EMPLOYEES’ STATE INSURANCE
ACT, 1948 & the SCHEME
• ESI Scheme for India is an integrated social security scheme tailored to provide Social Production to workers and their dependents, in the organised sector, in contingencies, such as Sickness, Maternity and Death or Disablement due to an employment injury or Occupational hazard
ESI RETURNS
ESI reutrns are submitted in every six months VIZ April to sept and oct to march.
Form 5 is used to submit esi returns.
FORM-01 | Employer | |||||
FORM-01(A) | Employer | |||||
FORM-1 | Employer | |||||
FORM-1(A) | Employer | |||||
FORM-2 | Employer | |||||
FORM-3 | Employer | |||||
FORM-5 | Employer | |||||
FORM-5(A) | Employer | |||||
FORM-5(New) | 31 | Employer | ||||
FORM-6 | Employer | |||||
FORM-9 | IP/Beneficiary | |||||
FORM-11 | Employer | |||||
FORM-12 | Employer | |||||
FORM-14 | IP/Beneficiary | |||||
FORM-15 | IP/Beneficiary | |||||
FORM-16 | IP/Beneficiary | |||||
FORM-19 | IP/Beneficiary | |||||
FORM-20 | IP/Beneficiary | |||||
FORM-22 | Beneficiary | |||||
FORM-23 | IP/Beneficiary | |||||
FORM-24 | IP/Beneficiary | |||||
ESIC-32 | Employer | |||||
ESIC-37 | Employer | |||||
ESIC-53 | IP/Beneficiary | |||||
ESIC-63 | IP/Beneficiary | |||||
ESIC-71 | Employer | |||||
ESIC-72 | IP/Beneficiary | |||||
ESIC-86 | Employer | |||||
ESIC-105 | Employer | |||||
ESIC-126 | Employer | |||||
ESIC-142 | Claim for conveyance allowance and/or compensation for loss of wages for an IP appeared before the medical board | IP/Beneficiary | ||||
COVERAGE
The ESI Act 1948 applies to
• Non – seasonal Factories using power in and Employing ten (10) or More persons
• Non – seasonal and non- power using factories and establishments employing twenty(20) or more persons
• Employees of the Factories and Establishments in receipt of wages not exceeding Rs.7500 /- Per month are covered under this Act.
Payable such as
1. Employees’ Contribution – 1.75% of the Wages
2. Employers’ Contribution – 4.75% of the Wages
TOTAL - 6.5 % of the Wages
Employees in receipt of an average daily wage of Rs.40/- or Less, are exempted from Payment of their share of contribution (w.e.f 8.4.00) but are entitled to all social security benefits under the Scheme.
Contribution & Benefit Period
• Employees covered under the ESI Act, are required to pay contribution towards the scheme on a monthly basis. A contribution period means a six month time span from 1st April to 30th September and 1st October to 31st March.
• Cash benefits under the scheme are generally liked with contributions paid. The benefit period starts three months after the closure of a contribution period. The two type of periods are elucidated below.
Contribution Period Benefit Period
1st April to 30th September 1st January to 30th June
of the following year
1st October to 31st March 1st July to 31st Dec.
ADVANTAGES OF EMPLOYERS
• Employers are absolved of their liabilities of providing medical facilities to employees and their dependents in kind or in the form of fixed cash allowance, reimbursement of actual expenses, lump sum grant or opting for any other medical insurance policy of limited scope unless it is a contractual obligation of the employer
2). Employers are exempted from the applicability of the : -
(a). Maternity Benefit Act
(b). Workmen's’ Compensation Act
in respect of employee covered under the ESI Scheme
3). Employers have their disposal, a productivity , well secured workforce, an essential ingredient for better productivity
4). Employers are absolved of any responsibility in times of Physical distress of workers such as sickness, employment injury or Physical disablement resulting in loss of wages, as the responsibility of Paying cash benefits shits to the corporation in respect of insured employees
5). Any sum paid by way of contribution under the ESI Act is deducted in computing ‘income’ under the Income Tax Act
Benefits to Employees
• ESI Scheme Major Social Security Benefits in Cash and Kind include …
1. Medical Benefit – for self & Family
2. Sickness Benefit – for self
3. Maternity Benefit - for self
4. Disablement Benefit
a). Temporary Disablement Benefit – for self
b). Permanent Disablement Benefit – for self
5. Dependents’ Benefit – for dependents in case of death due to employment injury
In addition, the Scheme also provides some other need based benefits to insured workers. These are:
i). Funeral Expenses – to a person who
performs the last rites of IP
ii). Rehabilitation allowances – for self
iii). Vocational Rehabilitation - for self
iv). Old age Medicare – for self and spouse
v). Medical Bonus – for insured women and
IP’s wife
Medical Benefit
• The Standard medical care consists of out-door treatment, in-patient treatment, all necessary drugs and dressing, pathological and radiological specialist consultation and care, ante-natal and post natal care, emergency treatment etc.,
• Insured worker and members of his family are eligible for medical care from the very first day of the worker coming under ESI Scheme.
• A worker who is covered under the scheme for first time is eligible for medical care for the period of three months. If he/she contributes at least for 78 days in a contribution period the eligibility is there up to the end of the corresponding benefit period.
• A worker is also eligible for extended sickness benefit when he/she is suffering from any one of the long term 34 diseases listed in the Act. This is admissible after the worker has been under ESI these conditions are satisfied medical benefit is admissible for a maximum period of 730 days for the IP and his/ her family.
Sickness Benefit
• Sickness signifies a state of health necessitating Medical treatment and attendance and abstention from work on Medical grounds. Financial support extended by the corporation is such a contingency is called sickness Benefit
• Sickness Benefit represents periodical payments made to an Insured Person for the period of certified sickness after completing 9 Months in insurable employment.
• To qualify for this benefit, contributions should have been payable for atleast 78 days in the relevant contribution period.
• The Maximum duration for availing sickness Benefit is 91 days in two consecutive benefit periods
• Standard benefit rate – this rate corresponds to the average daily wage of an Insured person during the corresponding contribution period and is roughly half of the daily wage rate.
Disablement Benefit
a). Temporary disablement benefit :
• In case of temporary disability arising out of an employment injury or occupational disease.,
• Disablement benefit is admissible to insured person for the entire period so certified by an Insurance Medical officer / Practitioner for which IP does not work for wages.
• The benefit is not subject to any contributory condition and is payable at a rate which is not less than 70% of daily average wages.
• However, not payable if the incapacity lasts for less than 3 days excluding the date of accident.
Permanent disablement benefit
• In case an employment injury or occupational disease results in permanent, partial or total loss of earning capacity,
• Periodical payments are made to the IP for life at a rate depending on the actual loss of earning capacity as may be determined and certified by a duly-constituted Medical Board.
• The rates of Disablement Benefits are determined in accordance with the provisions of Rule 57 of ESI (Central) Rules, 1991.
• In order to product erosion in real value of the periodical payments of Permanent Disablement benefits, against rise in the cost of living index, periodical increases are granted, based on actuarial calculation
Dependants’ Benefit
• Dependents Benefit is a monthly pension payable to the eligible dependents of an insured person who dies as a result of an Employment Injury or occupational disease
• Beneficiaries and Duration of benefit
a). Widow / widows during life or until remarriage
b). Legitimate or adopted son until age 18 or if legitimate son is infirm, till infirmity lasts.
c). Legitimate or adopted unmarried daughter until age 18 or until marriage, whichever is earlier, or if infirm, till infirmity lasts and she continues to be unmarried.
In the absence of any widow or legitimate child, the benefit is payable to a parent or grandparent for life, to any other male dependent until age 18 or to an unmarried or widowed female dependent until age 18.
Obligation of the Employers
1). Get your Factory / establishment registered with in 15 days after the Act becomes applicable. Submit Form 01 to the Regional office for this purpose. Obtain Employer’s code No. for use in all ESIC Forms / documents and correspondence with the offices of the ESI Corporation.
2). Fill up Declaration Forms in respect of all coverable employees and submit the same to the Regional Office/ Local Office of the corporation well before the ‘Appointed Day’ and obtain insurance Numbers from the concerned Local Office/ Regional Office, In respect of newly appointed employees, fill up the declaration form soon after appointment of such employees and submit the same to the Local Office Concerned.
3). Pending receipt of identity cards/ identity certificates you may issue “certificate of employment” in Form 86 to the covered employee(s) enabling them to avail cash/medical Benefits
4). Pay ESI contribution (Employee's Share @4.75% and the Employer’s share @ 1.75% of the wages) with in 21 days of the month following, in which the wages fall due.
