BENEFITS UNDER THE SCHEME S.THIAGARAJAN 12-08-2011

1. Welcome to the Session on BENEFITS UNDER THE SCHEME S.THIAGARAJAN 12-08-2011

2. Under the ESI Scheme Benefits are available both to the employers and employees

3. BENEFIT TO THE EMPLOYERS • Employers are absolved of all liability, of providing medical care to employees. • employers are exempted from the applicability of the: • Maternity Benefit Act, 1961 & • Workmen Compensation Act, 1923 • Employers have a well secured workforce, an essential ingredient for better productivity

4. BENEFITS TO EMPLOYERS • By employing physically challenged employees employers need not pay employers share of 4.75% contribution for three years from the date of commencement of the contribution period. • Wage limit for the coverage of the physically challenged employee is Rs.25000 • Under Rule 51-A of ESI Rules person with disability under the persons with Disabilities(Equal opportunities Protection of Rights and Full Participation)Act, 1995(1 of 1996), and under the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999(44 of 1999) respectively, shall be twenty five thousand rupees a month . • This facility is available only to the new entrant and not to the existing physically challenged employee

5. BENEFITS TO EMPLOYEES • There are two types of Benefits • Cash Benefit • Medical Benefit

6. MEDICAL BENEFIT(There is no cap for the Medical Benefit) CASH BENEFIT (SICKNESS AND DISABLEMENT) DEPENDANT BENEFIT MATERNITY BENEFIT(Cash Benefit is based on Average Daily wages) 4.75% EMPLOYERS CONTRIBUTION UNEMPLOYMENT ALLOWANCE VOCATIONAL REHABILATION FUNERAL EXPENSES OLD AGE HEALTH CARE. 1.75%EMPLOYEES CONTRIBUTION SO MUCH TO GAIN FOR SO LESS PREMIUM

7. CASH BENEFIT (1) SICKNESS BENEFIT normal extended enhanced • DISABLEMENT BENEFIT (employment injury)……temporary & permanent

8. SICKNESS BENEFIT

9. EXTENDED SICKNESS BENEFITfor 34 specified long term diseases

10. ENHANCED SICKNESS BENEFITFor undergoing sterilization operation for family planning

11. DISABLEMENT BENEFIT(employment injury or occupational diseases)

12. DEPENDANTS BENEFIT

13. MATERNITY BENEFIT

14. FUNERAL BENEFIT • HE SHOULD BE AN INSURED PERSON ON DATE OF DEATH. • ACTUAL EXPENDITURE ON FUNERAL NOT EXCEEDING Rs 10000/- • AMOUNT IS PAID TO ELDEST SURVIVING MEMBER OF THE FAMILY OR IN HIS ABSENCE TO THE PERSON WHO ACTUALLY INCURS THE EXPENDITURE ON THE FUNERAL.

15. REHABILATIONAL ALLOWANCE

16. MEDICAL BENEFIT

17. SUPERSPECIALITY CONDITIONS • IN CASE OF INSURED PERSONS 39 DAYS OF CONTRIBUTION AND 3 MONTHS CONTINUOUS SERVICE • IN CASE OF FAMILY MEMBERS 78 DAYS OF CONTRIBUTION AND ENTILTED FOR SB • NO CONTRIBUTORY CONDITIONS IN CASE OF ANY TYPE OF INJURY • FACILITY AVAILABLE BASED ON IMOS REFERENCE

18. CONFINEMENT EXPENSES

19. Unemployment Allowance named as Rajiv Gandhi Shramik Kalyan Yojana • Unemployment Allowance named as Rajiv Gandhi Shramik Kalyan Yojana, is payable to those workers facing involuntary unemployment due to closure of factory/establishment; retrenchment or permanent invalidity arising out of non-employment injury. The daily rate of Unemployment Allowance is at par with the sickness benefit rate . This allowance is payable for a maximum period of 1 year either in one spell or in different spells of not less than one month’s duration.

20. Contributory conditions for unemployment allowance • He should be an IP • He should have contributed for at least three years

21. Medical benefit to retired/disabled insured person and his/ her spouse

22. VOCATIONAL REHABILATIONAL ALLOWANNCE

23. OBLIGATION OF EMPLOYERS Maintain register of employees in form – 6 (reg.32) Ensure maintenance of separate register of employees by contractor and settle contractor’s bills only on production of this register to esic. ( sec-41 (1-a) Deposit both employee’s and employer’s contribution as per specified rates within 21 days of the following month. {reg. 31} Insure all employees by by generating Ins no. through online Facilitate proper inspection of records/registers and the premises by visiting officers of ESIC as and when so required. { u/s 45} Report promptly about the accident so as to enable esic to provide benefit in time

24. Not to make any false declaration or mis-representation of facts, concerning the applicability of the act, or, admissibility of benefits to employees –regular, hired or contractual. Report promptly the date of closure of a factory/establishment to the esic branch office/regional office, preferably within seven days of such closure and clear esi liabilities. Report any change in business activity, address, ownership or the management to esic authorities forthwith. Ascertain the liability towards esi dues, while taking over the ownership of a factory/establishment through purchase, gift, lease, license or otherwise as the new owner is liable to discharge past liabilities. (sec. 93-a)

25. Furnish any additional information called for sec. 44 (2) and reg. 109 • Help and assist employees to avail their legitimate esi benefits. • Maintain sanitary standard in and around the workplace and employees housing colony so as to minimize the risk of exposure to occupational hazardous and diseases. • The employer shall render all necessary assistance which the corporation may require in connection with the registration of his factory or establishment and the registration of his employees and especially for photographing such employees and their families for issue of bio metric cards affixing the photographs to the identity cards. (reg.16) • Indicate insurance number of Insured Person in chronological order in the return of contribution and his own code number in all correspondence.

26. IMPORTANT INFORMATION FOR THE EMPLOYERS • Employer should get factory/establishment registered online, immediately on applicability of ESI Act to his unit. • Employer should get his employee including the employee employed through the contractors registered online and T.I.C. generated immediately after taking him in insurable employment. • 3. The employer should direct and pursue his employees to get photographed for Pehchan Card.

27. The employer should not re-register a new employee, if he/she was already registered with E.S.I. Corporation while working with another employer. • The employer should immediately inform the RO/SRO about the permanent closure or transfer of factory/establishment within 21 days of such closure/transfer.

28. PROCEDURE FOR AVAILING BENEFIT • Insured Person has to submit leave certificate along with his claim to the Branch Office. • Branch Office after verifying the eligibility settle the claim either by cash or through ECS System. • It is proposed to introduce online settlement of claim shortly. • In that case Insured Person need not visit the Branch Office. • To avail Super Specialty Benefit IP need not spend any amount and cashless treatment will be provided to the Insured Person and his family. • With the introduction of Pehachan Card and computerization the Insured Person and his family can take treatment at his choice. • Two Pehachan cards will be issued. One for the Insured Person and other for the family.

29. VAZGAVALAMUDANThank You12-08-2011