ESI Scheme

offers a host of advantages

to Employers

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 ESI SCHEME-AN INTRODUCTION
The Employees’ State Insurance Scheme is an integrated measure of Social Insurance
embodied in the Employees’ State Insurance Act and it is designed to accomplish the task of
protecting ‘employees’ as defined in the Employees’ State Insurance Act, 1948 against the
impact of incidences of sickness, maternity, disablement and death due to employment injury
and to provide medical care to insured persons and their families. The ESI Scheme applies to
factories and other establishment’s viz. Road Transport, Hotels, Restaurants, Cinemas,
Newspaper, Shop, Educational/Medical Institutions wherein 10 or more persons are
employed. However, in some States threshold limit for coverage of establishments is still 20.
Employees of the aforesaid categories of factories and establishments, drawing wages upto
` 15,000/- a month, are entitled to social security cover under the ESI Act.
The ESI Scheme is financed by contributions from employers and employees. The rate of
contribution by employer is 4.75% of the wages payable to employees. The employees’
contribution is at the rate of 1.75% of the wages payable to an employee. Employees, earning
less than `100/- a day as daily wages, are exempted from payment of their share of
contribution.

BENEFITS UNDER ESI SCHEME

Sickness
l Benefit l
Disablement Benefit l
Dependants’ Benefit
Maternity
l Benefit l
Medical Benefit
Other benefits being provided to the beneficiaries are Confinement Expenses, Funeral
Expenses, Vocational Rehabilitation, Physical Rehabilitation, Unemployment Allowance and
Skill Upgradation Training.

ADVANTAGES TO EMPLOYERS
Employers who come under the purview of the ESI Act, 1948, derive the following benefits
under the Scheme:-
lEmployers are absolved of all their liabilities of providing medical facilities
to employees
and their dependants in kind or in the form of fixed cash allowance, reimbursement or
actual expenses, lump sum grant or opting for any other medical insurance policy of
limited scope, unless it is a contractual obligation of the employer.
lEmployers are exempted from the applicability of the :
Maternity Benefit Act.
l

Employees’ Compensation Act, in respect of employees covered under the ESI Scheme.
l

lEmployers have, at their disposal, a productive, well secured workforce - an essential

ingredient for better productivity.
lEmployers are absolved of any responsibility in times of physical distress of workers such
as sickness, employment injury or physical disablement resulting in loss of wages, as the
responsibility of paying cash benefits shifts to the Corporation in respect of insured
employees.
lAny sum paid by way of contribution under the ESI Act is deducted in computing
'income' under the Income Tax Act.
lIncentive Scheme for employers for persons with disabilities:
The Incentive Scheme for employers in private sector for providing employment to persons
with disabilities has come into force w.e.f. 1.4.2008. Persons with disabilities employed on
or after 1.4.2008 and drawing monthly wages upto ` 25,000/- are covered under the
scheme. Employers are exempted from paying employer’s share of contribution upto a
maximum period of 3 years and the same is reimbursed to the Corporation by the
Central Govt.

ROLE OF EMPLOYERS
lGet your factory/establishment registered within 15 days after the ESI Act becomes
applicable. Apply online to the Regional Office/Sub-Regional Office (RO/SRO) of the
ESIC for this purpose. Obtain Employer's Code No. for use in all ESIC Forms/documents
and also for correspondence with various offices of the ESIC.
lEmployers are advised to apply for coverage only through the ESIC web portal -
'[Link]'.
lAfter generation of 17 digit Employer’s Code No., the requisite documents should be
submitted to the RO/SRO.
lIn case of Labour/Manpower supplying agencies, challan of advance contribution should
be generated by the employers through the ESIC web portal, deposited in the bank and
then documents may be submitted to the RO/SRO for issuance of 17 digit Employer’s
Code number.
lPay ESI contributions (Employers' share @ 4.75% of the wages and employees' share
@ 1.75% of the wages) within 21 days of the following month, in which the wages fall due.
lThe employee Insurance Number, once given, is valid for the lifetime of an employee. He
need not register himself again if he changes location or employment. The Insurance
Number is a unique number, valid throughout the country.
lEmployer must ensure that the employee does not have any previous Insurance Number
before registering him as a new Insured Person. This is for the benefit of the employee.
lIn case the employee has already contributed in a particular Insurance Number, the same
number should be continued.
lUse of same Insurance Number will help to safeguard the medical history of the Insured
Person for reference and referral.
lThe employers themselves have been authorized to upload personal particulars of
employees, including family members of such employees. Hence, change of name
cannot be executed.
lDeletion of contribution once uploaded and challan once generated are not allowed.
lTransfer of contributions can be done to the Insurance Number which has a Pehchan Card
enrolment. Such transfers would be done only if both IP names and IP Numbers are same
and mapped to the same employer.
lPlease ensure that all employees have completed biometric enrolment for issue of
Pehchan Card.
lEmployers should upload/update their particulars viz e-mail ID, Mobile Number & PIN
Code of the area to the ESIC web portal '[Link]'.
lFill Form 01-A to the concerned authority by the 31st of January every year.
lSubmit an 'Accident Report' to the Branch Office (BO)/ESI Dispensary concerned
immediately in respect of accidents that could result in death or disablement of the
employee within 24 hours of its occurrence. Minor accidents which do not cause absence
from work need not be reported.
lGrant leave to insured employees on the basis of sickness certificates issued by any
authorized ESI doctor.
lEnsure that Return of Contribution is generated in time by making regular payments.
lFurnish any requisite information promptly as and when asked for by the
RO/SRO/BO/any other office of the Corporation/Scheme.
lFacilitate proper inspection of factory/establishment by any authorized officer of the
Corporation and produce before him all relevant records on demand.
lIntimate the date of closure or shifting (temporary or permanent) of the factory/
establishment to the RO/SRO/BO within seven days of its closure or shifting.
lPromptly report any change in the business activity, ownership of the concern or its
management.
lAscertain the liability towards ESI dues, while taking over the ownership of any factory/
establishment by purchase, gift, lease or licence or in any other manner whatsoever as
new owner is liable to discharge the past liabilities, if any.
lMaintain proper sanitation for a hygienic and healthy environment within the workplace
and in residential quarters allotted to the insured persons.
 WHAT TO DO WHEN
To ensure smooth flow of ESI Benefits to Insured Employees
lOnline registration of employees may be done correctly and promptly on appointment,
with all relevant information.
 Print out of Temporary Identification Certificate may be given to employees so that they
can avail of ESI benefit.
 Ensure that employees complete the formalities for enrollment and issue of Pehchan
Card, at the earliest.
 On receipt of Pehchan Cards from the BO, the same should be passed on to the insured
employees without delay.
 In order to facilitate a newly Insured Person to avail medical benefit under the Scheme in
absence of an identity certificate/identity card, a 'Certificate of Employment' may be
issued to the Insured Person in Form-86. This certificate, issued by the employer, remains
valid for 3 months but can be revalidated for a further period not exceeding 3 months.
 Whenever events, such as, marriage, birth or death entails any additions or deletions in the
family particulars of an Insured Person, the requisite information may be uploaded in the ESIC
web portal.
 On re-entry of a person into insurable employment or, where an Insured Person had been
disentitled to medical benefit due to non-generation of Return of Contribution, the
employer may issue a 'Certificate of re-employment' or 'continuing employment' to such
person in Form ESIC-37. This certificate will enable the Insured Person to avail of medical
benefit from the date of its issuance.
 If an insured employee needs a change of dispensary due to any valid reasons, the
employer may change the dispensary from the drop down list in the ESIC web portal.
 Whenever an Insured Person goes out of station on duty or leave, he may be issued a
certificate in Form ESIC 105. This will enable him and his family to avail of medical
treatment in ESI Dispensaries/hospitals elsewhere, if available at such outstation
locations.
 If any insured person is in need of a duplicate Pehchan Card, an application may be made
to the Branch Office Manager in Form ESIC-72.
 Employers may assist or guide individual employees, for claiming any lawful benefit under
the ESI Scheme, and also educate them properly about their rights and responsibilities
under the Scheme.
 The usefulness of the ESI Scheme in the face of an untoward event resulting in loss of
wages or earning capacity could be explained to the employees.
 For clarification of any doubt vis-à-vis your rights and responsibilities under the ESI Act, it
is advisable to get in touch with a ESIC official rather than depend on advice from self-
proclaimed consultants or any other unauthorized persons.
 RIGHTS OF EMPLOYERS
lTo be represented on ESI Corporation, Medical Benefit Council and other important
committees of the Corporation that may be formed from time to time.
 To be supplied requisite Forms as may be required for fulfilling any obligation under the
ESI Act.
 To recover employees share of contribution on the spot from the wages of insured
person.
 To appeal to appellate authority of the ESI Corporation in case of dispute on the claim.
 To appeal to Employees’ Insurance Court if not satisfied with the findings of Appellate
Authority.
 Right to seek exemption from the applicability of the Scheme in case benefits provided by
the management are similar or superior to those available under the ESI Scheme.
 Right of access to all essential information concerning the applicability of the Act,
benefits, contribution, inspections and other procedures.
ROLE OF ESIC IN SERVING EMPLOYERS
 To develop a responsive, purposive and productive relationship with employers.
 Seek their active involvement in the improvement of the ESI Scheme.
 Provide them necessary guidance in fulfilling their lawful obligation under the ESI Act.
 Make available to them requisite Forms and Proforma as may be required by them from
time to time.
 To ensure that any lax medical certification by IMOs/Panel Doctors does not bring down
the productivity of a factory or establishment.
 To ensure that in case of any difficulty, doubt or misunderstanding, employer is given a
chance to be heard at an appropriate level.
 To ensure that all correspondence emanating from the employer is responded to timely
and objectively.
 To ensure that an employer is not being harassed by any official of the Corporation
authorized to inspect the premises or the records of the employer.
 To ensure that any grievances received from employers are looked into promptly for
speedy redressal.
 SUVIDHA SAMAGAM
In order to deal with oral, written complaints/suggestions and grievances, Suvidha Samagam
is being held regularly in various field offices i.e. at RO/SRO/ESIC Hospitals on 2nd
Wednesday of every month and at ESIC BO on 2nd Friday of every month.

NEW INSPECTION POLICY-2014

OBJECTIVE
The Inspection Scheme aims to achieve the objective of simplifying business regulations and
bring in transparency and accountability in labour inspections. It envisages objective criteria
for selection of units for inspection.
Mandatory Inspection under New Inspection Policy - 2014
Mandatory Inspection for following categories
lAll New Covered/Registered Units.
 Units which have been defaulter for six months.
 Units for which Closure Request has been received.
 Units where no Inspection was carried out in last 3 years.
 Inspections required as decided by the Central Analysis and Intelligence
Unit (CAIU).
SYSTEM DRIVEN INSPECTION CRITERIA
 Drop in contribution by 30% and above compared to previous Contribution Period
(over a period of 6 months). Top 30% of the units falling in this category.
 Drop in number of Employees by 30% and above compared to previous Contribution
Period (over a period of 6 months). Top 30% of the units falling in this category.
 Security/Manpower Agencies employing more than 250 employees, if inspection
was not done in the last two years. Top 30% of the units falling in this category in
terms of no. of employees.
 Any other not faling in above categories (10%).

UNIFIED LABOUR PORTAL [Link]

Shram Suvidha or Unified Labour Portal [Link] is an initiative to
achieve good governance, and ensure welfare in the Labour sector. It is an ambitious step
towards transparency and accountability in the working of Labour ministry. It is the one stop
shop for all labour related services that enables easier compliance mechanism and faster
process.
 ESIC DECISIONS ON MEDICAL SERVICES - JULY, 2014
ESIC always tries to improve its services to suit the needs of India’s workforce. ESIC
constituted a Sub-Committee on Medical Services and Medical Education (MSME) for
improving medical services under the ESI Scheme. The recommendations of the MSME
Committee have been approved by the ESI Corporation in its 162nd meeting held on
31.07.2014 for overall improvement in delivery of medical care under the ESI Scheme. The
decisions are as under:
• Heavy dispensaries (OPD attendance of 200 patients/day or more) shall have facility for
carrying out essential lab investigations like blood sugar, urine analysis, simpler
Biochemistry investigations like KFT, LFT etc. and CBCT & ECG.
• Patients suffering from chronic ailments shall be issued medicines from dispensary for
one month at a time.
• For monitoring the performance of all ESIS Hospitals and Dispensaries in the State, a
State Executive Committee shall be constituted.
• ‘Kahin Bhi Kabhi Bhi’ would now be available for emergency situation only.
• Patients discharged from the hospital could be issued medicines from the hospital for
the period prescribed or maximum for one month, whichever is shorter.
• The patients shall be recommended for referral by the Specialist for SST, by following
specified clinical pathway/specified guidelines in this regard.
• Patients for Super-Specialty Treatment (SST) shall be referred for a specific/particular
procedures.
• Cashless SST shall be provided to only those IPs/beneficiaries who have been duly
referred to tie-up hospitals by ESIC/ESIS institutions.
• The eligibility of patients for SST shall be determined from the date of registration of
IP on IP portal.
• Upper limit on the expenditure for procedures not covered under CGHS package rates
would now be ` 10.00 lakh per beneficiary/year.
• In respect of children of IP, congenital diseases requiring referral to SST and genetic
dis-orders would be eligible for coverage up to the ceiling only in case the child is born
after the IP had become eligible for SST.
• In case of malignancy and chronic renal failure, pre-existing disease shall not be eligible
for coverage so as to prevent potential misuse of SST.
• Dialysis has been brought back within the definition of SST. Therefore, the eligibility for
dialysis shall be the same as that of SST.
• The ceiling on cost of artificial limbs would now be ` 1.00 lakh.
• The ceiling on medical expenditure to be reimbursed to the States has been raised from
` 1500/- per year to ` 2000/- per IP per year.
 REDRESSAL OF PUBLIC GRIEVANCES
The ESI Corporation has set up the Public Grievances Redressal System at all levels i.e. Hqrs.
Office/Regional/Sub-Regional/Divisional/Branch Offices/ESI Dispensaries/ESI Hospitals. To
ensure expeditious disposal and speedy redressal of public grievances under the ESI Scheme,
various measures have been taken by the Corporation. It includes a Toll Free Helpline
No. 1800-11-2526 activated at Hqrs. office.
Besides the above, the following helplines have also been installed in ESIC RO/
SRO to cater to local stakeholders.

Sl. Name of Region Toll Free Helpline Sl. Name of Region Toll Free Helpline
No. No. No. No.
1. Andhra Pradesh 12. Maharashtra
RO, Hyderabad 1800-425-2358 RO, Mumbai 1800-209-4599
SRO, Pune 1800-233-4143
2. Assam
RO, Guwahati 1800-345-3627 13. Madhya Pradesh
RO, Indore 1800-233-4414
3. Bihar
RO, Patna 1800-345-6190 14. Odisha
RO, Bhubaneswar 1800-345-6712
4. Chhattisgarh
15. Punjab
RO, Raipur 1800-233-5172
SRO, Ludhiana 1800-180-0026
5. Goa
16. Puducherry
RO, Panji 1800-233-0132
RO, Puducherry 1800-425-7642
6. Gujarat 17. Rajasthan
RO, Ahmedabad 1800-233-0424 RO, Jaipur 1800-180-6266
7. Haryana SRO, Udaipur 1800-180-6224
RO, Faridabad 1800-180-1475 18. Tamil Nadu
SRO, Gurgaon 1800-180-2526 RO, Chennai 1800-425-7080
8. Himachal Pradesh SRO, Madurai 1800-425-2527
RO, Baddi 1800-180-2862 SRO, Tirunelveli 1800-425-1505
19. Uttrakhand
9. Jammu & Kashmir
RO, Dehradun 1800-180-4161
RO, Jammu 1800-180-7029
20. Uttar Pradesh
10. Jharkhand RO, Kanpur 1800-180-5127
RO, Ranchi 1800-345-6532 SRO, Noida 1800-180-3181
11. Karnataka 21. West Bengal
RO, Bangalore 1800-425-0636 RO, Kolkata 1800-345-4454
SRO, Hubli 1800-425-0037 SRO, Barrackpore 1800-345-5985
For any other information about the ESI scheme individuals or organizations may log on to
ESIC website : '[Link]', '[Link]' or contact any of the officers of ESIC offices/
establishments. Grievances can also be reported in writing, over telephone through Toll Free
Helpline, by post, Email or in person to any of the following officers.
Branch Office Level : Branch Manager
Dispensary Level : Insurance Medical Officer Incharge
Hospital Level : Medical Superintendent/Deputy Medical Supdt.
Regional/ : (i) Regional Director (ii) Director/Joint Director Incharge
Sub-Regional Level (iii) Public Grievance Officer
State Level : (i) Senior State Medical Commissioner (ii) State Medical
Commissioner (iii) Director, Medical, ESI Scheme
Corporate Level (Hqrs.) : (i) Director General (ii) Medical Commissioner
(iii) Insurance Commissioner (iv) Director (Public Grievances)
Address: ESI Corporation, Panchdeep Bhawan, CIG Marg, New Delhi-110002
Website: [Link], [Link], E-mail: jd-pghq@[Link]
Phone: 011-23234092/93/98 Fax: 011-23234537 Toll Free Helpline No.: 1800 11 2526

VIGILANCE RELATED ISSUES

For vigilance related issues, employers and employees covered under the Scheme can contact
the Regional Director, ESIC of their areas or write to the :-

Chief Vigilance Officer (Vigilance)

Employees’ State Insurance Corporation, Panchdeep Bhawan, CIG Marg,
New Delhi-110002 Tel.: 011-23221105 E-mail: cvohq-dl@[Link]

Director (Vigilance)
Tel.: 011-23230434

ONLINE SERVICES
In ESI Corporation, bilingual (Hindi & English) Information Website, '[Link]' and
Service Website '[Link]' are already operational. The following services can be availed
online by stakeholders in case of need:-
i) Registration of employers & employees
ii) Issuance of TIC
iii) Online payment of ESI Contribution by the employers or online generation of
challan for payment of contributions.
iv) Payment of Cash benefits at Branch Offices
v) Facilitation of Medical Care at Dispensaries & Hospitals
vi) Stakeholders may lodge Grievance online and get redressal through internet facility
anytime & anywhere in ESIC.
vii) Stakeholders are empowered to lodge online public grievance through CPGRAM,
Govt. of India vide their Website [Link] and Helpline portal
[Link]

*******************
 Panchdeep Bhawan: C.I.G. Marg, New Delhi-110 002
Website: [Link], [Link] Toll Free No. 1800-11-2526