ESI

Current status and future prospects of ESIC

1. EMPLOYEES’ STATE INSURANCE SCHEME Dr. Sumaiya Khatun , 2 nd year PGT, Community Medicine, CNMCH

2. Mission Statement: To provide for certain benefits to Employees in case of Sickness, Maternity and Employment Injury and to make provisions for Related matters. Employees' State Insurance (abbreviated as ESI) is a self-financing social security and health insurance scheme for Indian workers. This fund is managed by the Employees' State Insurance Corporation (ESIC) according to ESI Act 1948 . ESIC is an autonomous corporation by a statutory creation under Ministry of Labour and Employment, Government of India. [1]

3. History: In March 1943, B. P. Adarkar   was appointed by Government of India to create a report on health insurance scheme for industrial workers. [2]  The report became the basis for the ESI Act of 1948. [2]   The promulgation of ESI Act, 1948 envisaged an integrated need based social insurance scheme that would protect the interest of workers in contingencies such as sickness, maternity, temporary or permanent physical disablement, death due to employment injury resulting in loss of wages or earning capacity. The Scheme was first implemented at Kanpur and Delhi on 24 February 1952. The act was initially intended for factory workers but later became applicable to all establishments having 10 or more workers. As on 31 March 2017, the total beneficiaries are 12.40 crores. [4] [5]

4. ESI Scheme today ( as on 31 st march 2017) Coverage in india : No. of States/UTs covered: 30 No. of Employees: 2.93 crores No. of Insured Persons/Family units: 3.19 crores No. of Insured women: 40.90 lakhs No. of Beneficiaries: 12.40 crores No. of Employers covered: 8.98 lakhs

5. Administration: Autonomous body- ESI Corporation . Chairman- Union Minister for Labour Vice-Chairman- Secretary to Govt of India Ministry of Labour Standing committee- Chief executive body for administration. Chief Executive Officer- Director General . Other Principal Officers- Insurance Commissioner Medical Commissioner Financial Commissioner Actuary Medical Benefit Council - headed by Director General of health services and assisted by Medical Commissioner.

6. Administration : Head Office- New Delhi Others - 23 regional offices 37 sub-regional offices 1 divisional office 2 camp office 627 branch offices 185 cash offices 422 inspection offices

7. ESI Scheme today ( as on 31 st march 2015) Infrastructure in India: ESI scheme is a type of social security scheme for employees in the organized sector. [7] No. of ESI hospitals: 151 No. of ESI Dispensaries: 1418 No. of Panel Clinics: 2100 No. of Diagnostic centers: 307 No. of Hospital Annexes: 42 No. of beds: 27000

8. Contributions : For all employees earning ₹21,000 (US$320) or less per month as wages, the employer contributes 4.75 percent and employee contributes 1.75 percent, total share 6.5 percent. State Govt. contributes 1/8 th of total cost of medical care and ESI’s Corporation share 7/8 th of total expenditure. This fund is managed by the ESI Corporation (ESIC) according to rules and regulations stipulated there in the ESI Act 1948, which oversees the provision of medical and cash benefits to the employees and their family.

9. Benefits to IPs under ESIC Scheme : ESI Scheme Provides The Following Major Social Security Benefits To The Insured Persons: SICKNESS BENEFIT MEDICAL BENEFIT MATERNITY BENEFIT DISABLEMENT BENEFIT DEPENDANT BENEFIT FUNERAL EXPENSES PHYSICAL REHABILITATION VOCATIONAL REHABILITATION

10. 1. SICKNESS BENEFIT There are three types under SICKNESS Benefit General Sickness Extended Sickness Enhanced Sickness

11. General Sickness General Sickness represents periodical cash payments made to an Insured person (IP) during the period of certified sickness And when IP requires medical treatment and attendance with abstention from work on medical grounds. Sickness benefit is roughly 50% of the average daily wages and is payable for 91 days, in any continuous period of 365 days. Eligibility Conditions: An IP should have paid contribution for not less than 78 days during the corresponding contribution period. A person who has entered into insurable employment for the first time has to wait for nearly 9 months for becoming eligible to sickness benefit

12. ii. Extended Sickness Benefit (ESB) An IP suffering from certain long term diseases is entitled to ESB ESB includes 34 chronic diseases which are grouped in 11 groups as per International Classification of diseases To be entitled to the Extended Sickness Benefit an Insured Persons should have been in continuous employment for 2 years or more at the beginning of a spell of sickness. ESB shall be payable for a maximum period of 2 years.

13. A) Infectious diseases : Tuberculosis Leprosy Chronic empyema AIDS B) Neoplasms: Malignant diseases C) Endocrine, Nutritional, Metabolic Disorders : Diabetes Mellitus with proliferative retinipathy /Diabetic Foot/Nephropathy D) Disorders of nervous system : Monoplegia Paraplegia Hemiplegia Hemiparesis Intracranial space occupying lesions Spinal compression Parkinson’s disease

14. 7. Myasthenia Gravis/Neuromuscular Dystrophy 8. Immature cataract with vision less than 6/60 9. Detachment of retina 10. Glaucoma E) Diseases of cardiovascular system : Coronary artery disease Unstable angina Myocardial Infarction with ejection fraction<45% Congestive heart failure Cardiac vulvular diseases with failure/ complications Cardiomyopathies Heart disease with surgical interventions along with complications F) Chest diseases : Bronchiectasis Interstitial lung disease COPD with CCF (Cor Pulmonale)

15. G) Diseases of digestive system : Cirrhosis of liver with ascites/active hepatitis H) Orthopedic diseases : Dislocation of vertebra/prolapse of intervertebral disc Non-union or delayed union of fracture Post traumatic surgical amputation of lower extremity Compound fracture with chronic Osteomyelitis I) Psychosis Schizophrenia Endogenous depression Manic depressive psychosis Dementia J) Others : More than 20% burn with infection/complication Chronic renal failure Reynaud’s disease/Burger’s disease

16. iii. Enhanced Sickness Benefit (ESB) IPs/IWs in the productive age group for undergoing sterilization operations for family welfare are paid of enhanced Sickness Benefits. Leave up to 7 days in the case of IPs (Male) and up to 14 days in the case of the IW’s (Female) from the date of operation or from the date of admission in the hospital Insured Persons eligible to ordinary sickness benefit are paid enhanced sickness benefit at double the rate of sickness benefit i.e., about full average daily wages.

17. 2. MEDICAL BENEFIT The Scheme provides full range of medical care to Insured person and family, through a network of ESI Dispensaries & Panel clinics, diagnostic centers and ESI Hospitals etc. All Insured Persons and members of their family are entitled to free, full and comprehensive medical care such as. Out patient treatment Domiciliary treatment Super specialty treatment Specialist consultation and diagnostic facilities In-Patient treatment Free supply of drugs and dressings.

18. 2. MEDICAL BENEFIT 7. X-ray and laboratory investigations 8. Vaccination and preventive inoculations 9. Ante-natal care, confinement and post natal care 10. Family planning services. 11. Ambulance Service or conveyance charges 12. Emergency Services 13. Free diet during admission in hospitals 14. Family welfare services and other national health programmed services 15. Medical certification

19. 2. MEDICAL BENEFIT Direct pattern and indirect pattern : Direct pattern- If population > 1000, then full time service dispensaries, medical and para-medical personnel are established. If population < 750, then part time ESI dispensaries are established. If residential concentration scattered over long distance, then mobile dispensaries. Indirect Pattern- Also known as Panel System. Registered Medical Practitioners designated as Insurance Medical Practitioners are appointed to provide medical care. Restricted Medical Care Expanded Medical care.

20. 2. MEDICAL BENEFIT Other medical facilities: Dentures, spectacles and hearing aids are provided for free. Artificial limbs and other prosthetics. Special appliances- hernia belts, walking caliper, surgical boots, spinal braces and jackets. Cost of medical benefit : Per capita medical benefit has been increasing under ESI Scheme steadily. In 2012-13 total expenditure was about Rs. 4058 crores.

21. 3. MATERNITY BENEFIT For entitlement to maternity benefit, the insured woman should have compulsorily work for 55days with in 9month from the date of employment. Maternity Benefit is payable for a period of 26 weeks for confinement to an Insured Woman. Miscarriage or Medical Termination of Pregnancy (MTP)-payable for 6 weeks (42 days) from the date following miscarriage. Sickness arising out of Pregnancy, Confinement, Premature birth-payable for a period not exceeding one month

22. 3. MATERNITY BENEFIT In the event of the death of the Insured Woman during confinement leaving behind a child, Maternity Benefit is payable to her nominee Maternity benefit rate is double the Standard Benefit Rate, or roughly equal to the average daily wage. The rate of confinement expenses has increased from Rs. 2500 to Rs. 5000 per confinement.

23. 4. DISABLEMENT BENEFIT Disablement benefit is the personal injury to an employee caused by an accident or by an occupational disease arising out of employment of the employee in a covered factory or establishment. There are two types under disablement Benefit Temporary Disablement Benefit (TDB) Permanent Disablement Benefit (PDB)

24. a. Temporary Disablement Benefit (TDB) TDB is payable to an employee who suffers employment injury (EI) or Occupational Disease and is certified to be temporarily incapable to work. This benefit is not subject to any contributory conditions. An IP is eligible from the day he joins the insurable employment. There is no prescribed limit for the duration of TDB. This is payable as long as temporary disablement lasts and significant improvement by treatment is possible.

25. b. Permanent Disablement Benefit (PDB) Permanent Disablement Benefit is paid to an insured person who suffers from permanent disability as a result of an employment injury (including occupational disease), which results in loss of earning capacity. If the employment injury results in partial or total/permanent disability, the PDB is payable till the death of the insured person. No contributory conditions are prescribed for this benefit. While the rate of temporary disablement benefit is 90 per cent of the wages and that of permanent disablement benefit is proportionate to the loss of earning capacity caused by the injury determined by a medical board.

26. 5. DEPENDANT’S BENEFIT Dependents' benefit consists of periodical payments to dependents of an insured person who dies as a result of an employment injury sustained as an employee under the ESI Act. There are no contributory conditions for qualifying to this benefit. Thus, if a person dies of employment injury even on the first day of his employment, his dependents are entitled to the benefit. The minimum rate of DB is Rs.14/- per day and these rates of the DB are increased from time to time. 90 % of wages shared by dependents in a fixed ratio on monthly basis. An eligible son or daughter is entitled to dependant’s benefit upto age of 18.

27. 6. FUNERAL EXPENSES Funeral expenses are in the nature of a lump sum payment up to a maximum of Rs. 10000/- made to defray the expenditure on the funeral of insured person. The amount is paid either to the eldest surviving member of the family or, in his absence, to the person who actually incurs the expenditure on the funeral.

28. 7. PHYSICAL REHABILITATION Disabled insured persons who remain admitted in an artificial limb centre for fixation or repair or replacement of the artificial limb are entitled to rehabilitation allowance for each day on which they remain admitted at Artificial limb centre at double the standard sickness benefit rate. This is not subject to any contributory condition.

29. 8. VOCATIONAL REHABILITATION This Scheme has been designed to provide financial assistance to the insured persons who are referred to vocational rehabilitation centre for training. Insured person who satisfy following conditions are entitled to avail benefits of the vocational rehabilitation scheme: whose permanent loss of earning capacity has been determined as 40% or more. who is in receipt of permanent disablement benefit under the ESI Act, 1948. who is not in any gainful employment, and who is not more than 45 years of age on the date of his application.

30. BENEFITS TO EMPLOYERS Exemption from Workmen’s Compensation Act 1923. Exemption from Maternity Benefit Act 1961. Exemption from payment of medical allowance to employees and their dependents. Rebate under Income Tax Act on contribution deposited in the ESI Account. Healthy work-force.

31. RAJIV GANDHI SHRAMIK KALYAN YOJANA : Came into effect from 1 st April 2005 Provides unemployment allowance for the employees covered under ESI scheme who are rendered unemployed involuntarily due to retrenchment/closure of factory etc. This allowance can be claimed for a maximum period of 6 months during entire service. Employee must have rendered insurable employment and have contributed under the scheme for 5 or more years. The daily rate for the allowance is the “Standard Benefit Rate” under ESI rules,1950.

32. Medical and Dental colleges Employees' State Insurance Corporation runs medical, dental, nursing and paramedical schools in many locations across India. [9]   Presently, there are 9 medical colleges and 2 dental colleges established by the ESI Scheme. There are 6 medical colleges managed by the Ministry of Labour and Employment (India) under the ESI Corporation which are located at Kolkata, Faridabad, Hyderabad, Chennai, Bengaluru and Gulbarga. Remaining 3 medical colleges were established by the ESI Corporation but are managed by the state government. They are: Shri Lal Bahadur Shastri Government Medical College & Hospital Mandi, Himanchal Pradesh Coimbatore ESIC Medical College Coimbatore, Tamil Nadu Government Medical College, Kollam, Kerala The Dental Colleges run by the ESI Corporation are located in New Delhi and Gulbarga, Karnataka. The Government of India plans to construct 12 more ESI Medical Colleges in various cities across India in the upcoming years. [10]

33. New Amendment: The Employees’ State Insurance Corporation (ESIC) raised the monthly wage limit to Rs . 21,000, from the existing Rs . 15,000, for coverage with effect from 1 January 2017  [11] Under the concept of Pehchaan Project initiated by ESIC, a unique card is issued to each insured person, i.e. employee.  Family members can use their card to avail medical facilities of ESI scheme if they are away or living in another town. 

34. ESI Scheme in West Bengal: West Bengal is the key facilitator for rendering the medical services under the ESI Scheme Apart from that Industries, hotels, restaurants, theatres, newspaper establishments, road motor or transport establishments, Shop and other establishments and recently private medical Institution and Educational Institution have been brought under the purview of this Scheme. The Scheme is administered in our state through a network of 14 nos. well equipped hospitals, about 378 insurance medical practitioners (IMP) 42 Service Dispensaries (SD) and specialty centres through OPD of each ESI Hospitals, dedicated to the service of employees with annual numbers of beneficiaries above 39,00,000 nos.

35. ESI Hospital Joka , Kolkata

36. Medical Care facilities available in West Bengal under the ESI(MB) Scheme: Indoor treatment for IP & Family in the hospitals including all specialties. 6 bedded ICCU Unit with facilities for implantation of Permanent Pacemaker . Super-specialty treatment including facilities of Cardiology, Neurology, Oncology, and Hemodialysis in the ESI setup and other super specialty facilities from private institutions through tie-up arrangements. Collection and supply of Blood through ESI Blood Bank at Manicktala . Ante-natal and post- natal care to women beneficiaries. 4 Bedded Neo-Natal Care Unit at Kamarhati ESI Hospital . Family planning and immunization services. Outpatient treatment at Service Dispensaries (SD) / Insurance Medical Practitioner's (IMP) clinics. Specialists' services at the OPD in all the 13 State ESI Hospitals. Cont …….

37. Medical Care facilities available in West Bengal under the ESI(MB) Scheme: Diagnostic facilities like all pathological / radiological investigations including ultrasonography,  Echo- Cardiography , CT Scan, MRI Scan, Angiography, Endoscopies etc. at ESI hospitals and through Tie-up arrangements. Free supply of drugs and dressings through SDs, and from Specialist OPDs at each hospital. Ambulance facilities at all ESI Hospitals. AIDS prevention , awareness & control through the VCCTCs. Tuberculosis control through DOTS by participating in RNTCP. Free supply of Spectacles and Hearing Aids for both IP & Family. Issue of Certificates in Statutory forms in respect of sickness, maternity etc. to I.Ps only. Pain Management Treatment at ESI Pain Management Institute, Sealdah .

38. Future Prospects of ESI in India: The ESI Corporation during its 173rd meeting held on 16.02.18 under the Chairmanship of Shri Santosh Kumar Gangwar , Honorable Minister of State for Labour & Employment, Govt. of India has taken some important decisions towards improvements in its service delivery mechanism. The salient features are- ESIC Vision 2022 Taking over/sanctioning of ESI Hospitals at Barielly (U.P.), Bhubaneshwar (Odisha) , Raigarh (Chhattisgarh) and Phulwarisarif (Patna) Establishing Modified Employer’s Utilization Dispensary (Modified EUD)

39. Future Prospects of ESI in India: Other important decisions which were taken during the meeting are as follows: The ESIC Vision 2022 envisages expansion of ESI Scheme in each district of the country with target of covering 10 Crores workers by 2022. Formation of a new sub-committee for fine tuning was also taken. 2. A) To strengthen medical care services in U.P., the decision of taking over of ESI Hospital, Barielly by ESI Corporation, was taken. B) Approval for setting up of ESIC Super Specialty Hospital at Bhubneshwar C)Sanction of 100 bedded ESI Hospital in Raigarh , Chhattisgarh were also reported upon in the meeting. 3. The decision for establishing Modified Employer’s Utilisation Dispensary (Modified EUD) on pilot basis was also taken in the meeting, with the objective to strengthen stake holders participation in the expansion of primary care services of ESIC. 4. In order to improve the delivery of health care services and ensuring proper use of resources available in ESIC Hospitals, decision of establishing Vigilance Inspection Unit in ESIC Hospitals has been taken. 5. Revised Estimates for the year 2017-18, Budget Estimates for the year 2018-19 and Performance Budget for the year 2018-19 were deliberated upon and approved.