Employees' State Insurance Scheme (ESIS)

Why Was the ESI Scheme Introduced

Before the Employees' State Insurance Scheme (ESI) was introduced, many organised-sector workers had limited access to affordable healthcare and financial support during illness, maternity, disability or employment-related injuries.

To address these gaps, the Government of India enacted the Employees' State Insurance Act, 1948, creating a social security system that provides both medical care and cash benefits to eligible workers and their families. The scheme was designed to reduce the financial burden of healthcare and provide income support during periods when employees are unable to work.

ESI – Key Highlights

Who is Eligible for ESI Scheme

• Employees Within the Wage Limit: Employees earning up to ₹21,000 per month and working in an establishment covered under the ESI Act are generally eligible for ESIC coverage. There is no wage ceiling for employees with disabilities.
• Employees of Covered Establishments: Coverage applies to factories employing 10 or more persons and other notified establishments such as shops, hotels, restaurants, cinemas, transport undertakings, newspapers, and certain educational and medical institutions, subject to applicable State/UT notifications.
• Eligible dependent family members of insured persons are also entitled to medical benefits, subject to prescribed conditions.

ESI Scheme Coverage and Benefits

• Medical Benefit: Comprehensive medical care for insured persons and eligible family members from the first day of insurable employment, with no expenditure ceiling on treatment.
• Sickness Benefit: Cash compensation of 70% of wages for certified sickness, generally for up to 91 days in a year, subject to contribution conditions.
• Extended Sickness Benefit: Up to 2 years for specified long-term and malignant diseases, generally at 80% of wages.
• Enhanced Sickness Benefit: Full wages during the prescribed period for insured persons undergoing sterilisation for family planning.
• Maternity Benefit: 26 weeks of benefit at full wages for eligible insured women, subject to applicable conditions.
• Temporary Disablement Benefit: 90% of wages for the period of temporary disability caused by an employment injury.
• Permanent Disablement Benefit: Periodic payment based on the extent of loss of earning capacity due to permanent disablement.
• Dependants' Benefit: Periodic payment to eligible dependants when an insured person dies due to an employment injury or occupational hazard.
• Funeral Expenses: Financial assistance of ₹15,000 towards funeral expenses, subject to applicable rules.
• Confinement Expenses: Financial assistance when an insured woman or an insured person's wife gives birth at a place where ESI medical facilities are unavailable.
• Rehabilitation Benefits: Vocational and physical rehabilitation for eligible insured persons with disabilities arising from employment injury.
• Unemployment Relief: Schemes such as Rajiv Gandhi Shramik Kalyan Yojana (RGSKY) and Atal Beemit Vyakti Kalyan Yojana (ABVKY) provide unemployment relief to eligible insured persons subject to prescribed conditions.

Documents Required for ESI Scheme Registration

• Employer: PAN card and business registration proof (incorporation certificate, partnership deed, GST certificate, or Shops & Establishment/Factory licence), proof of business address, bank account details, authorised signatory details.
• Employee: Aadhaar card, bank account details, recent passport-size photographs, family details for dependent coverage (for the e-Pehchan card).

How to Apply for ESI Scheme and Get an ESI Card (e-Pehchan Card)

ESIS enrolment is primarily employer-driven, meaning eligible employees are registered by their employer rather than applying individually.

1. Employer registers the establishment: The employer registers the covered establishment through the ESIC portal and submits the required establishment details.
2. Establishment code is generated: ESIC generates a unique establishment code after successful registration.
3. Employee registration: The employer registers each eligible employee online by submitting the required personal and family details.
4. Insurance Number and e-Pehchan Card: ESIC assigns the employee a unique Insurance Number and provides an e-Pehchan Card.
5. Download the e-Pehchan Card: The insured person can download the e-Pehchan Card through the ESIC IP Portal or UMANG App. It is also available through Digi Locker.
6. Complete the card: The card can include photographs of the insured person and eligible family members and, where required, can be countersigned by the employer or designated ESIC Branch Manager.
7. Access ESI benefits: The insured person and eligible family members can use their ESIC identification to access applicable medical and other ESI benefits.
8. Changing jobs: If the employee changes jobs, the same Insurance Number continues to be used. The employee should provide the existing Insurance Number to the new employer.

How to Check Claim Status

1. Visit the official ESIC portal at esic.gov.in.
2. An employer can track the status of their establishment registration, employee enrolment, and contribution filing via this portal.
3. An employee can check on the insurance number and e-Pehchan card status through the portal or at their nearest ESIC Branch Office.
4. The claim status of unemployment allowance can be tracked on the portal after submitting the required documents along with the claim form at the concerned Branch Office/DCBO.

Grievance Redressal Under ESI Scheme

• For registration related or portal related queries, the employer can contact the Shram Suvidha helpdesk (esic.gov.in/shramsuvidha.gov.in)
• For medical related queries, ESIC has a toll-free medical helpdesk number. The number can be found on the esic.gov.in homepage.
• A grievance can also be raised through the complaint section on the ESIC portal or by visiting the local Branch Office/DCBO.
• Keep the registration or claim acknowledgement number handy, as it's usually required for tracking.

ESI Scheme and Other Government Health Schemes in India

• Atal Beemit Vyakti Kalyan Yojana (ABVKY): Provides financial assistance to eligible insured persons who become unemployed, subject to the scheme's conditions.
• Rajiv Gandhi Shramik Kalyan Yojana (RGSY): Provides unemployment allowance and continued medical care to eligible insured persons who lose employment due to specified circumstances.
• Pradhan Mantri Jan Arogya Yojana (PM-JAY): A major government-funded health assurance scheme providing cashless hospitalisation cover of up to ₹5 lakh per family per year for eligible beneficiaries