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​​ESI & ESIC: Meaning, Benefits, Eligibility & More

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April 6, 2023

Summary

What’s Inside

In this blog, we will cover the meaning of ESI (Employee's State Insurance) and ESIC (Employee's State Insurance Corporation), along with ESIC eligibility. We will also explore how one can claim ESIC benefits if applicable and the list of ESI hospitals under this scheme. 

What is ESI (Employee's State Insurance)?

  • ESI is a comprehensive social security and health insurance scheme established under the Employees' State Insurance Act, 1948, in India.
  • It is primarily aimed at providing medical and cash benefits to employees and their families in case of sickness, maternity, disablement, or death due to employment injury.
  • Employees earning up to a specified wage limit (as determined by the government) are eligible for ESI coverage. 
  • This is a “self-financed” scheme where in employees and employers are required to contribute a portion to the ESI fund.

What is ESIC (Employee's State Insurance Corporation)?

  • ESIC is the statutory body responsible for implementing and administering the ESI scheme in India which manages and oversees the collection of contributions, disbursement of benefits, and overall administration of the ESI program.
  • ESIC operates a network of hospitals, dispensaries, and clinics to provide medical services to beneficiaries. 

What are the Benefits of ESIC?

1. Sickness Benefit

If you need to take medical leave, ESIC can help cover your expenses. You could get 70% of your average daily pay for up to 91 days per year. To qualify, you need to have worked for at least 78 days during the contribution period. And if you have a long-term or malignant disease, you may be eligible for an 80% enhanced rate of daily pay.

2. Medical Benefits

ESIC provides comprehensive medical benefits to employees and their families from day one of their insurable role. And for a nominal annual premium of ₹120, insured retirees and chronically disabled personnel, along with their spouses, can also avail themselves of ESIC insurance. 

3. Unemployment Allowance

The ESIC Scheme also provides an Unemployment Allowance to insured individuals who have lost their job due to factors such as the company's closure, among other circumstances, as long as they have worked an insurable job for at least three years. Under this benefit, an insured employee with an ESIC account can receive medical assistance from ESI dispensaries or hospitals for up to two years, and they'll get an allowance equal to 50% of their pay. During this time, ESIC may also cover travel expenses related to vocational training.

4. Maternity Benefit

ESIC provides maternity benefits to insured employees. An insured can get 100% of their median salary for twenty-six weeks of maternity leave which can be extended by one month. They must have contributed for 70 days in the two contributions prior to this. Six weeks of benefits are offered for miscarriages and twelve weeks for adoptions.

5. Disablement Benefit

If an employee becomes disabled due to an occupational risk, ESIC provides financial assistance for both short-term and permanent disability. They can receive 90% of their reimbursement, and the same amount is payable to their dependents in the event of the employee's demise. 

ESIC Eligibility & Coverage 

The ESIC eligibility and coverage in India is determined based on specific criteria related to an individual's employment, salary, and nature of work. Here are the key eligibility criteria for ESI: 

Salary Limit Covered

An employee must earn a gross monthly salary of ₹21,000 or less to be eligible for ESI coverage. The government periodically revises this salary threshold, so it's important to check the current limit.

Nature of Employment Covered

The ESI scheme applies to employees working in certain categories of employment such as factories, establishments, or businesses that employ 10 or more persons. However, this threshold may be lower in some states, such as establishments employing 20 or more employees.

Factory or Establishments Covered

Employees working in factories and certain types of establishments, such as shops, hotels, restaurants, cinemas, and more, are eligible for ESI coverage if they meet the salary criteria.

Type of Employees Covered

The ESI scheme covers the primary employee and their immediate family members, including spouse and dependent children. The family members are entitled to various medical and cash benefits.

Voluntary Coverage

In some cases, employees earning above the prescribed limit can also opt for voluntary ESI coverage by making a formal request to the Employee's State Insurance Corporation (ESIC).

How to Claim ESI Benefits?

If you possess a valid IP number or ESIC Insurance number, you are eligible to seek two categories of ESI benefits:

  • Cash Benefits: Individuals covered by the ESI scheme, such as employees and workers, have access to cash benefits for various situations, including sickness, disability (temporary or permanent), maternity, unemployment, dependency, funeral expenses, and vocational and physical rehabilitation.
  • Medical Benefits: Both you and your dependents can access medical care. To avail of this benefit, simply visit any of the hospitals that are part of the ESI network.

List of ESI Hospitals

The Employees State Insurance Corporation (ESIC) has established partnerships with numerous hospitals nationwide. To access the comprehensive directory of ESI hospitals in India, please visit the ESIC Portal

Conclusion

The ESIC scheme is a valuable program that provides financial security and comprehensive medical benefits to employees and their families in India. The scheme covers a range of benefits, including sickness, disability, unemployment, maternity, and more. The eligibility for the scheme is based on the employee's salary and the organisation's size. It is an important step towards promoting social welfare and ensuring a better quality of life for workers across India.

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Frequently Asked Questions

1. What is ESIC in salary?

The employer's contribution to the ESIC scheme is set at 3.25% of wages, while the employee's contribution is set at 0.75% of the wages. So, if you're enrolled in the ESIC scheme, your employer will pay 3.25% of your wages towards the scheme, and you'll pay 0.75%.

2. Who is eligible for ESIC?

To qualify for the ESIC scheme, the employee or worker's monthly salary can't be more than ₹21,000 or ₹25,000 for those with disabilities. So, if you earn more than that, you won't be eligible for the scheme.

3. What is the function of ESIC?

ESIC is a program in India that provides financial and medical support to employees and their families. It helps with things like sickness, disability, unemployment, maternity, and more. It's basically the country's social security system for workers.

4. What is the difference between ESI and ESIC?

ESIC is a program in India that provides financial and medical support to employees and their families. It's basically the country's social security system for workers, and it's administered by the Employees' State Insurance Corporation (ESIC).

5. Is it Mandatory for Companies to Register for ESI?

Registering for ESI is mandatory for establishments employing 10 or more people and paying a monthly wage of up to ₹21,000 per employee. 

Disclaimer

Fi Money is not a bank; it offers banking services through licensed partners and investment services through epiFi Wealth Pvt. Ltd. and its partners. This post is for information only and is not professional financial advice.
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