Employees State Insurance Act 1948 was enacted to protect the life of workers in sickness, any kind of accident, temporary or permanent physical disablement, injury, pregnancy which result in loss of salary or earning capacity of an employee. Employees whose monthly salary is Rs. 21000 of below are covered under ESI. The ESI Act primarily applies to premises where 10 or more persons are employed and therefore applies to both organised and unorganised sectors. The ESI applicability is also to non-seasonal factories employing 10 or more persons and since 2011 it has been extended to shops, hotels, restaurants, private medical and educational institutions, cinemas and newspaper establishments employing 20 or more persons. In some states coverage is still for 20 or more persons employed under sec 1(5). A few State Governments have not extended scheme to Medical & Educational Institutions.
Employer Contribution to ESI is 4.75% and Employee Contribution is 1.75%, a total of 6.5%. This fund is managed by ESI Corporation. Employer needs to register with Employees State Insurance Corporation within 15 days as it is the statutory responsibility of the employer under Section 2A of the Act read with Regulation 10-B, to register their Factory/ Establishment under the ESI Act within 15 days from the date of its applicability to them.
- Medical Benefits to Every registered person and his family for complete medical care.
- 70% of the salary for a maximum of 81 days in a year in case of certified sicknesses.
- In the case of long-term disease, 80% of the salary is payable for a period of 2 years.
- 3 months of maternity benefits to a pregnant woman working in an entity.
- 3 months period can be extended up to 30 days in case it is medically advised.
- 90% of the wage is payable by the employer if the worker is permanently disabled.
- 90% of Salary every month to dependent in case of death in the company premises
- Good Medical Care and Medical Reimbursement
- Un employment under Rajiv Gandhi Sharmik Yojana, employees insured for 3 +
- Cinema halls
- Newspaper Establishments
- Hotels or restaurants providing services and not with manufacturing activities
- Medical Institutions
- Private Educational Institutions
- Roadside Motor Transport Establishments
The Contribution should be deposited before 21st of the month.
- Filled Form 01 for Employer's Registration
- List of minimum 10 or 20 Employees with their Date of Joining and Rate of Salary
- Memorandum of Association (MOA) in case of Company
- Article of Association (AOA) along with Certificate of Incorporation for Companies
- Partnership Deed in case of Partnership
- Copy of the PAN Card
- A copy of the Bank Statements
- GST Registration Certificate copy
- Copy of Factory/ Shop & Establishment Registration
- A copy of any other Registration as required
- Declaration Form from each employee and 2 Postcard sized photographs (Optional)
- Filling of Application in Form 01 within 15 days of applicability to the establishment
- 17 Digit Identification Number also known as code number
- Return on declaration in Form 3
- Allotment of Insurance Number to the Employees
- Issue of Temporary ESIC Card for a duration of 3 months
- Issue of Permanent Photo Identity Card
Annual Return needs to be filed twice a year. The following documents are required to be filed with the Return
- Attendance register of employees
- Register- Form 6
- Wages' register
- Details of Monthly returns and challans
- Register of any accidents occurred in the business premises
Wages include basic pay, dearness allowance, city compensatory allowance, payment of day of rest, overtime wages, house rent allowance, incentive allowance, attendance bonus, meal allowance and incentive bonus.
Medical benefit is upto Full range of Medical, surgical & obstetric treatment consisting of out-door treatment, in-patient treatment, supply of all drugs and dressings, pathological and radiological investigations, prenatal and post-natal care, super specialty consultation & treatment, ambulance services, provision of artificial appliances etc.
Duration of getting benefits
The insured person and his family are entitled to the Medical Benefit from
the very first day of his/her joining the insurable employment. A person who is
just covered under the scheme for the first time is eligible for primary and
secondary medical care for self and family for three months. If he/she continues
in insurable employment for three months or more, the benefit is admissible till
the beginning of the corresponding benefit period. If the insured person is in
ESI coverage for at least 2 years from the date of Online Registration,
contributed for not less than 156 days and IP is eligible for
Sickness Benefit in any one of the contribution period and is suffering from any of the 34 specified long term diseases, the medical benefit is admissible till the incapacity lasts or up to 730 days during a period of 3 years for self and family.
Further, If the insured person is in ESI coverage for at least 2 years from the date of Online Registration, contributed for not less than 156 days before the date of diagnosis and IP/IW is eligible for Sickness Benefit in at least two contribution period then he along with his family members will be eligible for getting super specialty treatment. In case of an Accident in respect of IP/IW himself or his/her family member this contributory condition shall not be applicable for SST treatment.
Benefits to dependents
The rate of dependants' benefit is 90% of standard benefit rate of the wages of the deceased insured person. It is apportioned among the dependants as follows:
1) Widow: Till death or remarriage at 3/5th of the full rate.
2) Widowed mother till death @2/5th of the full rate,
3) to each child @ 2/5th of the full rate each till he attains the age of twenty –five years.
4) Unmarried daughters @2/5th of the full rate till they get married.
5) If the son or daughter is infirm and wholly dependent on the earnings of the insured person at the time of his death, they continue to receive the benefit even after attaining the age of 25 years/ marriage as the case may be.
If the total dependants' benefit for all the dependents worked out as above exceeds at any time, the full rate, the share of each of the dependents shall be proportionately reduced, so that the total amount payable to them does not exceed the amount at full rate. In case deceased Insured person does not leave behind any of the dependents referred above, then his parents will get 3/10 share or if no parent is alive then alive his paternal grant parent will get 3/10 share of Full rate of dependent benefit.