THE EMPLOYEE STATE INSURANCE ACT 1948

PRESENTED BY

NAJAF ALAM

Employees' State Insurance Scheme of India is an integrated social security scheme tailored to provide social protection to workers and their dependents , in the organized sector, in contingencies, such as, sickness, maternity and death or disablement due to an employment injury .

Came into force on 19th April 1948.

INTRODUCTION

The objective of the act is to

secure sickness, maternity and medical benefits to employees of factories and establishments and dependents benefits to the dependents of such employees.

OBJECTIVE

Act applies to factories using power not using

power and employing 20 or more persons Gradually extended to the following:

Smaller power-using factories with 10-19 persons

Non-power factories with 20 or more persons Shops Hotels and restaurants Cinemas including preview theaters Newspaper establishments

APPLICABILITY

Road motor transport undertakings employing 20

or more persons.

For Employed

The existing wage limit for coverage under the Act is Rs. 15,000/- per month ( w.e.f. 01/05/2010).

Any employee earning 15000 or less per month has to be covered under ESI act.

APPLICABILITY(CONTD.)

No. of Insured Person family units

1.95 Crores

No. of Employees 1.74 Crores

Total No. of Beneficiaries 7.58 Crores

No. of Insured women 0.29 Crores

No. of Employers, etc 6.69 Lacs

Coverage(as on 31st march 2014)

Source: : esic.nic.in

Covered employees contribute 1.75%   of  the   wages,

Employees earning up to  Rs.100/- a day are exempted from payment of their share of contribution.

Employers contribute 4.75%  of the wages, payable to their employees.

The State Governments contribute 1/8th of the expenditure of medical benefit within a per capita ceiling of Rs. 1200/- per Insured Person per annum.

** These contributions are subject to change from time to time

CONTRIBUTIONS

For employerwithin 21 days of the last day of the Calendar month in which the contributions fall due, An employer (both employer share and employee share) shall pay these contributions at the above specified rates to the Corporation.Contribution Period and Benefit Period

Contribution once started shall continue till end of the cycle even if the employee has moved out of 15000 per month wage limit. Subsequently is the benefit period.

CONTRIBUTION PERIODS

1. Sickness and extended sickness

benefit2. Maternity benefit3. Disablement benefit4. Dependants’ benefit5. Medical benefit6. Funeral benefit

BENEFITS

Represents periodical payments

made to an insured person for the period of certified sickness after completing 9 months in insurable employment.

To qualify, contributions should be for minimum 78 days in the relevant period.

Maximum duration for benefit is 91 days.

SICKNESS AND EXTENDED SICKNES BENEFITS

Rates of payment vary from rs.14-125 per

day, i.e. Average of 50% of daily wages. Insured persons suffering from tb, leprosy,

mental and malignant diseases or other specified long term diseases are entitled to extended benefits at higher rates, provided he has been continually employed for at least two years.

Contd.

Implies cash payment to an insured

woman in case of confinement or miscarriage or sickness arising out of pregnancy or premature birth.

Woman should have contributed for minimum 70 days in the preceding two consecutive contribution periods.

Daily rate of benefits double the standard sickness benefit rate, i.E. Full wages

MATERNITY BENEFIT

Normally payable for max 12

weeks for confinement and 6 weeks for miscarriage or medical termination of pregnancy.

Payable even in the event of the death of the woman

Contd.

In case of temporary disability arising out of employment injury, this benefit is admissible for the entire period certified by an insurance medical officer/practitioner for which the insured person does not work for wages.

Rate payable not less than 70% of daily wages; minimum 3 days of incapacity required

DISABLEMENT BENEFIT

In case injury results in

permanent, partial or total loss of earning capacity, periodical payments to be made for life. One-time lump sum is permissible in certain cases.

Contd.

Periodical pension paid to dependants of

deceased where death occurs out of employment injury or disease.

Widows: 3/5th of benefit rate for life or until remarriage

Children: 2/5th of benefit rate until 25 years. Total amount distributed not to exceed

ceiling of disablement benefit. Benefit not paid to married daughters.

DEPENDANT’S BENEFIT

In case there is no widow or child,

benefit can be paid to other dependants including parents.

Amount paid is reviewed and increases granted from time to time to compensate for erosion in real value and cost of living.

Contd.

Insured persons and their families

entitled to free, full and comprehensive medical care.

Extended upto two years for chronic and long-term diseases.

Treatment continues even if person goes out of coverage, till sickness ends.

MEDICAL BENEFIT

Package covers all aspects of health care from primary to super-specialist facilities, such as:1) Out-patient treatment2) Domiciliary treatment3) Specialist consultation and

diagnostic facilities

Contd.

In-patient treatment : Free supply of drugs and dressing X-ray and laboratory investigations Vaccination and preventive inoculations Ante-natal, confinement, post-natal care Ambulance service or conveyance charges Free diet during admission in hospitals

Contd.

Free supply of artificial limbs, aids and

appliances for physical rehabilitation Family welfare services and other national

health programme services Medical certification Special provisions including super-speciality

treatment

Contd.

Funeral expenses are in the nature of a

lump sum payment up to a maximum of rs. 10000 made to defray the expenditure of the funeral of deceased insured person.

The amount is paid either to the eldest surviving member of the family or, in his absence, to the person who actually incurs the expenditure on the funeral.

FUNERAL BENEFIT

ALL BENEFITS UNDER THE

ESI SCHEME ARE PAID IN CASH EXCEPT MEDICAL BENEFIT, WHICH IS GIVEN IN KIND.

An employer cannot dismiss or

punish an employee under treatment for sickness of in receipt of any benefit or absent from work due to illness. Any notice of dismissal, discharge or reduction is invalid.

PROTECTION

However, the employer can discharge or

punish the employee if: He has received temporary

disablement benefit and remained absent for 6 months or more

Is under treatment for sickness other than tb or arising out of pregnancy and remained absent for 6 months or more

Contd.

Right to receive benefit is not

transferable.

Disputes under the provisions of the act to be decided by the employees’ insurance court (eic) and not by a civil court. Appeals to the high court only by an order of the eic on a question of law.

Period of limitation for appeal is 60 days.

MISCELLANEOUS

THANK YOU

HAVE A GOOD

DAY