The section 46 of the Act envisages following six social security benefits :-
(a) Medical Benefit : 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/- .
- System of Treatment
- Scale of Medical Benefit
- Benefits to Retired IPs
- Administration of Medical Benefit in a State
- Domiciliary treatment
- Specialist consultation
- In-Patient treatment
- Imaging Services
- Artificial Limbs & Aids
- Special Provisions
(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.
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.
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.
(d) Disablement Benefit
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.
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.
(f) 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.
In addition, the scheme also provides some other need based benefits to insured workers.
Vocational Rehabilitation :To permanently disabled Insured Person for undergoing VR Training at VRS.
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.
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/-.
Employerss' 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.
|1.||Medical Care||Primary, Secondary and Tertiary medical care with no cap on individual expenditure.|
|2.||Sickness Benefit||91 days|
|3.||Extended Sickness Benefit||730 days(upto 2 years) for specified 34 diseases.|
|4.||Maternity Benefit||84 days + 1 months (due to complications arises out of pregnency, confinement , premature birth of child etc.)|
|5.||Permanent Disablement Benefit / Temporary Disablement Benefit||Based on loss of earning capacity / as long asthe disability lasts.|
|6.||Dependents's Benefits||On the death of IP to the wife till she is alive / remarried to family members as per conditions w.r.t age / marriage.|
|7.||Rajiv Gandhi Shramik Kalyan Yogna (Unemployment Allowance)||50% of daily average wages upto 12 months unemployment on account of closure of factories, retrenchment or permanent invalidity of not less than 40% arising out of non-employment injury.|
|8.||Incentive schemes to employer for employing persons with disabilities.||The employer's shares of contribution by the government for 3 years for providing employment persons with disabilities drawing monthly wages upto ₹25,000/-|
|9.||Medical care to retired IPs||Medical facility avilable within ESIC on payment of ₹120/- per annum|