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Employees State Insurance Scheme: Eligibility, Coverage, Benefits

What Is Employees’ State Insurance Scheme?

ESI stands as a social security initiative provided by the Indian government under the Employees’ State Insurance Act of 1948. It aims to safeguard employees from disability, and death caused by work-related injuries, illness, and maternity-related issues. To access medical care and other advantages, workers need to enroll in the program. The plan assists in compensating for the wage loss resulting from health problems and operates on a self-sustaining model where both employees and employers make monthly financial contributions based on a percentage of their earnings.

Employees State Insurance Act, 1948:

In 1948, the Employees State Insurance Act was enacted with the primary objective of providing financial support during illness, maternity, and disability while extending healthcare benefits to factory and establishment workers, as well as their dependents. The act is commonly referred to as ESIC for short. Once the Employees State Insurance Act of 1948 is put into action, it governs all employee funds in accordance with the stipulations outlined in the act. The Ministry of Labour and Employment oversees its operations as a statutory body, established on February 24, 1952.

Employees’ State Insurance Scheme: What is Covered?

The Employees State Insurance Scheme was launched In 1952 in Kanpur and Delhi, where it began its journey. However, as industrialisation continued to gain a steady pace over the nation, the scheme witnessed widespread adoption. By March 31 2019, it had widened its spectrum to Union Territories and over 34 states.

Today, the Employees State Insurance Act expands over almost 12 lakh businesses and factories, directly benefiting more than 3 crore employees and their families. This far-reaching scheme now provides essential support to over 13 crore employees across the country.

Employee's State Insurance Scheme: What Is Not Covered?

As of now, the ESIC program excludes individuals whose monthly earnings exceed Rs. 21,000, with a slightly higher limit of Rs. 25,000 for those with disabilities. Additionally, in Maharashtra as well as Chandigarh, the coverage threshold remains at 20 employees, differing from the standard 10 employees in other states and union territories.

Contribution Rates

ESI contributions for an employee consist of both the employer’s and the employee’s shares. These contribution rates are fixed and subject to periodic revisions. As of 2023, the employer’s ESI contribution rate stands at 3.25% of the employee’s wages, while the employee’s contribution rate for 2023 is 0.75% of their wage.

Moreover, if an employee’s daily average wage is up to INR 137, they are exempt from making contributions, although employers still need to fulfil their share. The ESI contributions are determined based on the wages paid to employees, with the following rates:

  1. ESI Employer’s Contribution Rate: 3.25% of the wage payable.
  2. ESI Employee’s Contribution Rate: 0.75% of the wage payable.

The total ESI contribution is calculated by adding the employer’s and employee’s contributions together.

Contribution Period

ESIS offers 2 contribution periods and 2 corresponding cash benefits periods. Here are the details as follows.

Contribution Period Cash Benefit Period
1st April to 30th September1st Jan of the following year to 30th June
1st October to 31st March of the following year1st July to 31st December

Employees State Insurance Scheme (ESIS) Infrastructure:

From its establishment in 1952, the Scheme’s infrastructure has consistently grown to address the evolving social security needs of an expanding workforce. The ESI Corporation has established a network of medical facilities, as well as specialised centres for occupational disease management, providing crucial services to workers. Here’s a breakdown of their extensive network:

Service typeNumber/Location
Hospital and Network hospitals151 hospitals and 42 annexes
Primary & Outpatient ServicesApproximately 1450 ESI dispensaries/AYUSH units and 954 panel clinics
Cash Benefit Payment FacilitiesLocated in Mumbai (Maharashtra), New Delhi, Kolkata (W.B.), Chennai (T.N.), and Indore (M.P.)
Occupational Disease CentersOver 628 Branch Offices/Pay Offices that is supervised by a total of 62 Sub-Regional or Regional Offices and and Divisional Centres.

Employees State Insurance Scheme (ESIS): Features And Benefits:

The Employees State Insurance Act of 1948 is instrumental in offering compensation benefits to employees, accompanied by an array of advantages. Here are some features and benefits of ESIS:

  1. Maternity Benefits: Among the most notable perks, this Act extends special provisions to pregnant women. They are entitled to additional leave both before and after childbirth, allowing them to stay away from work for months surrounding the delivery while receiving their full salary.
  2. Medical Benefits: Employees undergoing treatment do not experience salary deductions. Additionally, they receive a percentage of compensation in cases of severe medical conditions affecting their family members.
  3. Unemployment Benefits: The Act offers monthly compensation to eligible unemployed individuals and extends financial assistance, including loans at reduced interest rates, for those aspiring to launch their startups.
  4. Disablement Benefits: Differently-abled individuals receive extra support through the Employees State Insurance Act of 1948, with specific reservations for various disability categories.
  5. Insurance Benefits: This Act covers insurance benefits for both government and private sector employees, ensuring comprehensive coverage.

When is ESI Registration Required?

Employers falling under the purview of the ESI Act are obligated to undergo mandatory registration within the ESI scheme. This requirement applies to factories or establishments with over 10 employees (though this threshold can be 20 employees in some states), where the maximum monthly wages do not exceed Rs. 21,000. Registration with the ESIC must be completed within 15 days from the point at which the organisation falls under the ESI Act’s coverage.

 

Documents Needed For the Registration of ESI Online:

Here is the checklist of documents necessary for the online ESI registration process:

  1. The registration certificate if it’s a partnership or company.
  2. Registration Certificate obtained under the Factories Act or the Shops and Establishment Act.
  3. The official documents regarding the AOA or the Articles of Association as well as the MOA, i.e. the Memorandum of Association of the registered company.
  4. Detailed compensation information for all employees.
  5. A comprehensive data list of all the workers.
  6. A cancelled cheque from the company’s bank account.
  7. PAN Card particulars for both the company and all employees.
  8. A record containing the names of individuals holding shares and company directors.
  9. The official form of Employer’s Registration must be downloaded, completed, and posted on the section required on the ESIC portal accompanied with the aforementioned documents.
  10. An attendance register outlining employee attendance details.

Official Process For The ESI Registration:

The official process of the Employees State Insurance Scheme is made completely online, so you don’t have to worry about submitting anytime physically prior to or post the process. The following is the process you need to follow in order to register:

  1. Open the official ESIS website, and choose the “Login” option.
  2. Once you’re redirected to a new portal, choose the “Sign up” option.
  3. Fill in the blanks with your employer name, company name, region, state, email ID and phone number.
  4. Tick the boxes for verification that your factory or establishment is present under ELC, security agencies, manpower suppliers, or contractor-supplying categories.
  5. Select the submit option and you will receive an email.
  6. Visit the ESIC Portal and log in using the provided username as well as password from your email.
  7. Choose ‘New Employer Registration’ and specify the type of work.
  8. Provide unit details, such as name, full address, ownership status, and business nature.
  9. Enter employee information, including their number and earnings criteria.
  10. Input the date of employment commencement and any license details if applicable.
  11. Describe the ownership constitution and their details.
  12. Report the amount of employees and those who are making less than an amount of Rs. 21,000.
  13. Proceed to the ‘Employee Declaration Form,’ where you can register insured persons.
  14. Submit relevant details for each insured person.
  15. Declare the accuracy of the information provided.
  16. Select your ESI branch office and inspection division.
  17. Verify the provided information and proceed to pay the initial contribution.
  18. Complete the payment through the designated payment gateway. You’ll receive a Challan Number for reference.

How To Apply for a Pehchan Card for ESI?

The procedure to acquire an ESI card within the ESI scheme involves several steps:

  1. First, the employer must log in to the ESIC portal.
  2. Within the dashboard, the employer should select the ‘e-Pehchan Card’ option under the ‘Employee’ tab.
  3. Here, the employer will need to input the ‘Employee Insurance Number’ and click ‘View.’
  4. The insured person’s details will be displayed, and the employer should then select ‘View Counter Foil’ under the ‘Registration Employees Details’ tab.
  5. The counterfoil of the e-Pehchan card will open, featuring pre-filled employee and nominee details. After verifying these details, the employer should print this counterfoil.
  6. The printed counterfoil is then handed over to the employee.
  7. The employee is responsible for submitting their photograph and the photographs of their dependents to the employer for attestation.
  8. After attestation, the employee should sign the counterfoil and affix the attested photographs.
  9. The next step for the employee is to submit the counterfoil to the nearest ESIC office to obtain the physical e-Pehchan card or ESI card.
  10. When submitting the filled counterfoil at the ESIC office, the employee must bring their dependents along to capture their fingerprints.
  11. After capturing the fingerprints, the ESIC office will dispatch two ESI cards to the insured person via courier.

List of Hospitals under the Employees State Insurance Scheme:

The network of hospitals under the ESI scheme is always changing and improving. You can find the one best fit for you based on your residency or preference, through the official link. The hospitals are listed in an alphabetic order, but you can just type your state and hit search, in order to find the one closest to you.

What is The Progress of ESIC 2nd Generation Reforms (ESIC: 2.0)?

The ESI scheme introduced a series of impactful reforming initiatives in 2015, including:

  1. Launching a 24/7 Helpline (1800 11 3839) for enhanced support.
  2. Digitising the Health Records of ESI beneficiaries (both insured persons and their family members), allowing convenient online access to health records, eliminating the need for hospital visits solely for information.
  3. Introduced Operation Indradhanush (VIBGYOR), a system that mandates daily bedsheet changes according to a colour pattern, ensuring hygienic standards.
  4. Implementing rigorous quality checks on medicines.
  5. Establishing a dedicated Special OPD catering to differently-abled people and senior citizens
  6. Conducting regular inspections of ESIC hospitals by an ESIC member to maintain standards.
  7. Providing x-ray and pathology access facilities through the PPP (Public-Private Partnership) model.
  8. Focusing on behavioural training for paramedics, medical and doctors, introducing a reviews process for inpatients, efficient queue management, and dedicated child and maternal care hospitals.
  9. Creating specialised departments such as CT, ICU, MRI, CAT-Labs, and dialysis units.
  10. Offering additional services like ‘May I Help You’ counters, Yoga, and Ayush, and enhance the overall healthcare experience.

ESI Scheme Do’s and Don’ts:

It’s crucial for workers to be well-informed about the dos and Don’ts for making the most of ESI scheme benefits. Here’s a concise breakdown:

Do’s Don’ts 
Protect your Pehchan Card, it’s your social security.Do not include non-eligible individuals on your Declaration Form.
Inform your new employer if you have a Registration Number of the ESI to avoid conflicts.Never lend your ID proof or Pehchan Card to anyone.
Carefully follow all ESIC instructions when opting for benefits.When there are changes in your family, update or delete family members accordingly.
Report theft or loss of your card promptly for a speedy recovery process.Do not tamper with or deface your Pehchan Card or ID proof.
Comply with doctor’s instructions diligently.Never fake illness or injury to claim scheme benefits; it’s a punishable offence.
Adhere to referral procedures within the organisation.Do not forge or fake any document from a doctor; it’s illegal.
Understand that the benefits you receive are linked to your contribution history.Do not pay any money for ESIC forms; they are provided free of charge.

How To Claim The Benefits Under The ESI Scheme?

As an ESI scheme beneficiary, you’re entitled to two main categories of benefits, which are outlined in the table below:

Benefit Type Details 
Cash BenefitsBeneficiaries can receive cash benefits in various situations:
  • Sickness
  • Unemployment
  • Disablement (temporary or permanent) – Maternity
  • Funeral costs
  • Dependent support
  • Vocational as well as physical rehabilitation.
Medical Benefits
  • Access to medical care for both yourself and your dependents.
  • Utilise services at any ESI empanelled hospital.

Process to Check the Status of The ESIC Claim Online:

Here’s a straightforward guide to checking your ESI claim status online:

  1. Download then open the UMANG App on your smartphone and then install the same.
  2. Enter your IP adress or Employees State Insurance Scheme Number and request an OTP by clicking ‘Get OTP.’
  3. Insert the OTP sent to you and click ‘Submit’ to verify your identity.
  4. In the services option, choose ‘Claim Status.’
  5. If you’ve submitted any claims, you will be eligible to review their status.

ESI HO, i.e. the Head Office Along With Helpline Number

Here are the contact details for the ESI Head Office, conveniently listed for you:

ESI Head Office:

  1. Address: Employees’ State Insurance Corporation, Panchdeep Bhawan, Comrade Indrajeet Gupta (CIG) Marg, New Delhi – 110 002
  2. Phone Numbers:
    011-23234092
    011-23234093
    011-23235496
    011-23234098
    011-23236051
    011-23236998
    011-23235187
  3. Medical Helpline: 1800-11-3839
  4. Toll-Free/Help Desk Number: 1800-11-2526
  5. E-Mail Addresses:
    For Grievances/Suggestions: pg-hqrs@esic.nic.in
    For IT Related Issues: itcare@esic.nic.in

These contact details will assist you in reaching out to the ESI Head Office as needed.

Redressal of Public Grievances

You can file your grievances with the Employees State Insurance Scheme through their official Public Grievances form. This form can be downloaded through their official portal. All you need to do is, fill out the form with details such as address, name, phone number, email, and IP number along with the grievance brief and submit it online.

Frequently Asked Questions (FAQs)

Yes, ESIS forms are supplied to employees at no charge, so you should not pay any money for these forms at branch offices.

In case of a lost or stolen Pehchan Card, report it to the Dispensary or Branch Office immediately to expedite the recovery process.

Yes, you can continue to receive ESIS benefits even if you change jobs, as long as you inform your new employer about your existing ESIS registration.

Yes, family members of ESIS beneficiaries, such as spouses and dependent children, can access the scheme's benefits, including medical care and other financial support, if eligible.

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