What is Covered Under Employees’ State Insurance Scheme?

Initially, the ESI Scheme (ESIS) was implemented in Kanpur and Delhi in 1952 which were the two major industrial centres at that time. However, the scheme found itself being adopted across the country with the industrial revolution picking up pace. With the increase in industrialization over the years, the ESIS as of 31 March 2019, has been implemented in more than 34 states and Union Territories.

The ESI Act now covers nearly 12 lakh factories and business establishments and benefits more than 3 crore workers or family units. The scheme currently benefits more than 13 crore beneficiaries.

Details	ESI Coverage (As on 31 March 2019)
Number of Insured Persons/Family Units	3.49 crore
Number of Employees	3.14 crore
Number of Beneficiaries	13.32 crore
Number of Insured Women	51.20 Lakh
Number of Employers, etc.	12.11 Lakh

What Is Not Covered Under Employees State Insurance Scheme?

The ESIC scheme currently does not cover workers or employees earning more than Rs.21,000 per month and in the case of persons with a disability, the maximum wage is capped at Rs.25,000 per month. Also, in Maharashtra and Chandigarh, the current threshold for coverage is still 20 employees and not 10 employees in the case of other states or UTs.

Infrastructure of Employees State Insurance Scheme (ESIS):

Since the inception of the ESI Scheme in 1952, the ESI Corporation has set up several hospitals and annexes for medical services. Below is the ESI infrastructure network through which workers or employees can avail healthcare services:

Particulars	ESI Infrastructure Network
In-Patient Services	151 Hospitals42 Annexes
Out-Patient/Primary Services	1450 ESI Dispensaries188 Ayush Units954 Panel Clinics
Occupational Disease Centers	1 in Mumbai1 in New Delhi1 in Kolkata1 in Chennai1 in Indore
Payment of Cash Benefits	628 Branch Offices185 Pay Offices(Supervised by 62 Regional, Sub-Regional and Divisional Offices)

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

Below are the salient features of the ESI scheme provided the Employees State Insurance Corporation (ESIC):

Medical:

Under the scheme, the insured’s medical expenses are covered through affordable and reasonable health care facilities. Also, the worker or the employee is covered from day one of the person’s employment.

Maternity:

Under the scheme, the beneficiary can avail 100% of the daily wages for up to 26 weeks which can be extended to a further one month based on the medical advice. In the case of miscarriage, the benefit is 6 weeks, while in the case of adoption it is 12 weeks.

Disability:

In case of temporary disablement of the worker, they are eligible for a monthly wage of 90% until they recover. In the case of permanent disability, 90% of the monthly wage can be availed for the entire life.

Sickness:

During medical leave, the scheme offers cash flow during the said period. The worker can avail 70% of the daily wage for a maximum of 91 days. This can be availed in two consecutive periods.

Unemployment:

For a period of 24 months, the scheme offers a maximum of 50% of the average monthly wage in the case of involuntary loss of non-employment or due to permanent invalidity due to injury.

Dependents:

Through the scheme, dependents of the insured receive financial assistance in case of illnesses or injuries while at work. During such instances, dependents are eligible for monthly payments which are equally distributed among surviving dependents.

Coverage:

Under the scheme, workers or employees are covered from day one of their employment. This includes both the insured and their dependents

Funeral Costs:

The ESIC offers an amount of Rs.15,000 towards funeral costs. This is paid to the dependents or to the individual who does the last rites of the insured.

Confinement Costs:

In case of confinement occurs at a location where required medical care under the scheme is not available, the insured or the dependent can avail confinement costs.

Vocational Rehabilitation:

The ESIC provides this benefit based on the requirement of the insured. This is extended to those who are permanently disabled injured individuals for Vocational Rehabilitation (VR) training at VRS.

Physical Rehabilitation:

This benefit is also provided based on the need especially in the case of disability due to employment injury.

Old Age Medical Care:

When the insured person retires on attaining the retirement age or under VRS or ERS or when a person has to leave work due to permanent disability, the insured and spouse will receive Rs.120 per annum.