ESI.pptx

Employee State Insurance Act, 1948

1. Employee’s State Insurance ACT, 1948 By: Sachin Masan, BAMS (IIIrd Year)

2. Scope 1. Purpose : The ESI Act, 1948 , is a law in India designed to provide social security and health insurance benefits to industrial workers . 2. Amendments : The act was initially passed in 1949 and has been amended in 1975 , 1984 , and 1989 to improve its provisions. 3. Benefits : It offers cash and in-kind benefits to workers who face sickness , maternity , or employment-related injuries . This helps alleviate their financial and physical concerns . 4. Scope : The ESI Act applies to the entire country . It covers factories employing less than 20 workers with power and more than 20 workers without power . In 1975 , it was expanded to include various other establishments like hotels, cinemas, road transport, newspapers, and shops . In summary, the ESI Act serves as a safety net for workers in India, ensuring they receive support during health-related challenges and job injuries.

3. Coverage Expansion (2004) : The Act covers all employees, including manual, clerical, supervisory, and technical workers, earning up to ₹7500 per month. Extension to Other Establishments : The provisions of the Act can be applied to other agricultural or commercial establishments as needed. Name Explanation : The name “ ESI Act” has significance: “ Employees ” because it’s for workers . “ State ” because state governments are responsible for helping workers in times of crisis. “ Insurance ” because workers contribute a small percentage (1% to 2.5%) of their wages as a premium , even if they don’t immediately benefit.

4. Administration Imagine the ESI Scheme like a well-organized team: 1. ESI Corporation (The Big Boss): - Meets twice a year. - Led by the Labor Minister and other important folk like government, representatives of employees, employers and medical professionals - They create the game plan ( policies ) for the scheme. 2. Standing Committee (The Doers): - Made up of team members from ESI Corporation . - They meet four times a year. - Their head honcho is the Director General . - These are the folks who execute the game plan and make sure things run smoothly day to day.

5. 3. Medical Benefit Council (The Health Experts): - Led by the Director General of Health Services . - They have a mix of health experts, employees, employers, and representatives from different places. - Their job is to give advice on how to keep everyone healthy . 4. Field Offices (The Helpers): - There are 21 State Wise regional and 15 local offices - They handle claims and make sure everyone gets the money they need. - Inspectors keep an eye on things to make sure everyone's playing fair . So, it's like a big team effort. The bosses make the rules , the doers make things happen , the health experts keep everyone well , the helpers make sure the money gets to the right people . Teamwork makes the ESI Scheme work!

6. The benefits for employees under the ESI Scheme : Cash Benefits (First Five): 1. Sickness Benefit: Money when you're sick and can't work . 2. Maternity Benefit: Support for new moms during pregnancy and childbirth. 3. Disablement Benefit: Help if you're hurt at work and have a lasting injury. 4. Dependent Benefit: Assistance for your family if worker pass away. 5. Funeral Benefit: Financial help when a loved one passes away. 6. Medical Benefit: You get medical care and treatment when you're unwell. 7. Rehabilitation Benefit: Assistance to recover and return to work after a serious injury or illness. It's like a helping hand to rebuild your life . These benefits are for employees earning up to ₹7,500 per month , providing a safety net during tough times.

7. Sickness Benefit What is it? - Cash support when you're too sick to work . - Certified by an Insurance Medical Officer . How much? - 50% of your daily wage. - Up to 91 days for short -term illnesses. Extended Sickness Benefit: - For long-term illnesses. - Up to 309 days if you've worked continuously for two years. Covered Illnesses: - Includes diseases like tuberculosis , diabetes with complications, heart diseases, and more. - 34 diseases in total. Important Note: - Job is protected during sickness. - It covers illnesses, whether work-related or not.

8. Maternity Benefit: - For insured women workers. - Duration varies: - Miscarriage and premature birth: 6 weeks. - Sickness due to pregnancy: 30 days. - Confinement (before & after delivery): 12 weeks. - Paid at full wages . Disablement Benefit: - For workers disabled due to work-related reasons or job injuries. 3 types - Temporary disability: 85% of wages . - Total permanent disability: Full pension for life. - Partial permanent disability: A portion as a life pension.

9. Dependent's Benefit: - For the family of an insured worker who dies due to a work injury. - Paid periodically . - Children and widow get 40% more than the Standard Benefit Rate. - Minimum benefit: ₹14 per day. - Benefits for children until 18 years, or until the daughter gets married . - Widow gets benefits for life or until remarriage . Funeral Benefit: - Immediate cash benefit, up to ₹ 2500 . - Given to the eldest surviving family member to cover funeral expenses

10. Medical Benefit Medical Benefit: - Unlike other benefits, this is not cash but medical care. - It includes three types of medical care: 1. Full Medical Care: - Hospitalization , free for insured persons and their families during sickness, work injuries, and maternity. - Services include outpatient care, inpatient care, drugs , specialists , tests , antenatal and postnatal care, and more. - Complex cases may be referred outside the state, paid for by ESI. 2. Limited Medical Care: - Only outpatient care is provided. 3. Partial Medical Care: - Full care but no hospitalization

11. Direct and Indirect pattern Direct Pattern: - Through ESI hospitals and dispensaries. - Full-time medical and paramedical staff. - Established where there are more than 1000 families. Indirect Pattern (Panel System): - Care provided indirectly through private doctors known as 'Insurance Medical Practitioners.' - 1 doctor per 750 families. - Doctors receive a fixed payment , whether services are used or not.

12. Miscellaneous Medical Benefits: - Free supplies for disabled workers.(Spects, hearing aid etc) - Preventive shots. - Free contraceptives and rewards for sterilisation. - Yoga training Cost of Medical Benefit: - It's been rising over the years. - Was ₹23.79 in 1961-62, ₹67.53 in 1973-74, ₹905 in 2001-02. Rehabilitation Benefits are also received by workers.

13. ESI Scheme by March 31, 2003: - Covered 78 lakh employees, including 14 lakh women . - Total beneficiaries around 253 lakhs . - 27,000 beds available. - 700 ESI hospitals, 350 specialist centers, and 1500 hospitals. - Doctor to population ratio: 1:585 (better than the national average of 1:2148).

14. Benefits to Employers: - Exemption from Workmen's Compensation Act, 1923. - Exemption from Maternity Benefit Act, 1961. - No need to pay medical allowances or arrange medical care . - Rebate on Income Tax for ESI contributions. - Promotes a healthy workforce.

15. Workmen's Compensation Act, 1923: - Deals with compensating workers for occupational injuries or diseases. - Applicable where ESI Scheme isn't in place. - Compensation amount decided by labor courts. - Challenges due to illiteracy , ignorance , and employer indifference.

16. Thank you 😃