esi act 1948.pptx

IR

1. EMPLOYEE STATE INSURANCE ACT 1948

2. The employees’ state insurance act – 1948 Pioneering measure in social insurance in india . Health insurance first discussed in 1927 by indian legislature. Originally called “workmen’s state insurance bill” 1946. Came into force on 19 th april 1948.

3. OBJECTIVE The objective of the act is to secure sickness, maternity and medical benefits to employees of factories and establishments and dependents benefits to the dependents of such employees.

4. APPLICABILITY ACT APPLIES TO Factories irrespective of power-using with 10 or more persons employed Shops Hotels and restaurants Cinemas including preview theaters Newspaper establishments Road motor transport undertakings employing 20 or more persons Private medical institutes & educational institutes employing 20 or more persons State govt may cover other establishments in consultation with the esi corporation and with approval of the central govt.

5. DEFINITIONS Employee : employee refers to any person employed on wages in connection with the work of a factory or establishment to which this act applies. Includes technical, manual, clerical and supervisory functions No distinction between casual and temporary employees or technical and non-technical, or time-rate or piece-rate. Does not include naval, military or air force personnel.

6. DEFINITIONS (CONTD.) Wages : means all remuneration paid in cash, including payment in period of leave, lockout or strike which is not illegal. Does not include: Contribution paid to the provident fund or pension fund Travelling allowance Sum paid to special expenses Gratuity payable

7. Registration Registration of a factory/establishment with the employees’ state insurance corporation ( esi ) is a statutory responsibility of the employer under section 2-a and 10-b. Declaration of registration in form 01 to be furnished to the appropriate regional office within 15 days of the act becoming applicable. Employer should get the declaration form filled in by every employee covered under the scheme.

8. BENEFITS Sickness and extended sickness benefit Maternity benefit Disablement benefit Dependants’ benefit Medical benefit Funeral benefit

9. SICKNESS AND EXTENDED 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, contributions should be for minimum 78 days in the relevant period. Maximum duration for benefit is 91 days. Rates of payment vary from rs.14-125 per day, I.E. Average of 50% of daily wages. Insured persons suffering from tb , leprosy, mental and malignant diseases or other specified long term diseases are entitled to extended benefits at higher rates, provided he has been continually employed for at least two years.

10. MATERNITY BENEFIT Implies cash payment to an insured woman in case of confinement or miscarriage or sickness arising out of pregnancy or premature birth. Woman should have contributed for minimum 70 days in the preceding two consecutive contribution periods. Daily rate of benefits double the standard sickness benefit rate, i.e. Full wages. Normally payable for max 12 weeks for confinement and 6 weeks for miscarriage or medical termination of pregnancy. Payable even in the event of the death of the woman.

11. DISABLEMENT BENEFIT In case of temporary disability arising out of employment injury, this benefit is admissable for the entire period certified by an insurance medical officer/practitioner for which the insured person does not work for wages. Rate payable not less than 70% of daily wages; minimum 3 days of incapacity required. In case injury results in permanent, partial or total loss of earning capacity, periodical payments to be made for life. One-time lumpsum is permissible in certain cases.

12. DEPENDANTS’ BENEFIT Periodical pension paid to dependants of deceased where death occurs out of employment injury or disease. Widows: 3/5 th of benefit rate for life or until remarriage Children: 2/5 th of benefit rate until 18 Total amount distributed not to exceed ceiling of disablement benefit. Benefit not paid to married daughters. In case there is no widow or child, benefit can be paid to other dependants including parents. Amount paid is reviewed and increases granted from time to time to compensate for erosion in real value and cost of living.

13. MEDICAL BENEFIT Insured persons and their families entitled to free, full and comprehensive medical care. Extended upto two years for chronic and long-term diseases. Treatment continues even if person goes out of coverage, till sickness ends. Package covers all aspects of health care from primary to super-specialist facilities, such as: Out-patient treatment Domiciliary treatment Specialist consultation and diagnostic facilities

14. MEDICAL BENEFIT (CONTD.) In-patient treatment Free supply of drugs and dressing X-ray and laboratory investigations Vaccination and preventive innoculations Ante-natal, confinement, post-natal care Ambulance service or conveyance charges Free diet during admission in hospitals Free supply of artificial limbs, aids and appliances for physical rehabilitation Family welfare services and other national health programme services Medical certification Special provisions including super-speciality treatment.

15. FUNERAL BENEFIT Funeral expenses are in the nature of a lump sum payment upto a maximum of rs.2500 ( now rs 5000) made to defray the expenditure of the funeral of deceased 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.

16. PROTECTION An employer cannot dismiss or punish an employee under treatment for sickness of in receipt of any benefit or absent from work due to illness. Any notice of dismissal, discharge or reduction is invalid. However, the employer can discharge or punish the employee if: He has received temporary disablement benefit and remained absent for 6 months or more Is under treatment for sickness other than tb or arising out of pregnancy and remained absent for 6 months or more Is under medical treatment for tb or a malignant disease and has remained absent continuously for 18 months or more.

17. MISCELLANEOUS Cash benefits payable under the esi act are not liable to attachment or sale in execution of any court decree or order. Right to receive benefit is not transferable. Disputes under the provisions of the act to be decided by the employees’ insurance court ( eic ) and not by a civil court. Appeals to the high court only by an order of the eic on a question of law. Period of limitation for appeal is 60 days.