Section 46 of the ESI Act envisages the benefits that an Insured Person can avail under the ESI Act. The following are six social security benefits that have been provided under the beneficial employment law. The benefits below are in brief, for details you may visit http://www.esic.nic.in/benefits.php
MEDICAL BENEFITS –
1. Full medical care is provided to an Insured person and his family members from the day he becomes insured. There is no ceiling on expenditure on the treatment of an Insured Person or his family member.
2. The scale of Medical Benefit as per Section 57 of the Act is to be provided to the Insured Persons and members of their families as prescribed by the State Government in consultation with the ESI Corporation under Section 58(1 & 3) of the Act.
3. Insured Persons are entitled to avail treatment in ESI Dispensary/Hospital/Diagnostic Centre and recognised institutions, to which they are attached such as:-
i. Outpatient treatment
ii. Domiciliary treatment by visits at their residences.
iii. Specialists Consultation.
iv. In-patient treatment(Hospitalisation) etc
4. Family members of an Insured Person are entitled to the “FULL” Medical Care and “EXPANDED” Medical Care.
5. Medical Benefits can be provided (under Section 56 of the Act) to:
i. An Insured Person and his or her spouse who leaves insurable employment on attaining the age of superannuation after being insured for not less than five years, till the period for which contribution is paid.
ii. An Insured Person and his/her spouse who ceases to be in insurable employment on account of permanent disablement due to employment injury shall be entitled to medical benefit.
6. An Insured Person and his family members are entitled to free medical attendance by Insurance Medical Practitioner/Insurance Medical Officer at their residence.
7. For the domiciliary visit, the Insurance Medical Officers are paid conveyance allowance. The quantum of this allowance is decided by the State Government in consultation with the Corporation.
8. The standard of Medical Care under the E.S.I. Scheme provides for Specialist Consultation to all Insured Persons and to members of their families in areas with “Expanded” and “Full” Medical Care. Such consultation is provided in General Medicine, General Surgery, Pulmonary Medicine, Obstetrics and Gynaecology etc
9. Imaging and related investigations including CT Scan, MRI, Echocardiography and laboratory facilities are provided free of cost to Insured Persons and their families.
10. Insured Persons and their family members are also provided artificial limbs, hearing aids, Artificial Dentures, teeth (To insured persons only), Artificial Eye (To insured persons only), Wigs (replacement not earlier than 5 years) to female beneficiaries only, Cardiac pacemaker, Wheel Chair/tricycle, Spinal supports (jackets, braces etc.) etc.
11. Under Regulation 69 of ESI (General Regulations), 1950, every employer has to arrange for First-aid Medical care and transport of accident cases till the injured Insured Person is seen by the Insurance Medical Officer/Insurance Medical Practitioner and such employer is entitled to reimbursement of expenses incurred in this regard.
SICKNESS BENEFIT –
70 per cent of wages as Sickness Benefit in the form of cash compensation is payable to insured workers during the periods of certified sickness for a maximum of 91 days in a year. In order to qualify for sickness benefit the insured worker is required to contribute for 78 days in a contribution period of 6 months.
Extended Sickness Benefit (ESB) : Sickness Benefit extendable up to two years in the case of 34 malignant and long-term diseases at an enhanced rate of 80 per cent of wages
Enhanced Sickness Benefit : Enhanced Sickness Benefit equal to full wage is payable to insured persons undergoing sterilization for 7 days/14 days for male and female workers respectively.
MATERNITY BENEFIT –
Three months Maternity Benefit for confinement/pregnancy is payable which is extendable by a further one month on medical advice at the rate of full wage subject to contribution for 70 days in the preceding year.
DISABLEMENT BENEFIT –
Temporary disablement benefit (TDB) : Temporary Disablement Benefit at the rate of 90% of wage is payable so long as disability continues.
Permanent disablement benefit (PDB) : Paid at the rate of 90% of wage in the form of monthly payment depending upon the extent of loss of earning capacity as certified by a Medical Board.
DEPENDENT’S BENEFIT –
90% of wages paid in the form of monthly payment to the dependants of a deceased Insured person in cases where death occurs due to employment injury or occupational hazards.
OTHER BENEFITS –
Funeral Expenses: An amount of Rs.10, 000/- is payable to the dependents or to the person who performs last rites, from day one of entering insurable employment.
Confinement Expenses: An Insured Women or an Insured Person in respect of his wife in case confinement occurs at a place where necessary medical facilities under ESI Scheme are not available.
OTHER NEED BASED BENEFITS –
Vocational Rehabilitation, Physical Rehabilitation, Old Age Medical Care, Rajiv Gandhi Shramik Kalyan Yojana, Incentive to employers in the Private Sector for providing regular employment to the persons with disability etc.