BENEFITS & CONTRIBUTORY CONDITIONS


 

 

Sickness benefit:

 

Benefit

contributory conditions

Duration

Rate

Sickness (for self)

Payment for at least 78 days in the relevant contribution period

91 days in any two consecutive benefit periods.

Standard benefit rate (not less them 50% of wage)

Extended sickness benefit (for self) (For 34 specified long term diseases)

2 Years continuous employment and payment of contribution for at least 156 days in four-contribution period. 

309 days duration has been extended beyond 400 day (91 days S.B. plus 309 days E.S.B.) to two years in deserving cases.

140% of the standard benefit rate (but not less than 70% of the wage)

Enhanced sickness benefit (for undergoing sterilization)

Payment for at least 78 days in the relevant contribution period

7 Days vasectomy and 14 days for tubectomy.

Twice the standard benefit rate but not less than full wages.

 

Disablement benefits (employment injury or occupational disease):

 

Benefit

contributory conditions

Duration

Rate

Temporary Disablement benefit

No condition

Till the incapacity lasts

140% of the standard benefit rate.

Permanent Disablement benefit

No condition

For life

up to 140% of the standard sickness benefit rate.

 

Dependents' benefit:

 

Benefit

contributory conditions

Duration

Rate

For death due to employment injury or occupational disease (for dependants)

No Condition

To immediate dependants

140% of the standard benefit rate.

 

 

 

Maternity benefit:

 

Benefit

contributory conditions

Duration

Rate

Maternity benefit (for self)

Payment of contribution for 70 days in immediately preceding two consecutive contribution periods.

12 weeks of which not more than SIX can precede the expected date of confinement, 6 weeks for miscarriage. 

Double the Standard benefit rate (Not less than full wage)

 

Medical benefit:

 

Benefit

contributory conditions

Duration

Rate

Medical benefit (for self & family)

No condition

12 weeks of which not more than SIX can precede the expected date of confinement, 6 weeks for miscarriage. 

Double the Standard benefit rate (Not less than full wage)

 

Other benefits:

 

Benefit

contributory conditions

Duration

Rate

Funeral Expenses

No condition

 

Actual expenditure on funeral not exceeding Rs. 2500\-

Rehabilitation Allowance

No condition

For each day on which insured person remains admitted in artificial limb center for fixation/repair or replacement of artificial limb

Double the standard sickness benefit rate but not less than full wages.

Vocational & Rehabilitation

Insurable employment up to 40% permanent disablement and below 45 yrs of age.

Till such training lasts at a recognized center/ institute.

 

Medical benefit to retired and disabled insured persons

On payment @ of Rs.10 per month in lump-sum for one year in advance

Period for which contribution is paid

Full medical care for self and spouse only

Medical Bonus

No condition other than insurable employment of Self/spouse

Rs 1000/- is paid as a lump-sum grant towards confinement expenses to an insured women, wife of insured person (w.e.f. 1-4-03)

At places where necessary medical facilities are not available under the ESI Scheme.




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APPLICABILITY OF THE ACT & SCHEME:

 Is extended in area-wise to factories using power and employing 10 or more persons and to non-power using manufacturing units and establish-ments employing 20 or more person upto Rs.15,000/- per month w.e.f. 01.04.10. It has also been extend-ed upon shops, hotels, restaurants, roads motor transport undertakings, equip-ment maintenance staff in the hospitals.

COVERAGE OF EMPLOYEES:

 Drawing wages Upto Rs.15,000/- per month Engaged either directly or thru’ contractor

RATE OF CONTRIBUTION OF THE WAGES:

 Employers’ 4.75%

 Employees’ 1.75%

MANNER AND TIME LIMIT FOR MAKING PAYMENT OF CONTRIBUTION:

 The total amount of contribution (employee’s share and employer’s share) is to be deposited with the authorized bank through a challan in the prescribed form in quadruplicate on ore before 21st of month following the calendar month in which the wages fall due.

BENEFITS TO THE EMPLOYEES UNDER THE ACT:

 Medical Benefit
 Sickness Benefit(SB)
 Maternity Benefit(MB)
 Disablement Benefit
 Dependants’ Benefit(DB)
 Funeral Expenses

 In addition, the scheme also provides some other need based benefits to insured workers.

WAGES FOR ESI CONTRIBUTIONS:

 Registers/files to be maintained by the employers

CONTRIBUTION PERIOD:

 If the person joined insurance employment for the first time, say on 5th January, his first contribution period will be from 5th January to 31st March and his corresponding first benefit will be from 5th October to 31st December.

TO BE DEEMED AS WAGES:

• Basic pay
• Dearness allowance
• House rent allowance
• City compensatory allowance
• Overtime wages (but not to be taken into account for determining the coverage of an employee)
• Payment for day of rest
• Production incentive
• Bonus other than statutory bonus
• Night shift allowance
• Heat, Gas & Dust allowance
• Payment for unsubstituted holidays
• Meal/food allowance
• Suspension allowance
• Lay off compensation
• Children education allowance (not being reimbursement for actual tuition fee)

NOT TO BE DEEMED AS WAGES:

• Contribution paid by kthe employer to any pension/provident fund or under ESI Act.
• Sum paid to defray special expenses entailed by the nature of employment – Daily allowance paid for the period spent on tour.
• Gratuity payable on discharge.
• Pay in lieu of notice of retrenchment compensation
• Benefits paid under the ESI Scheme.
• Encashment of leave
• Payment of Inam which does not form part of the terms of employment.
• Washing allowance for livery
• Conveyance Amount towards reimbursement for duty related journey

PENALTIES :

 Different punishment have been prescribed for different types of offences in terms of Section 85: (I) (six months imprisonment and fine Rs.5000), (ii) (one year imprisonment and fine), and 85-A: (five years imprisonment and not less to 2 years) and 85-C (2) of the ESI Act, which are self explanatory. Besides these provisions, action also can be taken under section 406 of the IPC in cases where an employer deducts contributions from the wages of his employees but does not pay the same to the corporation which amounts to criminal breach of trust.

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