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EMPLOYEES’ STATE INSURANCE ACT, 1948

Applicability

  1. All factories excluding seasonal factories employing 10 or more persons. (w.e.f 01.06.2010)
  2. Any establishment which the Government may specifically notify as being covered.
  3. Shop Employing 10 or more persons. (Refer Act for Statewise applicability) except Assam, H.P. & Maharashtra

Note : As soon as the above conditions are fulfilled the employer should furnish the details in Form - 01 to ESI office and online for registration under ESI Act, 1948 & for obtaining of the Employer’s Code No.

Eligibility

  1. Any person employed for wages upto र 21000 a month. (w.e.f. 01.01.2017) excluding remuneration for overtime work in or in connection with the work of a factory or establishment;
  2. Any person who is directly employed by the employer in a factory or through his agent on work which is ordinarily part of the work of the factory or incidental to purpose of the factory.
  3. Any person who is classified as disabled employee and working in the private sector, with monthly wages unto र 25,000/- per month provided they are apponted on or after 01.04.2008. Further employer's share will be paid by Central Government for 3 years.
  4. No employees contribution for person drawing wages upto Rs. 137/- per day.

Benefits

  1. Free medical treatment is offered to covered employees at dispensaries and hospital run by the ESI Corporation & Tie-up hospitals, Limited to Rs. 10.00 Lacs per family / per year.
  2. About 70% of employees normal wage will be payable to him by ESl during sickness.
  3. Maternity benefit for 26 weeks of which not more than 12 weeks should be preceding confinement.
  4. Injury during/in course of employment resulting in temporary/permanent disablement entitles the covered employee to a regular payment to substitute his lost wages.
  5. Death during course of employment entities specified dependents to a regular payment.
  6. One time payment of र 10,000 to help meet funeral expenses. (w.e.f. 1.4.2011)
  7. Rajiv Gandhi Shramik Kalyan Yojna (Unemployment of the IPs who have been rendered unemployed involuntarily due to closure of factory/ establishment / retrenchment or permanent disablement)
  8. Vocational Rehabilitation Scheme (applicable to IPs in whose case loss of earning capacity resulting from employment injury, assessed as not less then 40%.)
  9. Insured person can avail cashless treatment in the hospitals referred by ESI Hospital.
  10. Medical benefit to IPs who have opted for VRS or superannuated.
  11. Super speciality treatment - for I.P. - 90 day, for family - 190 days.

Penal Provision for non-payment

For employees' contribution: Imprisonment for 1yr. to max. 3yrs. and/or fine of र 10,000/-

For employer‘s contribution: Imprisonment for 6 mths. to max 2 yrs. and/or fine of र 5,000/-

Temporary Disablement
90% of the Standard Benefit Rate
Benefit & Dependent Benefit Rate
Maternity Benefit Rate
Standard Benefit Rate

Note:-

  1. w.e.f. 1st April 2015, employers can pay their ESI contributions either through net banking or cheques, However, w.e.f. 1st May 2015 only electronic payment will be accepted by ESIC through net banking of SBI or 58 Major Banks.
  2. ESIC has been Made applicable to construction site workers w.e.f. 01/08/2015.
  3. On 8th April, 2016, ESIC issued a memorandum wherein it stated that the interest on omitted wages shall be claimed in the same manner as claiming interest on regular contribution u/s 39(5) of the ESI Act read with the Regulations 31. The bonafide impression of employer, whether remunerations paid to a worker in a covered unit constitute ‘wages’ u/s 2(22) of the ESI Act or not, does not absolve the employer from the liability of paying the interest on the delayed payment of contribution.
  4. W.e.f. 12th April, 2016 ESIC introduced Aadhar based authentication of the beneficiaries under the Act. Henceforth, in respect of insured persons who have entered their Aadhar numbers in the ESIC database will not have to separately enroll for the Biometric Pehchan Card. In absence of Aadhar number, the TIC (hereinafter e- Pehchan Card) will be valid only for a period of 30 days after registration. If the member does not wish to provide Aadhar number then he has to enroll for the Biometric Pehchan Card.
  5. ESI Act, 1948 has come into force in the following states;
    Effective Date States
    1st March, 2016 Several revenue villages of the Malappuram & Kottayam districts in kerala.
    1st April, 2016 12 revenue villages in Himachal Pradesh
    1st May, 2016 Areas falling in Narayanapuram and its surrounding 14 revenue villages in Ungutur Mandal of West Godavari District in Andhra Pradesh
    1st May, 2016 5 districts in Telangana and 1 district in Haryana
    1st August, 2016 28 districts in Rajasthan, 20 districts in Maharashtra and 8 districts in Jammu & Kashmir
    1st September, 2016
    1. 9 districts in Andhra Pradesh
    2. 16 districts in Bihar
    3. 4 districts in Karnataka and
    4. 22 districts in Madhya Pradesh

  6. W.e.f., 6th October, 2016, in areas where the ESI Act is implemented for the first time the rates of employer’s and employees' contribution for the initial 24 months from such date of implementation, shall be as under;

    1. Employer's contribution - A sum (rounded to next higher rupee) equal to three per cent of the wages payable to an employee; and
    2. Employee's contribution - A sum (rounded to next higher rupee) equal to one per cent of the wages payable to an employee:

    Provided that on completion of twenty-four months from the date of implementation of the Act, the rate of contribution as provided under rule 51 shall be applicable.”


  7. W.e.f. 01/06/2017 the ESI Contribution in respect of any employees shall be paid within 15 days of the last day of the Calender monthe in the contributions fall due, This shall come into force with effect from the contribution payable for the month of June-2017 i.e. by 15th July, 2017

New Amendments to the ESI Act, 1948

  1. Labour Ministry has proposed amendment in rule to increase the wage limit of Rs. 15000/- to Rs. 21000
  2. Labour Ministry has proposed to make changes in ESl Rules as under: -
    1. Increase Maternity Benefit from 12 weeks to 26 weeks for 1st two children. [Rule 56(2)]
    2. Women having 2 or more surviving children can avail maternity benefit of maximum 12 weeks (3rd proviso to rule 56 (2))
    3. ‘Insured woman’ shall indude commissioning mother and adopting mother.
    4. 12 weeks maternity benefit to a Commissioning Mother and Adopting Mother. [2nd proviso to rule 56 (2)]
    5. Sub-rule 4 to rule 56 which dealt with maternity benefit in case of sickness arising out of pregnancy, confinement, premature birth of miscarriage or medical termination of pregnancy shall be omitted.

Both the draft rules will be taken into consideration after expiry of a period of thirty days from the date on which the copies of the Offical Gazette in which the notification is published, are made available to the public;


Note: FOR ALL ESI REGIONAL OFFICES AND BRANCH OFFICES ADDRESS IN INDIA, THE SAME ARE AVAILABLE ON ESIC WEBSITE www.esic.nic.in



Employees’ State Insurance Corporation is a premier organization providing Social Security to workforce in the form of Medical and Cash Benefits in the contingencies of Sickness, Maternity, Disablement or death due to employment injury.
SI.No Benefits Entitlement Duration Rate of Benefit
1 Medical Benefit One should be an insured person From day one of entering into insurable employment to till date in insurable employment and during the corresponding benefit period. Reasonable medical care, Super Speciality treatment, comprehensive medical care & clinical investigation as per eligibility
2(a) Sickness Benefit 78 days in relevant Contribution Period Up to 91 days in two consecutive Benefit Period 70% of average Daily wages
2(b) Enhanced Sickness Benefit 78 days in one Contribution Period 7 days/ 14 days for male/female insured person respectively for undergoing sterilization operation 100% of average Daily wages
3 Extended Sickness Benefit 156 days in 4 consecutive Contribution Period 124 to 309 days may be extended to 730 days in case of specified long term diseases 80% of average Daily wages
4(a) Temporary Disablement Benefit From day one of entering Insurable employment As long as temporary disablement lasts 90% of average Daily wages
4(b) Permanent Disablement Benefit From day one of entering Insurable employment For whole life Depending upon loss of earning capacity of Insured
5 Dependents Benefit From day one of entering Insurable employment Paid to the dependents of the Insured Person. Who dies as a result of employment injury, in manner as detailed in Rule 58 90% of average Daily wages. Shareable in fixed proportion.
6 Maternity Benefit 70 days in immediately preceding 1 or 2 consecutive Contribution Periods 26 weeks in case of normal delivery for 1st two surviving child thereafter 12 weeks. 6 weeks in case of miscarriage. 12 weeks for commissioning/adopting mother. 100% of average Daily wages
7 Rajiv Gandhi Shramik Kalyana Yojana Insurable employment for the last 2 years with 78 days contribution paid/payable in each Contribution Period, Involuntary Unemployment due to closure of factory, retrenchment or permanent disablement due to non-employment injury>40% For a maximum period of 24 months. Vocational training of up to 1 year for upgrading skill of Insured Persons receiving unemployment allowance. I. Unemployment allowance at the rates of i. 50% of last avg. daily wages - 0 to 12 Months. ii. 25% of last avg. daily wages - 13 to 24 Months 2. Medical care for self and family during receipt of unemployment allowance.
8 Funeral Expenses From day one of entering Insurable employment For defraying expenses on funeral of an Insured Person Actual expenses subject to a maximum of Rs. 10000/-
9 Confinement expenses No condition other than insurable employment. Up to two confinements Rs. 5000/- per case of confinement to an Insured Women or an Insured person in respect of his wife in case facilities for confinement are not available in ESI institutions.
10 Medical Care to retired Insured Persons Superannuated/permanently retired/retired under VRS /Pre-mature retirement/ permanently retired due to employment injury after being in insurable employment for 5 years/spouses of such deceased Insured Persons/spouses receiving Dependent Benefit. On yearly basis. Medical facility within ESIC on payment of Rs. 120/- for self

Supply of special aids: Insured persons and members of their families are provided artificial limbs, hearing aids, artificial dentures. spectacles (for insured person only) & artificial appliances like spinal supports, cervical collars, walking calipers, crutches. wheel chairs and cardiac pace makers, dialysis/dialysis with kidney transplant etc. as part of medical care under the ESI Scheme.


CONTRIBUTION PERIOD (C.P) BENEFIT PERIOD (B.P.) DATE OF SUBMISSION OF RETURN

1st April to 30th September
1st October to 31st March

1st January to 30th June
1st July to 31st December

11th November
12th May


RECORDS TO BE KEPT READY FOR ESI INSPECTION

  1. Attendance Register/Muster Roll.
  2. Salary/Wage Register/Payroll.
  3. EC (Employees’ & Employer’s Contribution) Statement.
  4. Employees’ Register U/R 32(Form 7)
  5. Accident Register U/R 66.
  6. Return of Contribution (RC-Form 6)
  7. Return of Declaration Forms (RDF - Form3)
  8. Receipted Copies of Challans
  9. Inspection Book.
  10. Employer & Bank Details.
  11. Books of Accounts viz Cash/Bank Book, Expense register Sales/Purchase Register, Petty Cash Book, Ledger Supporting Bills and Vouchers, a/w Delivery ChaIIans (if any)
  12. Contractor Details.

ESI - IMPORTANT CHANGES AT A GLANCE

1. Contribution Repealing of Chapter V A and Consequent discontinuance of Employer's Special Contribution.

w.e.f. 01-07-1973

2. Rate of Contribution Employees' Share Employer's Share.
  1. 2.00% of wages 5% of TWB = 7%
  2. 2.25% “--------” 5% " = 7.25%
  3. 1.50% “-------" 4% " = 5.50%
  4. 1.75% “--------” 4.75% = 6.50%

07-07-83 to 26-01-1985
27-01-85 to 31-03-1992
01-04-1992 to 31-12-96
from 01-01-1997
3. Ceiling limit for coverage u/s 2(9) Total wages *
र 400/-
र 500/-
र 1,000/-
र 1,600/-
र 3,000/-
र 6,500/-
र 7,500/-
र 10,000/-
र 15,000/-
र 25,000/- for physically handicapped
र 21,000/-
Date from which applicable
up to 30-06-1973 * excluding
from 01-07-1973 i) Overtime
from 30-11-1975 ii) Washing Allowance where uniform supplied for employee
from 27-01-1985
from 01-04-1992
from 01-01-1997
from 01-04-2004
from 01-10-2006
from 01-05-2010
from 01-04-2011 upto 3 Years from date of appointment
from 01/01/2017
4. Ad hoc Calculation of Contribution Assumed wages per month
र 350/-
र 440/-
र 550/-
र 880/-
र 1,650/-
र 3,575/-
र 4,125/-
र 5,500/-
र 8,250/-
from 01-06-1976
from 07-09-1980
from 01-04-1983
from 27-01-1985
from 01-04-1992
from 01-01-1997
from 01-04-2004
from 01-10-2006
from 01-05-2010
5. Coverage of employees working in H.O/B.O/S.O. etc u/s 2(9) w.e.f. 28-01-1968
6. Extension of coverage to commercial sectors in Mumbai Region u/s 1(5) of the Act.
Sectors covered :
  1. Hotels & Restaurants
  2. Cinema Theatres including Preview theatres
  3. Shops
  4. Newspaper Establishments
  5. Road Motor Transport

w.e.f. 12-11-1978




w.e.f. 13-03-1989
7. Rate of Interest Rate
6%
12%
15%
12%
Period from which applicable
up to 19-10-1989
from 20-10-1989
from 01-09-1994
from 01-10-2005
8. Rate of damages (by way of Penalty) 19%
13%
Slab system
  1. Below 2 months 5%
  2. 2 months & above, but below 4 months 10%
  3. 4 months & above, but below 6 months 15%
  4. 6 months & above (Subject to max 100%) 25%
from 09-75 up to 19-10-89
from 20-10-89 up to 31-12-91
from 01-01-1992

LIST OF DISEASES FOR WHICH EXTENDED SICKNESS BENEFIT IS ADMISSIBLE

  1. Tuberculosis
  2. Leprosy
  3. Chronic Empyema
  4. Bronchiactesis
  5. Intersistial Lung Disease
  6. HIV / AIDS
  7. Malignant Diseases
  8. Diabetes Mellitus with proliferative retinopathy / diabetic foot / Nephropathy.
  9. Monoplegia
  10. Hemiplegia
  11. Paraplegia.
  12. Hemiparesis
  13. lntracranial space occupying lession
  14. Spinal Cord Compression
  15. Parkinson's disease
  16. Myaesthenia Gravis / Neuromuscular Dystrophies
  17. Immature Cataract with vision 6/60 or less
  18. Detachment of Retina
  19. Glaucoma
  20. Coronary Artery Disease
    1. Unstable Angina
    2. Myocardial Infarction with ejection less than 45%
  21. Congestive Heart Failure Left / Right
  22. Cardiac Valvular Diseases with failure complications
  23. Cardimyopathies
  24. Heart Disease with Surgical Intervention alongwith complications
  25. Chronic Obstructive Lung Disease (COPD) with congestivem heart failure (Cor Pulmonale)
  26. Cirrhosis of liver with ascitie / chronic active hepatitis.
  27. Dislocation of vertebra / prolapse of intervertebral disc.
  28. Non union or delayed union of fracture.
  29. Post Traumatic Surgical amputation of lower extremity.
  30. Compound Fracture with chronic ostemyelitis.
  31. Psychosis- the following sub groups:-
    1. Schizophrenia
    2. Endogenous depression
    3. Manic Depressive Psychosis (MDP)
    4. Dementia
  32. More than 20% burns with infection / complication.
  33. Chronic Renal Failure
  34. Reynaud's disease/ Burger's disease