during confinement leaving
behind a child, Maternity Benefit is payable to her nominee on production of
Form 24 (B).
(d) Disablement Benefit
1. Temporary disablement benefit (TDB) : From day one of entering insurable

employment & irrespective of having paid any contribution in case of employment injury.
Temporary Disablement Benefit at the rate of 90% of wage is payable so long as
disability continues.

2. Permanent disablement benefit (PDB) : The benefit is paid at the rate of 90% of
wage in the form of monthly payment depending upon the extent of loss of earning
capacity as certified by a Medical Board.
(e) Dependants' Benefit(DB) :
DB paid at the rate of 90% of wage in the form of monthly payment to the dependants of
a deceased Insured person in cases where death occurs due to employment injury or
occupational hazards. This is payable to the widow for life or until her re-marriage and
also to the dependent children till the age of 25 years and also to the dependent
parents, subject to conditions. In an endeavour to reach out to the beneficiaries and
make the system more customer friendly, long-term benefits such as Permanent
Disablement and Dependants Benefits are being credited to the bank account of the
beneficiaries through ECS System.
(f) Retirement Benefit
When an insured person who leaves the insurable employment on attainment of the age
of superannuation or retires under a voluntary Retirement Scheme or takes premature
retirement, after being an insured person for not less than 5 years, shall be eligible to
receive medical benefit for himself and his spouse subject to production of proof thereof,
and payment of a nominal contribution of Rs.120/- (rupees one hundred and twenty
only) for one year.
In case, the insured person expires, his spouse is entitled to the medical benefit for the
remaining period for which the contribution was made, and she can continue to receive
the medical benefit on payment of the contribution of Rs.120/- (rupees one hundred and
twenty only) per annum for further period. This medical benefit is also admissible to an
insured person who ceases to be in employment on account of permanent disablement
caused due to employment injury for himself and his spouse on payment of similar

contribution till the date on which he would have vacated the employment on attaining
the age of superannuation, had not sustained such permanent disablement
(g) Other Benefits:
Funeral Expenses:
An amount of Rs. 10,000/- is payable to the dependents or to the person who performs
last rites from day one of entering insurable employment.
Confinement Expenses:
An Insured Women or an I.P.in respect of his wife in case confinement occurs at a place
where necessary medical facilities under ESI Scheme are not available.

NEED BASED BENEFITS
In addition, the scheme also provides some other need based benefits to insured
workers.
Vocational Rehabilitation: Vocational Training in case of physical disablement due to

employment injury for which the actual fee charged or Rs.123/- per day, whichever is
higher is paid as long as the vocational training lasts.
Physical Rehabilitation: In case of physical disablement due to employment injury.
Old Age Medical Care: For Insured Person retiring on attaining the age of
superannuation or under VRS/ERS and person having to leave service due to
permanent disability insured person & spouse on payment of Rs. 120/- per annum.
Rajiv Gandhi Shramik Kalyan Yojana: This scheme of Unemployment allowance was
introduced w.e.f. 01-04-2005. An Insured Person who become unemployed after being
insured three or more years, due to closure of factory/establishment, retrenchment or
permanent invalidity are entitled to: -
Unemployment Allowance equal to 50% of wage for a maximum period of upto one
year.
Medical care for self and family from ESI Hospitals/Dispensaries during the period IP
receives unemployment allowance.
Vocational Training provided for upgrading skills - Expenditure on fee/travelling

allowance borne by ESIC.

Un-employment Allowance
under RGSKY is payable in case of involuntary loss of employment due to closure of
factory, retrenchment or permanent invalidity due to nonemployment injury and
contribution for three years prior to the loss of employment, 50 % the average daily
wages is payable for a maximum period of twelve months during life time. Under
RGSKY, in case of involuntary loss of employment, skill up gradation training is
provided for duration of maximum 6 months, so that the IP can enhance his skill and opt
for other jobs.
Incentive to employers in the Private Sector for providing regular employment to

the persons with disability:
Minimum wage limit for Physically Disabled Persons for availing ESIC Benefits is
25,000/-.
Employers' contribution is paid by the Central Government for 3 years.
Benefits & Contributory Conditions:
An interesting feature of the ESI Scheme is that the contributions are related to the
paying capacity as a fixed percentage of the workers wages, whereas, they are
provided social security benefits according to individual needs without distinction.
Cash Benefits are disbursed by the Corporation through its Branch Offices (BOs) / Pay
Offices (POs), subject to certain contributory conditions.

THE EMPLOYEES STATE INSURANCE SCHEME AS A MECHANISM TO POOL
RISK
The ESIS was introduced in India in 1955 with the intention of providing financial
protection to those in the lowest income groups in the industrial/manufacturing sector.
Although it has grown in both size and scope, many have been critical of the scheme.
One criticism is that most beneficiaries, or members, of the scheme do not utilize the
services for a variety of reasons, the primary one being a perception of the poor quality
of care. Description of the Employees State Insurance Scheme The promulgation of the
ESI Act by the Parliament in 1948 was the first major legislation on social security for
workers in India.
The Act envisages protection to workers in the organized sector in the case of sickness,
maternity and death or disability due to injury at work. Based on the principle of pooling
of risks and resources, this health insurance scheme provides medical facilities to
beneficiaries and cash compensation for loss of wages or earning capacity while in
service.
The ESI Act applies to non-seasonal factories or manufacturing units employing ten or
more people in a power using factory and twenty or more people in a non-power using
factory. Employees drawing wages of up to Rs. 10,000 per month (as on Jan 2009) are
currently entitled to a health insurance scheme. However, the wage ceiling for the
purpose of coverage is revised from time to time. To increase the coverage the ESI Act
has also been extended gradually to other establishments such as shops, hotels and
restaurants, road and motor transport undertakings, newspaper establishments and
cinema halls.

The ESI Act however, is not applicable to factories or establishments run by the State
Governments/Central Government whose employees receive other social security
benefits. Under the ESI scheme, employees contribute 1.75% of their wages and the
employers contribute 4.75% of the wages of eligible beneficiaries/employees towards
premium payments. Employees earning less than Rs. 50 per day are exempted from
contribution towards premium payments. The contributions made by the employees and
the employers are deposited in a common pool known as the ESI Fund, which is used
for meeting administrative expenses as well as cash and medical benefits to Insured
Persons (IP) and their dependents. The state governments, as per the ESI Act,
contribute 12.5% of the total expenditure (within the per capita ceiling of Rs.1000 per
annum) incurred by the ESIC on medical care in respective states.

NEW INITIATIVES AWARENESS
24x7 medical helpline no.1800 11 3839 in all esic hospitals:-
The ESI Corporation has launched a 24x7 Helpline No.1800 11 3839 for attending the
calls of Insured Persons and their family members who wish to seek advice and
guidance from casualty/emergency of ESIC Hospitals. In case an Insured Persons calls
on 24x7 helpline functioning at ESIC Headquarter Office and desires to have some
medical advice in emergency from a doctor, this call will be connected through
conference from 24x7 helpline to the emergency of ESIC Hospital of the concerned
state and the doctor available in the casualty/emergency will attend the call for needful.
Redressal of public grievances: -
The ESI Corporation has set up the Public Grievances Redressal System at all levels
i.e. Hqrs. Office/Regional/Sub-Regional/Divisional/Branch Offices/ESI Dispensaries/ESI
Hospitals. To ensure expeditious disposal and speedy redressal of public grievances
under the ESI Scheme, various measures have been taken by the Corporation. It
includes a Toll-Free Helpline No. 1800-11-2526 activated at Hqrs. office. Besides the
above, the following help lines have also been installed in ESIC RO/SRO to cater to
local stakeholders
Suvidha Samagam:-
In order to deal with oral, written complaints/suggestions and grievances, Suvidha

Samagam is being held regularly in various field offices i.e. at RO/SRO/ESIC Hospitals
on 2nd Wednesday of every month and at ESIC BO on 2nd Friday of every month.

Enhancement of exemption limit: -
The ESI Corporation has also decided to enhance the exemption limit from payment of
employees contribution for employees drawing wages upto Rs. 137/- per day from
existing Rs. 100/- per day.
ENHANCEMENT OF PERMANENT DISABLEMENT BENEFIT & DEPENDANT

BENEFIT RATES: -
The ESI Corporation has approved for enhancement of the Permanent Disablement
Benefit and Dependants Benefit Rates for its Insured Persons vide its notification dated
12.05.2015 in order to address the erosion in its real value due to inflation.
HAPPY EMPLOYEES, HAPPY EMPLOYER: -
1. Employers are freed of all liabilities of providing medical facilities to employees and
their dependants in kind or in the form of fixed cash allowance, reimbursement or actual
expenses, lump sum grant or any other medical insurance policy of limited scope,
unless it is a contractual obligation.
2. Employers are also exempted from the applicability of the Maternity Benefit Act and
Employees Compensation Act for employees covered under the ESI Scheme.
3. Employers are freed of any responsibility in time of physical distress of workers such
as sickness, employment injury or physical disablement resulting in loss of wages, as
the responsibility of paying cash benefits shifts to the Corporation in respect of insured
employees.
4. Any sum paid by way of contribution under the ESI Act is deducted in computing
Income under the Income Tax Act.

5. Besides this, a New Inspection Policy has also been launched and integrated with
Shram Suvidha Portal of the Ministry of Labour & Employment wherein 13 Central
Labour Acts, DGMS and EPF Act are aligned. It aims to achieve the objective of
simplifying business regulations and bringing transparency and accountability in labour
inspection.
Fast and efficient Services: -
Project Panchdeep: To digitize internal and external processes and to ensure

efficiency in operations, especially services to Employers and Insured Persons,
ESIC has launched its IT Project Panchdeep.
Employer Portal under Panchdeep: The Employer Portal permits various

transactions online without visiting any ESIC Office, saving time and avoiding the
drudgery of routine paperwork. Employer and Employee Registrations are done
online. The portal enables employers to file monthly contributions, generate
Temporary Identity Cards and create monthly contribution challans online.
IP Portal under 'Panchdeep': Insured Persons (IPs) can check contributions

paid/payable by employers, family details, entitlement to various benefits and
status of claims.
Pehchan Card for IP: The photograph of the Insured Persons (IPs) and their
family members are clicked during registration. Their fingerprints are also
scanned for Pehchan Card. Two sets of Pehchan Card (one for the IP, another
for his/her family members) are provided for swift and convenient delivery of
services.

e-Biz Platform: ESIC is the first entity to integrate its services (Registration of
Employers via e-Biz portal of Department of Industrial Policy and Promotion of
DIPP) to promote ease of business and curb transaction costs.
Online payment of ESI Contribution by the Employer made easier via the
payment gateway of State Bank of India and 58 other banks was launched on
01st April, 2015.

ESIC 2.0: REFORM INITIATIVES OF ESIC
With a view to accelerating expansion of coverage of ESIC, ESIC has launched the 2nd
Generation Reforms Agenda named ESIC-2.0 during the inaugural session of 46th
Indian Labour Conference by Shri Narendra Modi, Honble Prime Minister of India on
20th August, 2015 at Vigyan Bhawan, New Delhi. Some of the salient features of ESIC
2.0 are: -
(i) Starting ESIC Scheme in Arunachal Pradesh, Mizoram, Manipur, Andaman &
Nicobar Island.
(ii) At present, ESIC Scheme is being implemented in industrial/commercial clusters.

Now, the target is to cover whole of the 393 districts, where these clusters are located.
(iii) Covering all the construction workers under ESI Scheme.
(iv) Opening Health Scheme for selected group of unorganized workers like rickshaw
pullers/auto rickshaw drivers in selected urban/metropolitan areas.
(v) Up-grading dispensaries to six bedded hospitals in phases.
(vi) Providing appropriate cancer detection/treatment facilities at different levels of

hospitals.
(vii) Providing appropriate cardiology treatment facilities at different levels of hospitals.
(viii) Providing dialysis facilities in all ESIC Model Hospitals on PPP Mode.
(ix) Providing all possible pathological facilities in hospital premises by outsourcing or by

upgrading.

(x) Tracking each and every mother and new born child of IP family to achieve 100%
immunization as well as safe delivery.
(xi) Creating at least one Mother Child care hospital with higher facilities in every State.
(xii) To start setting up State ESI Corporations/Societies in all States as subsidiary of

ESI Corporation.
(xiii) Electronic Health Record will be made available to the IP family members on-line.
The record will also include laboratory record in digital format and there will be no need
to visit the hospital for getting this information.
(xiv) In another initiative, 24x7 medical helpline No. 1800 11 3839 have been made
operational through which IP can directly talk to Doctor, in case of emergency. This
helpline will be toll free and will also be available in regional languages.
(xv) In an unique initiative under Swachh Bharat Swachh Bharat Campaign of Honble
Prime Minister, besides the on-going cleanliness drive being taken up in all the ESIC
hospitals, ESIC has decided that under Abhiyan Indradhanush bedsheets in Hospitals
will be changed every day and for each day of the week specific colour of bed sheet has
been fixed based on VIBGYOR pattern, as given below:-
Day Colour of Bedsheet

Sunday Violet
Monday Indigo
Tuesday Blue
Wednesday Green
Thursday Yellow
Friday Orange
Saturday Red

(xvi) From 20th July, 2015, every hospital of ESIC have started to operate Special OPD
every day in the afternoon from 3.00 pm to 5.00 pm for senior citizens/differently abled
patients.
(xvii) Appropriate Queue Management System in every Hospital for helping in

registration and pharmacy.
(xviii) To provide behavioural training to Para-medical and other staff of the hospitals
guiding them to provide due courtesy in dealing with the patients/attendants.
(xix) To provide facility for Reception and May I Help You in each hospital to guide the
patients/attendants.
(xx) To provide for a feedback system for all indoor patients.
(xxi) To put in place proper and attractive signages at the required places in all ESIC
Hospitals for guidance and proper communications to the patients and beneficiaries.
(xxii) To provide yoga facilities in all ESIC Hospitals.
(xxiii) AYUSH facilities to be extended up to the dispensary level in phases.
(xxiv) To create tele-medicine facilities for the beneficiaries in phases. Further, ESIC
has set up 8 new ESI Hospitals, 7 Postgraduate Medical Institutes & Medical Colleges,
1 Dental College, 1 Nursing College and 1 Paramedical Institute during the period.

RECENT NEWS
ESIC is going to promote Khadi by introducing Khadi Products in ESIC Hospitals

& Dispensaries
ESI Corporation has been providing health care and other social security benefits to the
workers of specified wage group over the past 65 years as a labour welfare measure.
As a part of Swach Bharat initiative launched by the Honble Prime Minister, ESIC has
introduced many new initiatives like change of bedsheets every day on VIBGYOR
pattern in all ESIC Hospitals & Dispensaries.
In order to promote Khadi, a meeting was held under the chairmanship of Shri Giriraj
Singh, Honble Minister of State for MSME, Govt. of India with Shri Deepak Kumar, IAS,
Director General, Employees State Insurance Corporation. During the meeting, Shri
Deepak Kumar, Director General, ESIC informed that ESIC is having network of 151
Hospitals and 1500 Dispensaries across the country and suggested that as part of the
70th year of Independence Day Celebrations, in line with the Honble Prime Ministers
clarion call for promoting Khadi, Memorandum of Understanding (MoU) may be signed
between KVIC and ESIC for supply of bedsheets and pillow covers in ESI Hospitals and
Dispensaries.
He also suggested that as far as possible the supplies should be made from the locally
available Khadi institutions so that there is no additional burden on transportation. It was
also suggested by Shri Deepak Kumar that ESIC has recently introduced a system of
laying disposable paper rolls on the examination beds while examining the patients and
asked KVIC to manufacture these paper rolls and supply to ESIC. Apart from this, he
also mentioned that Coir Board could supply mattresses, medical examination beds and
door mats etc. to the Hospitals.

Smt. Hema Malini associates with ESIC in its awareness programme through
TVC/Film on ESIC - 2.0
ESI Corporation has produced a TV Commercial/Film on Health Reforms Agenda- ESIC

2.0, launched by Honble Prime Minster in the month July, 2015 for awareness amongst
ESI beneficiaries covered under ESI Scheme. The main character of this TVC/Film has
been played by Smt. Hema Malini, Honble Member of Parliament and famous film
personality. This TVC/Film has been done by Smt. Hema Malini free of cost, on
complimentary basis for ESIC being a social security organisation for working class in
the lower wage bracket.
In this film, she gives words to the significance and role of ESIC in the sphere of social
security: ESIC is the countrys singular organization in the sphere of social security that
thinks of the millions of workers and their families all the time. Besides taking care of
their health & supports in the case of maternity, disability, sickness, unemployment, old
age and death, I am happy that I am associated with ESIC.
It is worth noting that her father was also associated with ESI Corporation, who served
as an officer in ESIC Regional Office, Delhi. Smt. Hema Malini ji has become a part of
ESICs new initiatives under Health Reforms Agenda-ESIC 2.0, launched by Honble
Prime Minister, Shri Narendra Modi Ji. This TVC/Film was launched by Shri Bandaru
Dattatreya, Honble Minister of State for Labour & Employment (Independent Charge),
Govt. of India in the 168th Meeting of ESI Corporation held on 12.02.2016 at
Hyderabad, Telangana. It is hoped that this TVC/Film on ESIC will enthuse and bring
awareness about the benefits of the ESI Scheme and educate to the millions of workers
in the country.

ESI Scheme in India
The Employees State Insurance Corporation is a pioneer Social Security organization

providing comprehensive social security benefits like reasonable Medical Care and a
range of Cash Benefits in times of need such as employment injury, sickness, death etc.
The ESI Act applies to premises/precincts where 10 or more persons are employed.
The employees drawing wages up to Rs. 15,000/- a month are entitled to health
insurance cover and other benefits, under the ESI Act.
The Act now applies to over 7.23 lakh factories and establishments across the country,
benefiting about 2.03 crores family units of workers. As of now, the total beneficiary
population of ESI Scheme stands over 7.89 crores. Ever since its inception in 1952, the
ESI Corporation has, so far, set up 151 Hospitals, 1459/188 Dispensaries / ISM Units,
812 Branch/Pay Offices and 61 Regional & Sub-Regional/Divisional Offices.
ESICs latest initiatives ESIC 2.0 A.
A. Extending coverage of ESI Scheme for extending its social security net to the
whole country
1. Extending the social security benefits of ESI Scheme in the remaining North-East
States Arunachal Pradesh, Mizoram, Manipur and Andaman & Nicobar Island. It has
been implemented in Mizoram w.e.f. 1.12.2015 and in Port Blair w.e.f. 01.01.2016.
2. At present, ESI Scheme is being implemented in industrial/commercial clusters within

districts. Now, the target is to cover whole of the 393 districts of the States by
31.03.2016, where these clusters are located.
3. Opening Health Scheme for selected group of unorganized workers like rickshaw
pullers/auto rickshaw drivers in selected urban/metropolitan areas, on pilot basis.

4. ESI Coverage has been extended to Construction workers in the implemented area.
Construction site Workers has been covered to avail benefits under the ESI Scheme
w.e.f. 1st August, 2015.
B. New Initiatives under Health Reforms Agenda of ESIC 2.0, for improving the
medical care
Aimed at providing better health services, Honble Prime Minister of India had launched
a series of Health Reforms Agenda of ESIC on 20.07.2015 which includes-
Online availability of Electronic Health Record of ESI Beneficiaries (Insured Persons

and their family members).
Abhiyan Indradhanush : Ensuring the change of bedsheet according to VIBGYOR

pattern during the week i.e. to be changed everyday
Medical Helpline No. 1800 11 3839 for emergency and seeking guidance from
casualty/emergency of ESIC Hospitals.
Special OPD for Sr. Citizens and differently-abled persons in ESIC hospitals.
Other initiatives for Improving Patients/Attendant Care
(i) ESIC has now resolved to adopt two Model Hospitals, in each State.
(ii) Providing appropriate cancer detection/treatment facilities, cardiology treatment

facilities, dialysis facilities on PPP Model at different levels of hospitals.
(iii) For facilitating the practice of telemedicine, the RFP for pilot run has already been
floated and the project is expected to go live in the next three months.

(iv) Special focus has been paid for upgradation of Dispensaries, 24 Dispensaries in
ESIC buildings have been identified for upgradation to 30 bedded set up to provide
24x7 services.
(v) Pathological & X-ray facilities will be provided on PPP model in all the dispensaries
in phases. Pathological services in all dispensaries of Delhi has been started from 30th
November, 2015. Laboratory and ECG Services has been started in ESI Dispensary of
Delhi/Noida area.
(vi) Tracking of every pregnant mother & new born: With a view to ensure 100%
immunization as well as safe delivery, every mother and new born child of Insured
Person, a pilot project for tracking every pregnant mother and new born is to be started
in Delhi, for which coordination will be done with the State Programme Officer under
Ministry of Health and Family Welfare.
(vii) Mother and Child Care Hospital in every State: ESIC has constituted a committee to
prepare the norms for setting up a Mother and Child Care Hospital in every State.
(viii) AYUSH: Besides Allopathic treatment, ESIC hospitals also provide treatment under
AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy). Facilities of AYUSH are to
be extended to all dispensaries in phases by December, 2015 and Yoga in all ESIC
Hospitals by 30th November, 2015.
C. Digital India e-initiatives of ESIC
e-Biz Platform: ESIC is the first organization of Central Government, to integrate its
services (Registration of Employers via e-Biz portal of Department of Industrial Policy
and Promotion of DIPP) to promote ease of business and curb transaction costs.

Under its flagship digital project Panchdeep ESIC has facilitated Online payment of
ESI Contribution by the Employer, via the payment gateway of State Bank of India and
58 other banks with launch on 01st April, 2015.
ESIC has launched independent Public Grievance Module 2.0 from 15.08.2015 for
lodging ESIC related Grievance online through ESIC website www.esic.in or
www.esic.nic.in.
Launch of dedicated website www.esichospitals.gov.in for ESIC Hospitals and

Dispensaries in December, 2015.

HEALTH REFORMS AGENDA TO EASE THE HARDSHIPS FACED BY ESIC
BENEFICIARIES
Dialysis facilities, Cath Lab, CT Scan and MRI facilities now going to be available in
ESIC, shortly. The Dialysis facilities are now going to be there, in most of the ESIC
Hospitals on PPP Model for which MoU and the process of installation of equipments
are underway at present in the 11 ESIC Hospitals in the first phase. Likewise, seven
ESIC Hospitals are now being selected for establishment of Cathlab in its first phase
and the treatment may commence shortly.
It is also heartening to note that almost all the ESIC Hospitals are now going to be
equipped with MRI (1.5 Tesla) and CT Scan facilities on PPP Model. The MRI facilities
in 08 ESIC Hospitals are now open and have started functioning. Earlier, for these
medical services, the beneficiaries of ESIC were referred to other outside service
providers or medical establishments.
Against the backdrop of Health Reforms, ESIC has undertaken major Health Reforms
initiatives on PPP (Public-Private-Partnership) Model to provide specialized medical
treatment and diagnostic services to the beneficiaries covered under ESI Scheme.
Emphasis has been given to introduce appropriate Cardiology treatment, Dialysis and
Pathological facilities, Dental services, Physiotherapy services, X-ray facilities and
establishment of ICUs in all the ESIC Hospitals. The appropriate cancer
detection/treatment facilities at different levels are also going to be provided in the ESIC
Hospitals.
Aimed at providing better and improved facilities to the ESIC beneficiaries, ESIC had
launched a series of Health Reforms Agenda named ESIC-2.0 last year which included
availability of Electronic Health Records of ESI Beneficiaries, Abhiyan Indradhanush, 24
X 7 Medical Helpline Number in all ESIC Hospitals, Special OPD for Sr. Citizens and
differently-abled persons in all ESIC Hospitals.

For providing specialized treatment in the field of Physiotherapy and Dental and also for
providing ECG and X-ray facilities, the necessary infrastructure and formalities are
being completed and the ESIC beneficiaries will now be getting all such treatment and
facilities under one roof. Not only this, Pathological facilities in the hospital premises
have been created either by outsourcing or by upgrading the existing facilities.
Besides the above, some of the basic infrastructure facilities like Queue Management
System in the registration area and pharmacy have also been introduced. Also
reception area and May I help you desk of such Hospitals have been further
strengthened to guide the patients/attendants. The feedback system for all the indoor
patients has been upgraded and appropriate/attractive signages to communicate and
guide the visitors have been put in place. Further, AYUSH facilities are being further
introduced in all the ESIC Hospitals.
ESIC is now geared up for meeting all the requirements and aspirations of all covered
under ESI Scheme. The establishment of most modern medical facilities in the ESIC
Hospitals has made it a better health service provider and improved the hardships being
faced by the patients.

ACHIEVEMENTS/INITIATIVES OF ESIC
DURING PAST TWO YEARS
ESIC has been providing health care and other social security benefits to the workers of
specified wage group over the past 65 years as a labour welfare measure.
During the last two years, under the guidance and leadership of Shri Bandaru
Dattatreya, Honble Minister of State (Independent Charge) for Labour & Employment,
Govt. of India, ESIC has taken a number of new initiatives in order to extend the social
security coverage of ESI Scheme and to improve the medical care being provided under
the ESI Scheme as under: -
(1) Extending coverage of ESI Scheme for extending its social security net to the
whole country
Extending the social security benefits of ESI Scheme in the remaining North-East
States Arunachal Pradesh, Mizoram, Manipur and Andaman & Nicobar Island. It has
been implemented in Mizoram w.e.f. 1.12.2015 and in Port Blair w.e.f. 01.01.2016.
At present, ESI Scheme is being implemented in industrial/commercial clusters within

districts. The target was to cover all 393 districts, where these clusters are located. In
this regard, Now, the further target is to cover all 681 districts of the country by end of
this year i.e December 2016.
Opening Health Scheme for selected group of unorganized workers like rickshaw
pullers/auto rickshaw drivers in selected urban/metropolitan areas, on pilot basis.
ESI Coverage has been extended to Construction workers in the implemented area.
Construction site Workers has been covered to avail benefits under the ESI Scheme
w.e.f. 1st August, 2015.

Facilities for Cancer, Cardiology, Dialysis, Dental, CT Scan, MRI and ICU facilities
introduced on PPP model in ESIC Hospitals and also Pathology and X-Ray facilities in
ESIC Dispensaries.
AYUSH and Yoga introduced in ESIC Hospitals and introduced facility for
telemedicine.
Resolved to set up two Model Hospitals and one Super Speciality Hospital in each
state
Launched ESIC-2.0 Reform Agenda with facilities for changing bed sheets every day
in ESIC Hospitals, Online Electronic Health Records, 24x7 Medical Helpline, special
OPD for sr. citizens and differently-abled persons and grading of Hospitals based on
performance.
As a part of Digital Initiative, launched Aadhar linked e- Pehchan Card, integrated

ESIC services with e-Biz Portal, Launched Public Grievance Module 2.0 for lodging
grievances online and launched a dedicated website
www.esichospitals.gov.in

(2) New Initiatives under Health Reforms Agenda of ESIC 2.0, for improving the
medical care
Aimed at providing better health services, Honble Prime Minister of India had launched
a series of Health Reforms Agenda of ESIC on 20.07.2015 which includes-
Online availability of Electronic Health Record of ESI Beneficiaries (Insured Persons

and their family members).
Abhiyan Indradhanush : Ensuring the change of bedsheet according to VIBGYOR
pattern during the week i.e. to be changed everyday
Medical Helpline No. 1800 11 3839 for emergency and seeking guidance from
casualty/emergency of ESIC Hospitals.
Special OPD for Sr. Citizens and differently-abled persons in ESIC hospitals.
(3) Other initiatives for Improving Patients/Attendant Care
(i) The ESI Corporation has launched a pilot project of Tele-medicine Services at 11 ESI
locations in co-ordination with Health Informatics and Electronics Division (HIED), C-
DAC, Mohali under Digital India programme of Government of India.
(ii) In order to improve the health care facilities for the beneficiaries, ESI Corporation
has decided to open 6 bedded Day Care Centres in various ESI Dispensaries, all over
the country. To begin with, 1st Day Care Centre at ESIC Dispensary at Factory Road,
Sarojini Nagar, New Delhi has been started from 10.06.2016.
(iii) ESIC has introduced a landmark health initiative to keep Insured Persons (IPs)
healthy and aware about their health by starting of Annual Preventive Health Check-up
for Insured Persons (IPs) of age 40 years and above in all ESIC/ESIS Hospital and
equipped ESI Dispensary.

(iv) Providing appropriate cancer detection/treatment facilities, cardiology treatment
facilities, dialysis facilities on PPP Model at different levels of hospitals.
(v) Pathological & X-ray facilities will be provided on PPP model in all the dispensaries
in phases. Pathological services and ECG Services in all dispensaries of Delhi have
been started.
(vi) Quality Control on Medicine & Drugs: - ESIC has made testing of drugs more
stringent. Now, all batches of Drugs/Medicines supplied are subjected to quality testing
through Govt. approved laboratories at the time of supply or at any time during the shelf
life.
(vii) Queue Management System in hospitals.
(viii) Behavioural training to doctors, paramedics and other staffs is being given in most
of the hospitals.
(ix) May I Help Your Desk facility is available in all hospitals.
(x) Pilot project for tracking of pregnant mothers and new-borns.
(xi) Special mother and child care hospital.
(xii) AYUSH facilities to be extended to all dispensaries in phases.
(xiii) Yoga facilities in all the ESIC hospitals.
(xiv) In order to promote Khadi, ESIC proposes to sign a Memorandum of

Understanding (MoU) between KVIC and ESIC for supply of bedsheets and pillow
covers in ESI Hospitals and Dispensaries.

FETAL MEDICINE UNIT AT ESIC SUPER SPECIALTY HOSPITAL
By Shri Bandaru Dattatreya, Honble Minister of Labour & Employment, Govt. of India
(Independent Charge) on the occasion of World Birth Defects Day on 3rd March, 2016.
About 5 10 % of the babies are born with Birth Defects. Infant Mortality Rate is high in
India. Birth defects are one of the leading causes of infant deaths in India.
Every year, third day of this month is designated as World Birth Defects day. The cost of
the treatment of this group of malformations is high as the birth defects are common
and most of the major defects need super specialty treatment.
Children who are successfully treated are at an increased risk for long-term medical and
surgical issues. Hence the role of prevention of Birth Defects and education about the
Birth Defects is very important. In this direction, as a Chairperson of the ESI corporation
with around 8 Crore ESI beneficiaries in India, he propose to start the Fetal Medicine
unit at ESIC Super Specialty Hospital associated with the proposed ESIC Medical
College at Sanath nagar , Hyderabad.
This unit is contemplated to start a unique national program - ESIC CARES program.
CARES : Congenital Anomalies Registration and Education Service. Our Insured
Persons would be educated and counselled for the Birth Defects through this initiative.
Once well established at Hyderabad, this would be extended to the rest of the country
through the ESIC Hospitals. Surgical intervention for the Birth Defects carries significant
mortality in India.
He proposes to start the Neonatal Surgery Services unit at ESIC Super Specialty
Hospital associated with proposed ESIC Medical College at Sanath nagar, Hyderabad.
This unit is envisaged to start International Collaborative ESIC NSS [Neonatal Surgery
Service] and ESIC Bids Birth Defects Surgery units.

OTHER INITIATIVES
(i) ESIC has decided to enhance period of unemployment allowance under RGSKY
from 12 months to 24 months along with the medical benefit to Insured Person/Insured
woman and his/her family. The eligibility of contribution condition has also been reduced
from three years to two years for getting the benefits under RGSKY.
(ii) ESI Corporation has also decided to enhance wage ceiling for coverage of
employees under the ESI Act from Rs. 15,000/- to Rs. 21,000/-
(iii) The duration of Maternity Benefit in confinement has been increased from 12 weeks
to 24 weeks.
As of now, the total beneficiary population of ESI Scheme stands over 7.89 crores. Ever
since its inception in 1952, the ESI Corporation has, so far, set up 151 Hospitals,
1459/188 Dispensaries / ISM Units, 812 Branch/Pay Offices and 61 Regional & Sub-
Regional/Divisional Offices.

LAUNCHES OF TELE-MEDICINE SERVICES OF ESIC
In order to improve the health care facilities for the beneficiaries, Shri Bandaru
Dattatreya, Honble Minister of State (Independent Charge) for Labour & Employment,
Govt. of India launched the first phase of the Tele-medicine services on 06.09.2016 at
Constitution Club of India, New Delhi whereby ESIC Model Hospital, Basaidarapur, New
Delhi connected with three ESI Dispensaries at Rudrapur (Uttrakhand), Unnao (Uttar
Pradesh) and Kathiyar (Bihar).
ESI Corporation has been providing health care and other social security benefits to the
workers of specified wage group since the last 65 years as a labour welfare measure.
Under this new initiative, the ESI Corporation has launched a pilot project of Tele-
Medicine Services at 11 ESI locations in co-ordination with Health Informatics and
Electronics Division (HIED), C-DAC, Mohali under Digital India programme of
Government of India.
The chosen HUBs are ESICs Post Graduate Medical Institutes in which Super
Specialists & Specialists may be able to provide door-step consultative services to the
ESI beneficiaries. The ESI Dispensary is chosen as Spokes from those States where
there is no secondary care medical services are available. The launch of telemedicine
services of ESIC are going to provide the specialized ESI Health care services to the
ESI beneficiaries residing/working at different geographical locations with limited
medical specialist services.

ESIC GRIEVANCE REDRESSAL
This ESIC scheme, being a multi-disciplinary, service intensive, social security

programme for workers, an estimated 3.5 lakhs of beneficiaries visit the service outlets
at the grassroots level daily either for treatment purposes or for availing cash benefits.
In such a highly interactive and dynamic system, there is ample scope for any unlawful,
inadvertent or willful harassment being caused to the beneficiaries of this scheme.
Hence, to overcome such incidents, ESIC Corporation has set up an elaborate system
for speedy redressal of public grievances and complaints at various levels as follows: -
a) Branch Office Level Manager, In charge of Branch Office
b) Dispensary Level IMO In charge.
c) Hospital Level Medical Superintendent/Deputy Medical Superintendent
d) Regional Level Public Grievance Officer Regional Director ESIC
e) Director Public Grievances, ESI Corporation, Kotla Road, New Delhi-110002. Tel
No.: (011) 23239424/23234092
The ESIC has taken various remedial measures for ensuring timely redressal of
grievances to the beneficiaries of this scheme. In accordance with Regulation 10 and
10A of ESI (General) Regulations 1950, Local Committees and Regional Board
representing employers, employees and Scheme administrators have been constituted
under ESIC Scheme.

All the units/offices of the ESI Corporation dealing with the public grievances have been
given specific instructions to register complaints from varied sources viz. Insured
Persons/Employers/VIPs/Associations of Employees and Employers/News items and
Complaint-Boxes that are provided at the Branch Offices/Regional Offices. Based on
the classification of the nature of complaints received, a registration number should be
allotted to each case.
On conducting proper enquiries of such grievances, the cases are settled promptly. In
case of rejection of any complaint/grievances, the complainant is informed regarding the
reasons of rejection of such petitions.
Subsequently, the ESI Corporation has taken the policy decision to set up an
independent cell to deal with the public grievances exclusively at Regional levels across
India with effect from April 1999.
Accordingly, special cells to deal with the public grievances as well as to promote the
public relations have been set up at Regional Offices across India. This is done with for
the purpose of monitoring the redressal of grievances of the beneficiaries and
dependants attached to this ESIC Scheme.
The complaints of the beneficiaries including the Employers and representatives of

Associations/Labour leaders are given due attention and weightage so as to settle
claims and other grievances on priority basis. Besides, 'SHIKAYAT ADALAT' has
specially been constituted to deal with the public grievances.
A facilitation centre has been opened at Sub Regional Offices across India allowing
insured person, employers etc. to lodge their complaints/grievances freely without any
fear and interact with the ESIC. The Complaints are duly attended to and wherever
essential, detailed investigations are conducted so that such Complaints are redressed
in a prompt and judicious manner and recurrence of such grievances are nipped in the
bud.

MEDICAL APPEAL TRIBUNALS
The State Government constitutes Medical Appeal Tribunal for the purpose of Section
54 A of ESI Act and Rule 20 A of ESIC (Central) Rules 1950 and regulation 76 of the
ESI (General) regulations, 1950. The Medical Appeal Tribunal consists of a Judicial
Officer appointed by the State Government of status not higher than judge of the
Employee Insurance Courts. He/She will be assisted by one or more senior State
Medical Service Experts drawn from the panel from the respective branch of medicine
to which the case pertains. This Tribunal also includes officials nominated by the State
Government of recognized trade unions for this purpose.
Procedure of Medical Appeal Tribunal
An insured person or ESI Corporation, whosoever, is dissatisfied with the decision of

the Medical Board may appeal to the Medical Appeal Tribunal on Form B.I.5 within 3
months of being informed of the decision., If it is satisfied that the Appellant had
sufficient and valid reasons for not submitting the application with the prescribed time as
specified by ESIC, then the Tribunal even after the stipulated period of three months
may entertain an application. The Tribunal has the powers to confirm, reverse or vary
with the decision of the Medical Board in part or in whole.

EMPLOYEES' INSURANCE (EI) COURTS
Under Section 74 of the ESIC Act, the State Government shall constitute an EI
(Employees Insurance) Court for local areas by notification in the Official Gazette. Any
person who is or has been a judicial officer or is a legal practitioner of five years
standing shall be qualified to be a Judge of the Employees Insurance Court.
Under Section 54A(2) of the Act, the Employees Insurance (EI) Court can decide to
appeal against the decision of Medical Board/Medical Appeal Tribunal, in case of any
shortfalls.
The insured person or the Corporation can file an Appeal under Section 54A of the Act
and Rule 20B of ESI (Central) Rules, 1950 to the Employees Insurance (EI) Court by
presenting an application within three months of the date of communication of the
decision of the Medical Board/Special Medical Board or to the Medical Appeal Tribunal
to the insured person or the ESI Corporation as the case may be.
The Employees Insurance (EI) Court may entertain application after the stipulated
period of three months, if it is satisfied that the applicant had sufficient and valid reasons
for not presenting the application within the said period. The Rules made by the State
government in respect of form and procedures to be followed in presenting an
application to Employees Insurance (EI) Court shall be applicable to the applications
presented for the above purpose.
An appeal can be made against the decision of an Employees Insurance (EI) Court can
be transferred to the High Court, if a substantial question of interpretation of law is
involved under Section 82 of the Act and period of limitation for an appeal shall be sixty
days.

ADMINISTRATIVE & OPERATIONAL BENEFITS OF ESIC ACT
EMPLOYEES AND EMPLOYERS, RETIRED AND DISABLED PERSONS
Role of ESIC in Delivery of Benefits for Employees/Workers
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.

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 employers
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.

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.

FREQUENTLY ASKED QUESTIONS
What is the benefit admissible to the family members?
(i) Family members are also entitled to full medical care as and when needed
(ii) The family members are also entitled to artificial limbs, artificial appliances etc. as a
part of medical treatment.
(iii) The medical benefit is also admissible to the family during the period the insured
person is in receipt of unemployment allowance. In case he dies during the period, his
family continues to receive the medical benefit till the end of those twelve months.
(iv) Reimbursement of expenditure incurred on the funeral of the deceased employee.
(v) In case of the death of the insured employee due to employment injury, the widow,
widowed mother and children are entitled to Dependants' benefit.
(vi) Any benefit due to the insured employee at the time of death is paid to the nominee.
What is Rajiv Gandhi Sharmik Kalyan Yojana?
In the event of closure of factory/establishment or non-employment injury related

unemployment, the insured Person would be entitled to un-employment allowance
subject to three years of insurable employment. The un-employment allowance is
payable for twelve months in life time.

Benefit after Retirement to the Insured Person (IPS)/Widow
What is the benefit admissible after retirement of an employee?
An insured person who leaves the insurable employment on attainment of the age of
superannuation or retires under a voluntary Retirement Scheme or takes premature
retirement, after being an insured person for not less than 5 years, shall be eligible to
receive medical benefit for himself and his spouse subject to production of proof thereof,
and payment of a nominal contribution of rupees one hundred and twenty for one year.
In case the insured person expires, his spouse is entitled to the medical benefit for the
remaining period for which the contribution was made, and she can continue to receive
the medical benefit on payment of the contribution @ 120/- p.a. for further period. This
medical benefit is also admissible to an insured person who ceases to be in
employment on account of permanent disablement caused due to employment injury for
himself and his spouse on payment of similar contribution till the date on which he
would have vacated the employment on attaining the age of superannuation, had not
sustained such permanent disablement.
Further, this medical benefit is also available to widows of insured persons who are in
receipt of dependant benefit on payment of contribution as prescribed under rule 60
However, the medical benefit extended under this rule does not include Super Specialty
Treatment (SST).

Introduction about Johnson & Johnson
Johnson & Johnson, through its family of companies, is engaged in the research and
development, manufacture and sale of a broad range of products in the health care field
in virtually all countries of the world. Johnson & Johnson's primary interest, both
historically and currently, has been in products related to human health and well-being.
Johnson & Johnson was incorporated in the State of New Jersey in 1887.
Johnson & Johnson is organized on the principle of decentralized management. The

Executive Committee of Johnson & Johnson is the principal management group
responsible for the strategic operations and allocation of resources of the Johnson &
Johnson Family of Companies. Johnson & Johnson's operating companies are
organized into three business segments: Consumer, Pharmaceutical and Medical
Devices. A Group Operating Committee, composed of managers who represent key
operations within the segment, as well as management in specialized functional
departments, oversees and coordinates the activities of domestic and international
companies related to each of the business segments.
However, in line with the principle of decentralized management, senior management

groups at U.S. and international operating companies are each responsible for their own
strategic plans, as well as the day-to-day operations of those companies, and each
international company is, with some exceptions, managed by citizens of the country
where it is located. The company's business is divided into three major segments,
Pharmaceuticals, Medical Devices and Diagnostics, and Consumer Products. In 2013,
these segments contributed 39%, 40%, and 21% of the company's total revenues

Products
J & J is the worlds most inclusive and broadly-based manufacturer of health care
products as well as a provider of related services for the consumer the world over. A
wide variety of products across adverse range of categories are continuously innovated,
manufactured and marketed to help people across the globe to lead healthy and happy
lives.
Consumer Products
The company meticulously offers products and information about babycare, skin and
hair care, oral care, nutritionals, pain relief, topical careand the like.
Medical Devices & Diagnostics

Their medical devices & diagnostics businesses provide help to doctors, nurses and
hospitals with enabling technologies to cure patients who suffer from some of the
worlds most pervasive and chronic conditions.
Pharmaceuticals
The Pharmaceutical segments broad portfolio focuses on unmet medical needs across
several therapeutic areas: oncology; infectious disease; immunology; neuroscience;
cardiovascular and metabolism. It includes products in the anti-infective, antipsychotic,
cardiovascular, contraceptive, dermatology, gastrointestinal, haematology immunology,
neurology, oncology, pain management, urology and virology fields.
To find out the exact details on how the ESIC works in Johnson and Johnson I did ask
some question to the concerned person Mr. Shailendra Dhamdhere who is the HR
Director in JNJ who takes care of all such benefits for the employees. There were some
questions which I asked him. They are as follows: -

1. Are all the persons employed who are not coverable under the Act are also
counted for 10/20 employees to determine eligibility?
Yes. All the persons employed in the premises including the boundaries thereof
irrespective of their wages including casual, trainees, contract employees are
counted for the purpose of coverage of the Factory. Even the Directors employed
are to be counted.
2. How are the employees registered under the Scheme?
At the time of joining the insurable employment, an employee is required to fill in

a Declaration Form (form1) and submit a family photo in duplicate to the
employer, which is to be submitted to the ESI Branch Office/entered in the online
system by his employer. The employee is then allotted an insurance number for
the purpose of his identification under the scheme and issued a temporary
identity card for availing medical benefit for self and family for a period of three
months. Thereafter, he is provided with a permanent photo identity card. A
person once registered need not register again in case of change of employment.
The same registration can be transferred from one place to the other.
3. What is difference between Temporary Insurance Card and Permanent

Insurance Card?
Temporary Insurance Card (TIC) is generated online from ESI website of the
organization registered under ESI mentioning all the demographic, wages,
contribution details of the employee. The said TIC is valid for 13 weeks only and
employee is supposed to register for permanent card within the period.
Permanent Insurance Card (PIC) is issued by ESI department after TIC and
biometric fingerprints of the employee and family members are recorded by the
nearest ESI local office.

4. Did employees are covered under ESIC after retirement?
After retirement if the person works with principal employer then PF & ESI
deduction is depends on terms & conditions of the employment
PF - After 58 years - No upper limit of age prescribed by the act.
All amounts go to PF account only & no EPS contribution
EPS - Upper age limit is 58 years
ESI - This act has not prescribed any upper limit of age so you can deduct
the ESI in mutually agreed between the parties.
After retirement if the person works with principal employer then PF & ESI
deduction is depends on terms & conditions of the employment.
5. Whether the Act provides for voluntary coverage by employees and

employer?
No. the ESI Act does not provide for voluntary coverage at the request of
employees and employer.
6. What is a Code number?
It is a 17-digit unique identification number allotted to each of the

factory/establishment registered under the provisions of the Act. Such a number
is generated through ESIC portal on submission of the pertinent information by
the employer or generated on receipt of Survey report from the Social Security
Officer.

7. Is there any interest to be paid by Employer for delayed payments? Did
Johnson & Johnson ever have paid such?
Yes they had. If an employer who fails to pay the contribution within the limit
prescribed under Regulation 31, shall be liable to pay simple interest at the rate
of 12% per annum in respect of each day of default or delay in payment of
contribution.
8. Which records are being maintained for ESI purpose at Johnson &
Johnson?
In JNJ we maintained the Muster roll, wage record and books of Account
maintained under other laws, the employer is required to maintain the following
registers for ESI: -
Accident Register in new Form-11 and
An inspection book.
The immediate employer is also required to maintain the Employee's Register for
the employees deployed to the principal employer.
9. What is Standard Benefit Rate of Johnson and Johnson?
Means average daily wages obtained by dividing the total wages paid during the
contribution period by the number of day for which these wages were paid. The
standard benefit rates are specified in Rule 54, lowest rate being Rs. 14.00 and
the highest being Rs. 145.00.

10. What is Contribution period and Benefit period?
Contribution period and Benefit period are periods fixed for the purpose of paying
contributions and deriving benefits under the Act. In respect of the contribution
period from 1st April to 30thSeptember, the corresponding benefit period shall be
from 1st January of the year following, to 30thJune; and in respect of the
contribution period from 1st October to 31st March of the year following, the
corresponding benefit period shall be from 1st July to 31st December of the year
following.
11. For Newly employed persons, how contribution and benefit period is
calculated?
In the case of a newly employed person, the first contribution period shall
commence from the date of employment, and the corresponding first benefit
period shall commence on the expiry of 9 months from the said date. {Rule 2 &
Regulation 4}
12. What is meant by Sickness Benefit?
When an insured employee is sick, he is entitled to receive for the period of his
sickness, benefit at the daily Standard Benefit Rate. This benefit is available to
the insured employee for sickness occurring during any benefit period if he has
paid contributions for not less than seventy-eight days of the corresponding
contribution period. Sickness benefit is not available for the first 2 days of
sickness.
13. Payroll Software used at Johnson & Johnson?
There is no such specific payroll been used in Johnson and Johnson. We used
the same software (Workday) for this payment as well.

Status of Permanent Disablement Benefit (PDB) and
Dependant Benefit (DB)
Cases and Payments
Amount Amount
No. of
No. of paid in paid in
No.of fresh
Year No. of IPs No. of IW fresh PDB in DB in
Beneficiaries cases
PDB Million Million
in DB
(INR) (INR)
2011-12 17,100,958 2,407,302 66,351,717 14,059 1143.95 705 1123.90
2012-13 18,582,000 2,721,789 72,098,160 14,441 1334.39 1841 906.50
2013-14 19,547,620 2,922,345 75,844,766 12,747 1662.65 1984 1164.50
2014-15 20,344,530 3,360,697 78,933,944 11,386 1853.97 2020 1244.30
2015-16 21,320,339 3,517,856 82,722,915 12,331 2135.70 1890 1550.10

FINDINGS OF THE STUDY
1. All the workers are aware of sickness benefits; dependants benefits and leave
benefits of ESI scheme.
2. Majority of workers are aware of the payment funeral expense provided by ESI
Corporation.
3. Interpersonal communication is the main source of information about ESI scheme

of workers. Some of the workers are getting information from ESI the employer as
well as the ESI office.
4. Media is the least sought source of information for getting the ESI.
5. Majority of workers are utilizing the sickness benefits, maternity benefits and
dependants benefits provided by the ESI dispensary.
6. All the workers are utilizing the leave benefits provided by ESI Corporation. l
Majority of workers are utilizing the ESI dispensary.
7. Large majority of workers are utilizing the ESI dispensary for treatment of minor
diseases and majority of them are for occupational hazard.
8. Very few are visiting to the ESI dispensary for treatment of major diseases and all
the diseases.
9. A large majority of workers feels that bottlenecks in procedure and lack of medical
facility as the main barrier in getting services from ESI dispensary.

The findings show that the overall utilization level is very low due to; perceived low
quality drugs, long waiting periods, insolence of personnel, long waiting spells to
unusual delays in reimbursement of money spent on treatment outside, lack of or low
interest of employers and low awareness of ESI procedures.
These findings may reflect the existing problems with the operation of the ESI scheme,
the reimbursement and the referral systems adopted by the scheme. More specifically if
the ESI enrolees are less likely to access their insurance 24 benefits when seeking
care, then one might wonder why do the organisations will voluntarily purchase
insurance coverage for their workers? Like any other study based on a primary survey,
some caveats are in order for this study.

RECOMMENDATIONS
Not only is the utilization pattern of the ESI facilities relatively very low but the cost of
treatment in the private sector is quite high. On an average the in-patients in the private
facilities spent around Rs.6327 (including indirect expenses) and Rs.1104 for out-
patient care. This clearly shows that the scheme is failing to provide the financial
protection that it should. Based on the responses from policy makers on how to improve
the overall effectiveness of the scheme, we offer below some suggestions for
improvements.
The government could improve access by constructing more ESI facilities or adding
more private facilities to the panel of recognized hospitals where the insured patients
can get treatment. The latter is particularly important as the current perception of quality
of care among beneficiaries is poor. Private providers are spread throughout rural and
urban areas and are available wherever there is a demand for services. They are also
more easily accessible to people than public facilities and have flexible opening hours
and short waiting times. Other documented reasons for their popularity are their greater
sensitivity to user needs and the assurance of confidentiality. Between 75% and 80% of
households in India prefer to use the private sector for treatment of major and minor
illnesses respectively (National Council of Applied Economic Research, 1995).
The basic infrastructure of the existing facilities could be improved to provide higher
quality of service to the beneficiaries; this includes making basic diagnostic equipment
available, providing nursing personnel, laboratory services and making conditions more
sanitary. A multiple card system could be introduced so that the beneficiaries can use a
convenient facility whenever required; this will particularly help those employees whose
family members or dependents do not live with them. It would mean that employees and
their families could hold a card each so that even if they lived apart each could use the
most convenient health facility. Finally, our discussion with policy makers suggest that
there has been little continuity in the highest policy making system, thereby
considerably

CONCLUSION
ESIC has played a significant role in providing social security millions of workers in the
organized sector. It is only social security organization in the country which provides
insurance coverage for exigencies related to health, maternity, disablement, death and
employment. The corporation thus extends complete social security cover to the
workers and their family members. However, the working of ESI is not up to the
expected level of the insured person from three sectors.

WEBLIOGRAPHY
www.esic.nic.in
www.esicmaharashtra.gov.in
www.en.wikipedia.org
www.medindia.net

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PROJECT REPORT ON

AWARENESS AND EFFECTIVE UTILIZATION OF ESI

UNDER THE GUIDANCE OF

MASTER IN HUMAN RESOURCE DEVELOPMENT

N.L. DALMIA INSTITUTE OF MANAGEMENT STUDIES

Awareness and Effective Utilization of ESI Benefits 1

Signature of Director of the Signature

Awareness and Effective Utilization of ESI Benefits 2

direct or indirect help in the completion of this project work.

Awareness and Effective Utilization of ESI Benefits 3

I, Mr. Ankit Krishna Patkar of N. L. Dalmia Institute of Management Studies and

(Mr. Ankit Krishna Patkar)

Awareness and Effective Utilization of ESI Benefits 4

Awareness and Effective Utilization of ESI Benefits 5

Awareness and Effective Utilization of ESI Benefits 6

Awareness and Effective Utilization of ESI Benefits 7

The highly heterogeneous array of health financing arrangements justifies the

This study was undertaken with the following objectives:

Awareness and Effective Utilization of ESI Benefits 8

What is Social Security?

Awareness and Effective Utilization of ESI Benefits 9

History of Social security

each member of a particular trade (blacksmiths, painters, weavers etc) was

Social Security in India

However, with rise of migration, urbanization, nuclear families and demographic

Awareness and Effective Utilization of ESI Benefits 10

Examples: employees of union and state Government, army, navy, airforce,

Awareness and Effective Utilization of ESI Benefits 11

Rural Areas Urban Areas

1. landless agricultural labourers

Awareness and Effective Utilization of ESI Benefits 12

Employees State Insurance Act, 1948 (ESI Act)

Employees Provident Funds Act, 1952

Workmens Compensation Act, 1923 (WC Act)

Maternity Benefit Act, 1961 (M.B. Act)

Payment of Gratuity Act, 1972 (P.G. Act)

Awareness and Effective Utilization of ESI Benefits 13

Employees' State Insurance (abbreviated as ESI) is a self-financing social security

ESIC is an autonomous corporation by a statutory creation under Ministry of Labour and

In March 1923, B. P. Adarkar was appointed by Government of India to create a report

Awareness and Effective Utilization of ESI Benefits 14

Awareness and Effective Utilization of ESI Benefits 15

Employees' State Insurance Corporation (ESIC), established by ESI Act, is an

Awareness and Effective Utilization of ESI Benefits 16

The promulgation of Employees' State Insurance Act, 1948 envisaged an integrated

APPLICABILITY OF THE ESI ACT

The appropriate Government State or Central is empowered to extend the provisions

Awareness and Effective Utilization of ESI Benefits 17

Awareness and Effective Utilization of ESI Benefits 18

Awareness and Effective Utilization of ESI Benefits 19

Coverage(As on 31st March, 2015)

No. of Insured Person family units 2.03 Crores

No. of Employees 1.79 Crores

Total No. of Beneficiaries 7.89 Crores

No. of Insured women 3.36 Lacs

No. of Employers, etc. 7.23 Lacs

Awareness and Effective Utilization of ESI Benefits 20

Awareness and Effective Utilization of ESI Benefits 21

Awareness and Effective Utilization of ESI Benefits 22

Contribution Period and Benefit Period

Awareness and Effective Utilization of ESI Benefits 23

Contribution Period Cash Benefit Period

ESI SCHEME AT A GLANCE -- MAHARASHTRA

SUB REGIONAL OFFICES 5