Emergency No. +91 (033) 2438-0732

Citizen Charter

Citizen Charter Booklet


1.INTRODUCTION

Employees’ State Insurance Scheme of India, is an integrated social security scheme tailored to provide social protection to workers in the organised sector and their dependants in contingencies, such as, sickness, maternity or death and disablement due to an employment injury or occupational disease. The scheme tailored to suit health insurance requirements of workers provides full medical facilities to insured persons and their dependants, as well as, cash benefits to compensate for loss of wages or earning capacity in different contingencies.

2.APPLICABILITY OF THE ESI ACT

The ESI Act, (1948) applies to the following categories of factories and establishments in the implemented areas:-

The “ appropriate Government ” State or Central is empowered to extend the provisions of the ESI Act to various classes of establishments, industrial, commercial, agricultural or otherwise in nature. Under these enabling provisions most of the State Govts have extended the ESI Act to certain specific classes of establishments, such as, shops, hotels, restaurants, cinemas, preview theatres, motors transport undertakings and newspaper and advertising establishments etc., employing 20 or more persons.

3.ORGANISATION

As provided under the ESI Act, the scheme is administered by a duly constituted corporate body called the Employees’ State Insurance Corporation (ESIC). It comprises members representing Central and State Governments, Employers, Employees, Parliament and the medical profession. Union Minister of Labour functions as Chairman of the Corporation whereas the Director General, as chief executive, discharges the duty of running the day-to-day administration.

A Standing Committee representing all stake holders is elected from the body corporate for managing the affairs of the scheme and monitoring the progress of implementation of various decisions and policies etc. from time to time.

The Medical Benefit Council , a statutory body advises the Corporation on matters related to administration of medical benefit under the ESI scheme.

4.INFRASTRUCTURE

The central headquarters of the Corporation is located at New Delhi. For purpose of coverage, revenue collection, extension of the scheme to new classes of establishments, implementation of the scheme in new areas, co-ordination with the State Governments and general administration the Corporation has established Regional and sub-Regional Offices across the country mostly located in State capitals.

Given the huge number of beneficiaries – about 329 lakhs now – the Corporation has set up a wide spread network of service outlets for prompt delivery of benefits in cash and kind that includes full medical care.

Medical facilities are provided through a network of 1427 ESI Dispensaries, over 2100 Panel Clinics, 307 diagnostic centres besides 152 ESI hospitals and 43 hospital annexes with over 27000 beds. For providing super-speciality medical care the Corporation has tie up arrangements with advanced medical institutions in the country, both in public and private sector. The medical benefit is administered with the active co-operation of State Governments.

The payment of cash benefits is made at the gross roots level through as many as 800 Branch Offices and Cash Offices that function under the direct control of the Corporation.

5.CONTRIBUTION

The ESI Scheme is mainly financed by contributions raised from employees covered under the scheme and their employers, as a fixed percentage of wages. As of now, the rates of contribution are:-

( i )

Employees’ Contribution

:

1.75 percent of wages

 

(ii)

Employers’ Contribution

:

4.75 percent of wages

 

  1. Employees’ earning upto Rs.50/- a day as wages are exempted from payment of their part of contribution.
  2. The State Govts bear one-eighth share of expenditure on Medical Benefit within the per capita ceiling of Rs.900/- per annum and any additional expenditure beyond the ceiling.

6.WAGE CEILING

Employees of covered units and establishments drawing wages upto Rs.21,000/- per month come under the purview of the ESI Act, 1948 for multi-dimensional social security benefits.

7.SOCIAL SECURITY BENEFITS

Quantum, Scale and Contributory Conditions

Employees covered under the scheme are entitled to medical facilities for self and dependants. They are also entitled to cash benefits in the event of specified contingencies resulting in loss of wages or earning capacity. The insured women are entitled to maternity benefit for confinement. Where death of an insured employee occurs due to employment injury or occupational disease the dependants are entitled to family pension – the dependants benefit.

Various benefits that the insured employees and their dependants are entitled to, the duration of benefits and contributory conditions therefore, are as under ; -

(I)Medical Benefit:

Full medical facilities for self and dependants are admissible from day-one of entering insurable employment. Whereas, the primary, out patient, inpatient and specialist services are provided through a network of Panel clinics, ESI dispensaries and hospitals, super speciality services are provided through a large number of advanced empanelled medical institutions on referral basis.

Eligibility to Medical Benefit

II)Sickness Benefit (Cash)

Sickness Benefit is payable to an insured person in cash, in the event of sickness resulting in absence from work and duly certified by an authorised insurance medical officer/practitioner.

II( a)Extended Sickness Benefit (Cash )

Extended Sickness Benefit is payable to insured persons for the period of certified sickness in case of specified 34 long term diseases that need prolonged treatment and absence from work on medical advice.

II (b)Enhanced Sickness Benefit (Cash)

This cash benefit is payable to insured persons in the productive age group for undergoing sterilisation operation, viz. vasectomy/ tubectomy .

III Maternity Benefit (Cash)

Maternity Benefit is payable to insured women in case of confinement or miscarriage or sickness related thereto.

IVDisablement Benefit (Cash)

Disablement Benefit is payable to insured employees suffering from physical disablement due to employment injury or occupational disease.

VDependants’ Benefit (Cash)

Dependants benefit (family pension) is payable to dependants of a deceased insured person where death occurs due to employment injury or an occupational disease.

VI Other Benefits

Some other benefits offered by the Scheme are:-

a) Funeral expenses on death of an I.P. subject to a maximum of Rs.2500/- payable at the Branch Office.

b) Vocational Rehabilitation in case of disabled insured persons under 45 years of age with 40 percent or more disablement.

c) Free supply of physical aids and appliances such as crutches, wheelchairs, dentures, spectacles and other such physical aids.

d) Preventive health care services such as immunisation, family welfare services, HIV/AIDS detection, treatment etc.

e) Confinement Allowance @ Rs.1000/- is paid to an insured woman or in respect of the wife of an insured person in case she does not avail medical facilities of the scheme for child delivery.

8. RIGHTS AND DUTIES OF EMPLOYERS

a) Duties of Employers

(b) Rights of Employers

9.SAFE GUARDS FOR INSURED EMPLOYEES

i) Right to receive payment of any benefit under the Act shall not be transferable or assignable.

ii) Cash Benefits payable under the Act are not liable to attachment or sale in execution of any decree or order of any court.

iii) Employer shall not dismiss, discharge or reduce the wages or otherwise punish a covered employee during the period he/she is in receipt of Sickness Benefit or Maternity Benefit etc.

iv) By reason of his liability to pay his share of contribution under the ESI Act, no employer shall directly or indirectly reduce the wages of a covered employee.

v) Right to register their grievances/complaints at any level for immediate redressal.

vi) Right to approach ESI Court against any action/decision of the Medical Board etc.

10. ROLE OF ESIC IN DELIVERY OF BENEFITS

The ESIC is to ensure that:

11. ROLE OF ESIC IN SERVICING EMPLOYERS

12. REDRESSAL OF PUBLIC GRIEVANCES

ESI Scheme, being a multi-discipline service intensive social security programme for workers, an estimated 3.5 lakh beneficiaries visit the service outlets at the grassroots level daily, either for treatment or for availing cash benefits. In such a highly interactive and dynamic system there is sufficient scope for any inadvertent or wilful harassment being caused to the beneficiaries. The Corporation has, therefore, set up an elaborate system for speedy redressal of public grievances and complaints at various levels. Grievances can be reported in writing, on telephone, by post or in person to any of the following officers:-

BRANCH OFFICE LEVEL

 

Manager, Incharge of Branch Office.

DISPENSARY LEVEL

 

IMO Incharge .

HOSPITAL LEVEL

 

Medical Supdtt./Dy.Med.Supdtt .

REGIONAL LEVEL

 

i) Public Grievance Officer.

ii) Regional Director ESIC.

iii) Director Medical ESI Scheme.

CORPORATE LEVEL

 

Director Public Grievances,

ESI Corporation, C.I.G. Road,

New Delhi-110 002.

011-23236786

23234092 (Extn.279)

13. VIGILANCE RELATED ISSUES

For vigilance related issues Employers and Employees covered under the scheme can contact the Regional Director ESIC of their area or write to the:-

Chief Vigilance Officer/Director Vigilance,

Employees’ State Insurance Corporation,

Panchdeep Bhawan , Kotla Road,

New Delhi-110002.

Tel: 011-23239424

011-23234092 (Extn.214/233).

14. GENERAL INFORMATION

For any other information about the scheme individuals or organisations may log on to ESIC Website:

Director Public Relations,

ESI Corporation,

Panchdeep Bhawan , C.I.G. Road,

New delhi – 110 002.

Tel.: 23236764/23234092 (Extn.212/221)

CORPORATE HEADQUARTER

DIRECTORATE GENERAL,

EMPLOYEES’ STATE INSURANCE CORPORATION,

Panchdeep Bhawan , C.I.G.Road ,

New Delhi – 110 002.

PBX : 011 – 23234092, 23234093

FAX : 011 - 23234537

E-mail : hq@esic.in