• 1)   Free medical treatment is offered to covered employees at dispensaries and hospital run by the ESI Corporation & Tie-up hospitals, Limited to Rs.
•       10.00 Lacs per family / per year.

2)   About 70% of employee’s normal wage will be payable to him by ESI during sickness.

 

• 3)   Injury during / in course of employment and while coming to and from the place of Employment resulting in temporary/permanent disablement entitles
•       the covered employee to a regular payment to substitute his lost wages.

 

• 4)   Vocational Rehabilitation Scheme (applicable to IPs. in whose case loss of earning capacity resulting from employment injury, assessed as not less
•       than 40%.

 

• 5)  Insured person can avail cashless treatment in the hospitals referred by ESI Hospital.

 

• 6)   As per circular dated 18th August, 2020 an ESI insured person & his family members can avail SST benefits from 1st day of insurable employment on
•       a case to case basis subject to the final order of the Hon'ble court.

 

• 7)   In the standing committee meeting held on 29.03.2019, it has been decided to take up distribution of Health passbook on need basis. The Health
•       Passbook shall be distributed to the Beneficiaries by employers and also by ESIC through its Branch Offices/ DCBO's

 

• 8)   ESI Covid Relief Scheme which started on 24.03.2020 for a period of 2 years has stopped on 24.03.2022

 

• 9)   W.e.f. 30.10.2018 new Regulation 96-B Scale of Medical Benefit for Reimbursement

 

•       An insured person and his family (where such Medical benefit is extended to his family) Shall be entitled to receive reimbursement of Medical
•       treatment in emergent condition to the extent rates prescribed & published by the state Government or the Corporation or for the Central Government
•       Health Scheme (CGHS).

 

• 10) Insured person shall only be eligible for cash benefit.

   

  11) ESIC-Aadhaar Implementation-along with ABHA [Ayushman Bharat Health Account/Health Id Card]

                 

        To qualify benefits to the IP under ESIC, Employer can seed and authenticate Aadhaar while registering a new Employee. After authentication of

•       Aadhaar, by providing consent, ABHA will also be generated based on provided Aadhar number. ABHA is nothing but 14-diait identification number
•       that can be used anywhere in India to identify one's identity and update health records across multiple Healthcare service provider. It is hassle free as
•       it can track all medical related history and stores information at one place thus benefiting ESIC employees.

   

  12. 12) ESI-Status of re-entrant employee w.r.t benefit

   

        To avail benefits under ESI Act, employee being the member under the Act for the first time, contribution shall commence from date of such

  13.       employment in contribution period followed by corresponding benefit for him which shall commence on the expiry of the period of nine months from
  14.       date of such employment. [Ref- Regulation 4].

       

            A person who has already been employee but ceased to be employee either due to his wages going above the coverage limit or due to any reason,

  15.       once re-enters as an employee 2d time and thereafter not becoming an employee within the meaning of Act for the first time. Therefore, stipulation of
  16.       completing 9-month period again to start his benefit would not be applicable but would be governed by general contribution as period mentioned in
  17.       the regulation.

       

            In simple meaning, it is clarified that stipulation of 9-month period be applied only for start of 1st benefit period in respect of person who becomes

  18.       employee for the first time. The re entrant employees are to be governed by general contribution in a benefit period provided they have completed
  19.       period of 9 month once they become employee for first time in accordance with the Act. In conclusion, the re-entrant employee's claim shall be
  20.       settled in same manner as new employee in correspondence to completion of 9 months contribution period on becoming member under Act.

                 

      13. 13) Notional Extension

       

            An Employee after being insured person under ESI Act can avail benefit/compensation from ESI, if there is a personal injury caused by accident or

  21.       occupational disease arising out of and in the course of insurable employment. The words' arising out of employment' are wide enough to cover a
  22.       case where there may not be necessarily a direct connection between the injury to the employee, the accident, and the employment. It is enough if
  23.       the circumstance is attending the employment to be one arising out of employment. Thus, accidents happening while commuting from employee's
  24.       residence to the place of work and vice versa for duty shall be deemed to have arisen out and in the course of employment, if nexus between
  25.       circumstances, time and place in which accident occurred and employment is established.