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ESIC Benefits: Medical, Sickness & More

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Understanding the Benefits Under ESIC: Medical, Sickness, and More

The Employees’ State Insurance (ESI) Act, 1948, provides a robust social security system for employees, offering multiple benefits such as medical care, sickness benefits, maternity leave, and financial support during disability or death due to work-related injuries. Employers and employees must understand these benefits to maximize their coverage under the ESIC scheme.

This blog explores the key benefits under ESIC, their eligibility, and how they impact employees’ well-being.

 

 

Medical Benefits

What is Covered?

  • Free medical care for insured employees and their dependent family members.
  • Includes doctor consultations, medicines, diagnostic tests, hospitalization, and surgery.
  • Access to ESIC dispensaries, hospitals, and empanelled private medical institutions.

 

 

Impact on Employees
  • Ensures free and quality healthcare for employees and their families.
  • Reduces out-of-pocket medical expenses, leading to financial relief.

 

 

Sickness Benefits

Eligibility & Compensation

  • Employees who have contributed to ESIC for at least 78 days in a contribution period can avail of sickness benefits.
  • 70% of the average daily wages is paid for up to 91 days in a year.
  • Special extended sickness benefits are available for long-term diseases such as tuberculosis, cancer, and mental disorders.

 

Impact on Employees

  • Provides financial security during health-related absences.
  • Encourages employees to take necessary rest and recover without income loss.

 

 

Maternity Benefits

Eligibility & Compensation

  • 26 weeks of paid maternity leave for insured women employees.
  • 100% of the average daily wage is paid during the leave period.

Impact on Employees

  • Ensures income security during pregnancy and post-delivery recovery.
  • Promotes better maternal health and childcare.

 

 

Disability Benefits

Temporary Disability Benefit (TDB)

  • 90% of wages is paid if an employee is temporarily disabled due to an accident or occupational hazard.
  • Benefits continue until the employee fully recovers.

Permanent Disability Benefit (PDB)

  • If an employee suffers permanent disability, ESIC provides a lifelong pension based on the severity of disability.
  • Compensation is calculated as a percentage of wages depending on disability level.

Impact on Employees

  • Financial support ensures stability for disabled employees.
  • Encourages a safe working environment by promoting accident prevention measures.

 

 

Dependent Benefits

Eligibility & Compensation

  • If an insured employee dies due to an employment injury, dependents receive a lifelong monthly pension.
  • 90% of the deceased employee’s wage is distributed among spouse, children, and dependent parents.

Impact on Employees

  • Provides financial security to families in case of accidental death.
  • Ensures education and well-being of the deceased employee’s children.
Funeral Expenses

What is Covered?

  • A lump sum funeral grant of Rs. 15,000 is provided to the family of a deceased insured employee.
  • Helps cover the costs of funeral rites.

Impact on Employees

  • Offers financial support to grieving families during a difficult time.

 

 

How Employers Can Ensure ESIC Benefit Utilization
  • Timely registration of employees under ESIC.
  • Regular contribution payments to maintain employee eligibility.
  • Educating employees about their ESIC rights and claim process.
  • Assisting employees in claiming medical and cash benefits through the ESIC portal.

 

 

Conclusion

The ESIC Act provides a comprehensive safety net for employees by ensuring financial protection during sickness, maternity, disability, and unemployment. Employers must stay compliant and educate employees about their entitlements to maximize the scheme’s benefits.

For expert guidance on ESIC compliance, employee benefits, and claim processing, contact Exertion HR Solutions Pvt. Ltd. today!

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