Employees’ State Insurance Scheme (ESIC)

Getting health insurance is a crucial aspect of at least two areas of life – financial planning for a better future and planning for your health. While a wide array of people today can opt for private health insurance, there may be a section of people who may want to rely on services provided by the state for a variety of reasons. State-sponsored schemes can help multiple sections of society get access to basic healthcare services. The Employees’ State Insurance Scheme (ESIC) stands as a testament to the Indian government's commitment to safeguarding workers from health-related contingencies. Launched with the primary goal of providing financial protection during sickness, disablement, maternity, and more, ESIC ensures that workers and their dependents can face unforeseen challenges without succumbing to financial distress. Let’s take a closer look at the ESIC scheme, its eligibility, and what it has to offer for the beneficiaries. If you are not eligible for this scheme, you may look for other health insurance policies that are rather suitable for you.

What is the ESIC Scheme?

Enacted through the Employees’ State Insurance Act, 1948, the ESIC scheme addresses the social security needs of workers across various sectors. This legislation marked a significant stride in post-independence social security measures, covering workers in factories, business establishments, and organisations employing 10 or more individuals. The ESIC benefits for employees range from medical care and cash benefits to maternity benefits for insured workers and their dependents.

Who is Eligible for the ESIC Scheme?

Employees or workers falling under categories like factories, hotels, road transport, cinemas, newspapers, educational or medical institutions, and shops, with a monthly wage of up to Rs. 21,000, are eligible for ESIC benefits. As of March 31, 2019, ESIC covers around 3.14 crore employees and 13.32 crore beneficiaries across various states and union territories. It’s important to note that the scheme does not cover individuals earning more than Rs. 21,000 per month.

Benefits and Inclusions

Let’s take a look at some of the ESIC benefits for employees.

Medical Benefits

ESIC provides comprehensive medical coverage from day one of employment. The infrastructure includes 151 hospitals, 42 annexes, 1450 ESI dispensaries, 188 Ayush units, and 954 panel clinics. Workers and their dependents can access affordable healthcare facilities under this scheme.

Maternity Benefits

Pregnant beneficiaries can avail 100% of daily wages for up to 26 weeks, extendable by one month based on medical advice. In cases of miscarriage or adoption, specific benefits are provided, emphasising the scheme's commitment to family welfare.

Disability Benefits

In the event of temporary disablement, workers receive 90% of their monthly wage until recovery. In cases of permanent disability, this benefit continues for the entire duration of the individual’s life, providing financial stability during challenging times.

Sickness Benefits

During medical leave, the scheme ensures a steady cash flow, offering 70% of the daily wage for a maximum of 91 days. This financial support helps workers meet their daily needs while recovering from sickness.

Unemployment Benefits

For up to 24 months, workers facing involuntary loss of non-employment or permanent invalidity due to injury can receive a maximum of 50% of the average monthly wage. This provision ensures financial security during periods of job loss or incapacitation.

Dependents Benefits

The dependents of insured workers receive financial assistance in case of illnesses or injuries occurring at the workplace. Monthly payments are distributed among surviving dependents, alleviating the economic burden during challenging times.

Funeral Costs

ESIC offers a sum of Rs. 15,000 towards funeral costs. This amount is disbursed to the dependents or individuals performing the last rites of the insured, demonstrating the scheme’s commitment to supporting families in times of grief.

Confinement Costs

In instances where confinement occurs in a location without access to necessary medical care under the scheme, beneficiaries can avail confinement costs. This provision ensures that maternity-related expenses are adequately covered.

Vocational and Physical Rehabilitation

ESIC provides vocational rehabilitation training for permanently disabled individuals, preparing them for re-entry into the workforce. Additionally, physical rehabilitation benefits are extended to those requiring specialised care due to employment-related injuries.

Old Age Medical Care

Upon retirement or permanent disability, insured individuals and their spouses receive Rs. 120 per annum for old-age medical care. This provision underscores ESIC’s commitment to the well-being of workers even after the cessation of active employment. The Employees' State Insurance Scheme (ESIC) stands as a beacon of social security for workers across India. By providing comprehensive health and financial benefits, ESIC ensures that workers and their dependents can face life’s challenges without fearing financial instability. The scheme's broad coverage, coupled with its commitment to various aspects of workers' well-being, reflects its importance in the social security landscape of the country. As individuals and organisations navigate the complexities of the workforce, ESIC remains a cornerstone, contributing to the overall welfare of the nation’s labour force. If you are looking for a health policy with a varying scope that you can adjust to a certain extent to suit your needs, you may find a plan online or consult your insurance agent. Starting with an online health insurance calculator can help you understand the premium you may be required to pay.*   *Standard T&C Apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.