Section 46 of the Act envisages following six social security benefits :
Medical benefit
TYPE OF MEDICAL BENEFITS PROVIDED
The Employees State Insurance Scheme provides full medical care in the form of medical attendance, treatment, drugs and injections, specialist consultation and hospitalization to insured persons and also to members of their families where the facility for Specialist consultation, hospitalization has been extended to the families.For the families, this benefit has been divided into two categories as under:-
FULL MEDICAL CARE
This consists of hospitalization facilities and includes specialist services, drugs and dressings and diets as required for in-patients.
EXPANDED MEDICAL CARE
This consists of consultation with the specialists and supply of special medicines and drugs as may be prescribed by them in addition to the out-patient care. This also includes facilities for special laboratory tests and X-Ray examinations.Apart from the curative services provided through hospitals and dispensaries, the Corporation also provides the following facilities including family welfare services.
IMMUNIZATION
The Corporation has embarked upon a massive programme of immunization of young children of insured persons. Under this programme, preventive inoculation and vaccines are given against diseases like diphtheria, pertusis, polio, tetanus, measles, mumps, rubella, tuberculosis etc.
FAMILY WELFARE SERVICES
Along with the immunization programme, the Corporation has been undertaking provision of family Welfare Services to the beneficiaries of the Scheme. The Corporation has organized these services in 180 centres besides reserving 330 beds in hospitals for undertaking tubectomy operations. So far, 828976 sterilization operation viz. 176197 vasectomies and 652779 tubectomies have been performed upto 31.3.1999. The ESI Corporation has also extended additional cash incentive to insured persons to promote acceptance of sterilization method by providing sickness cash benefit equal to full wage for a period of 7 days for vasectomy and 14 days for tubectomy. The period for which cash benefit is admissible is extended beyond the above limits in the event of any complications after Family Planning operations.
SUPPLY OF SPECIAL AIDS
Insured persons and members of their families are provided artificial limbs, hearing aids, and artificial appliances like spinal supports, cervical collars, walking calipers, crutches, wheel chairs and cardiac pace makers as a part of medical care under the Scheme
b) Sickness Benefit
Sickness Benefit represents periodical cash payments made to an IP during the period of certified sickness occurring in a benefit period when IP requires medical treatment and attendance with abstention from work on medical grounds. Prescribed certificates are; Forms 8,9,10,11 & ESIC-Med.13. Sickness benefit is roughly 50% of the average daily wages and is payable for 91 days during 2 consecutive benefit periods.
c) Maternity Benefit:
Maternity Benefit is payable to an Insured Woman in the following cases subject to contributory conditions:-
Confinement-payable for a period of 12 weeks (84 days) on production of Form 21 and 23. Miscarriage or Medical Termination of Pregnancy (MTP)-payable for 6 weeks (42 days) from the date following miscarriage-on the basis of Form 20 and 23. Sickness arising out of Pregnancy, Confinement, Premature birth-payable for a period not exceeding one month-on the basis of Forms 8, 10 and 9.In the event of the death of the Insured Woman during confinement leaving behind a child, Maternity Benefit is payable to her nominee on production of Form 24 (B) Maternity benefit rate is double the Standard Benefit Rate, or roughly equal to the average daily wage.
d) Temporary & Permanent Disablement benefit:
TDB is payable to an employee who suffers employment injury (EI) or Occupational Disease and is certified to be temporarily incapable to work. ""Employment Injury"" has been defined under Section 2(8) of the Act, as a personal injury to an employee caused by accident or occupational disease arising out of and in the course of his employment, being in insurable employment, whether the accident occurs or the occupational disease is contracted within or outside the territorial limits of India.
PDB is payable to an IP who suffers permanent residual disablement as a result of EI (including Occupational Diseases) and results in loss of earning capacity. The proper authority for assessing loss of earning capacity for injuries is the Medical Board and for Occupational Diseases, Special Medical Board.
e) Dependant's Benefit
The dependants benefit is payable to the dependants as per Section 52 of the Act read with provision of 6(A) of Section 2 in cases where an IP dies as result of EI. The age of dependants, has to be determined either by production of Documentary evidence as specified in Regulation 80(2) or Age certified by Medical Officer In charge of Government Hospital or Dispensary.The minimum rate of DB w.e.f 1.1.90 is Rs.14/- per day and these rates of the DB are increased from time to time. The latest enhancement is with effect from 01.08.2002
f) Funeral Expenses:
An interesting feature of the ESI Scheme is that the contributions are related to the paying capacity as a fixed percentage of the workers wages, whereas, they are provided social security benefits according to individual needs without distinction.Cash Benefits are disbursed by the Corporation through its Local Offices LOs/ Mini Local Offices (MLOs)/Sub Local Offices SLOs)/pay offices, subject to certain contributory conditions.]In addition, the scheme also provides some other need based benefits to insured workers. These includes Rehabilitation allowance]Vocational Rehabilitation Unemployment Allowance (Under Rajiv Gandhi Shramik Kalyan Yojana)
Courtesy:ESI Website
