Employee State
Insurance
  • Sickness Benefit
  • Maternity Benefits
  • Avail Value AddedBenefits
Employee State Insurance
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Employee State Insurance

The Government of India established the Employment State Insurance Scheme (ESIC) in 1948 to provide social security to the workers of New Independent India. The Employees State Insurance Corporation created the ESIC scheme to protect employees from the effects of sickness, maternity, illnesses, accidents, or deaths caused by work-related injuries, as well as to cover medical expenses for the insured individual and their family. The financial assistance offered by the ESIC may replace the employees' income loss due to any injury, sickness, or disablement.

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The main benefits provided under ESI Scheme are:

  • Sickness Benefit
  • Disablement Benefit
  • Dependant's Benefit
  • Maternity Benefit
  • Medical Benefit

In the beginning, the Employee State Insurance Scheme was only implemented in two industrial centers in the country, Kanpur and Delhi. However, over time, the plan has grown to include over 830 centers across 31 states and union territories. Furthermore, the scheme covers 7.23 lakh factories and establishments across the country, resulting in aiding about 2.03 crore people. As of now, the total number of beneficiaries exceeds 7.89 crores. The Employees state corporation has provided great infrastructure that serves insured lives and helps them lead a secure life by setting up 151 hospitals and 42 hospital annexes for inpatient services. The outpatient medical services are provided through a network of about 1418/140 ESI dispensaries, and 1017 panel clinics. Along with that, the corporation has set up five occupational disease centers in different states namely in Maharashtra, West Bengal, and Madhya Pradesh. These centers are set up in order to detect and treat occupational diseases prevalent among workers employed in hazardous industries.

Eligibility Criteria for Employee State Insurance Corporation Scheme

If you are wondering, who can avail of the benefits of the ESI scheme it is important to understand the below given eligibility criteria that individuals need to meet to be eligible for the employee state insurance scheme.

  • Anyone who wants to avail of the benefits of this scheme must be employed in a non-seasonal factory that has more than 10 employees working for it. This criterion is applicable under Section 2(12) of the Employee State Insurance Scheme.
  • The individual must have a monthly wage limit of INR 21,000 per month.

Employees State Insurance Corporation Scheme Key Benefits

The Employee State Insurance is applicable for businesses that have 10 or more employees and the number of employees required to avail of the ESI scheme varies with states. The scheme is only applicable to individuals who have a monthly wage of less than INR 21,000 per month and it comes with a plethora of benefits for the employees under the ESI scheme.

  • Cover for Unemployment It is beneficial to workers in case they lose their job due to circumstances like firing or just resigning from a previous job. The income gap is fulfilled through the Employee State Scheme during the time an individual is looking for another employment opportunity.
  • Death Benefit ESI Scheme offers protection to the insured family in case of death of the insured life under the Employee State Scheme. The widow will be insured for life or until her re-marriage and for dependent children the cover is till the age of 25 years.
  • Long-Term Sickness Benefit In case an employee has contracted a long-term sickness out of the 34 listed ailments under the ESI the individual is offered 80% of the average daily wages as an income to survive their family.
  • Value Added Benefits Along with the basic benefits offered under Employee State Insurance Scheme, individuals are also offered other benefits like vocational training, physical rehabilitation benefit, funeral expense cover, skill up-gradation, and more.
  • Disablement Benefit The ESI scheme offers 90% of the average daily wages to employees suffering from temporary disablement for as long as the disablement lasts. For employees who have been permanently disabled the benefit is applied for their entire life.

Brief Description of Coverage Offered by ESI Scheme

The Employee State Scheme offered to individuals offers various coverage benefits which are mentioned below.

Benefit Contributory Condition Duration  Rate
SICKNESS BENEFIT
Sickness Benefit Payment of contribution for 78 days in the corresponding contribution period Up to 91 days in two consecutive benefit periods. 70% of the average daily wages
Enhanced Sickness Benefit Same as Above 14 days for Tubectomy & 7 days for vasectomy, extendable on medical advice 100% of the average daily wages
Extended Sickness Benefit For 34 specified long-term diseases, continuous insurable employment for two years with a minimum of 156 days' contribution in four consecutive contribution periods. 124 days during a period of two years. This may be extended up to two years on medical advice. 80% of the average daily wages. 
DISABLEMENT BENEFIT
Temporary Disablement Benefit From day one of entering insurable employment for disablement due to employment injury As long as temporary disablement lasts. 90% of the average daily wages approx.
Permanent Disablement Benefit From day one of entering insurable employment for disablement due to employment injury. For whole life For permanent total disablement - 90% of average daily wages. For permanent partial disablement proportionate to the loss of earning capacity as determined by the medical board
Dependants Benefit From day one of entering insurable employment in case of death due to employment injury. For life to the widow or until her re-marriage. To dependent children till the age of 25 years. To dependant parents etc. subject to conditions 90% of average daily wages are shareable in fixed proportion among all dependants.
Maternity Benefit Payment of contribution of 70 days in two preceding contribution periods. Upto 12 weeks in case of confinement. Upto 6 weeks in case of miscarriage. Extendable by 1 month on medical advice in case of sickness arising out of Pregnancy, Confinement, Miscarriage 100% of the average daily wages.
Medical Benefit Reasonable medical facilities for self and family from day one of entering insurable employment Reasonable medical care till he/she remains in insurable employment

Latest Developments in Employee State Scheme

The contribution rates towards the scheme by employers are 3.25%*total wage which is paid to the employees and 0.75%*total wage contributed by employees in the scheme. The most recent expansions and revisions to the Employee State Insurance Scheme include expanded coverage for employees working in theaters, restaurants, hotels, stores, and motor-transport employees, among other things. The system also applies to employees in private educational and medical institutions, although only in selected states and union territories. According to the latest reports, the ESI scheme is now accessible to over 3.49 Crores families in India as of March 2021.

To make the ESI scheme even more efficient and effective the government has initiated its IT Project "Panchdeep" to digitize internal and external processes and ensure efficiency in operations, especially services to Employers and Insured Persons. The Employer Portal permits various transactions online without visiting any ESIC Office, saving time and avoiding the drudgery of routine paperwork.

Other Benefits Offered Under Employee State Scheme

There are other additional benefits offered under the ESI scheme such as funeral expenses, confinement expenses, vocational training and more. To understand the limits for these benefits we have created a detailed table.

Benefit Contributory Condition  Duration  Rate
Funeral Expenses From day one of entering insurable employment For defraying expenses on the funeral of an insured person Actual expenses are subject to a maximum of Rs.10,000/
Vocational Training In case of physical disablement due to employment injury  As long as vocational training lasts. The actual fee charged or Rs.123/- a day, whichever is higher.
Physical Rehabilitation In case of physical disablement due to employment injury As long as the person is admitted to an artificial limb center. 100% of the average daily wages.
Unemployment Allowance (RGSK In case of involuntary loss of employment due to closure of factory, retrenchment or permanent invalidity due to non employment injury and the contribution in respect of him has been paid/payable for a minimum of three years prior to the loss of employment Maximum 12 months during lifetime 50% of the average daily wages
Skill Up-gradation Training Same as above. For a duration of maximum 6 months  

What is Not Covered Under ESC Scheme?

According to the Employee State Insurance Corporation, there are certain limitations attached to the scheme. This particular scheme can not be availed by those who are earning over Rs.21,000 per month or in the case of a disabled individual the limit is set to INR 25,000. Apart from this, in states like Chandigarh and Maharashtra, the minimum employee capacity of an organization should be 20 employees to apply for this scheme.

Registration Process on ESIC Portal

ESIC portal allows individuals to apply for online registration making the process easier and stress-free. Here are the steps to follow for online registration

  • Login To the ESIC portal.
  • Register on the ESIC portal by clicking on the "Employer Login" option on the home screen.
  • Fill in the required details and click on "Sign Up".
  • Once the process of signing up is complete the employer receives a confirmation email on their registered email address.
  • The employer is further asked to fill in the employer registration form -1 which includes details related to the employer unit, factory/ company details and more.
  • After completion of the Employer Registration Form-1, the employer is asked to pay the advance contribution for 6 months.
  • On successful completion of the 6-month contribution payment, the ESIC portal provides the employer with a registration letter containing a 17-digit registration number which acts as proof of registration of the employer.

Documents Required to Avail of ESI Scheme

To avail the employee state insurance scheme entities need to submit the following documents:

  • Factories Act and Establishment Act registration certificate obtained through the Factories Act or Shops and Establishments Act
  • Certificate of Incorporation such as company registration certificate, partnership deed or GST certificate of the company
  • Article of association
  • Address Proof
  • Utility Bills
  • Business PAN Card
  • List of employee working in the company
  • Canceled Cheque
  • List of Shareholders of the company

Employee State Insurance Scheme Claim Status

A beneficiary of the Employee state insurance scheme can claim medical as well as cash benefits. In order to check your claim status you can follow these simple steps given below:

  • Download the ESIC App on your mobile available for Android and Ios platforms.
  • Fill in your insurance number and click on "Get OTP".
  • The Insured individual will receive the OTP on his/her registered mobile.
  • Once you enter the OTP go on the services menu and click on "Claim Status".

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Employees State Insurance Scheme: FAQs

1. What is Employee State Insurance?

Employee State Insurance is an insurance scheme provided by the Government of India to the people and their families who work for the government. It was started in 1948 and comes with several benefits.

2. What are the benefits of the State Health Insurance Scheme?

State Health Insurance Scheme provides protection against scenarios like death, sickness, maternity, disability, accidents etc. The scheme comes with sickness, disablement, dependants’, maternity and medical benefits.

3. How does ESI help in disablement cases?

Employee State Insurance provides monthly cash allowance in case of disablement. If the disability is temporary then a monthly payment is made till the injury lasts and if it is permanent then the monthly payment is provided for whole life.

4. What benefit does ESI give for maternity?

The scheme provides 100% of average daily wages for up to 26 weeks in confinement and 6 weeks in case of a miscarriage, during maternity leave and 12 weeks for commissioning mother and adopting mother.

5. What is unemployment allowance in ESI?

The ESI provides monthly cash for a maximum of 24 months in case of loss of income due to involuntary circumstances or permanent loss of income due to injury.

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Reviewed By: Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.