1. AN OVERVIEW OF THE ESI ACTBY
ESIC AURANGABAD

2. What is ESI Act ?
It is the First Social Security Legislation In Independent India.
Was passed by the Parliament in 1948
Came into effect in the year 1952, 24th February at Kanpur.
It is an Act to provide certain benefits to Employees in case of
Sickness
Maternity
Employment Injury
Certain other matters.

3. Coverage
It is a process by which the Act is brought into effect at a determined place.
A Notification is issued by the Central Government under Section 1(3) of the Act, with a specific date for implementation.
From the date of Notification all coverable Factory/Establishment should register themselves under the Act and obtain code No and do Compliance.

4. Applicability for Coverage
1. Factory:
Having 10 or more persons working and manufacturing activity is being carried out. Coverage done as per Sec 2(12) of Act.
2. Establishment:
Having 20 or more employees working and coverage done as per Sec 1 (5) of the Act. Examples (shops, contractors etc)
As per Sec 1(6) of the Act, once a factory/establishment is covered, it will remain covered even if the employee strength falls below the required limit.

5. Basic Concepts 1. Wage Limit for Coverage: 2. Rate of Contribution:
Upto Dec-2016 : Rs 15000/- pm
From : Rs /-pm
2. Rate of Contribution:
Employee Share : %
Employer Share : %
Total Payable %
In newly Implemented areas for the Initial 2 years rate of contribution will be :
Employee Share : 1 %
Employer Share : 3 %
Total Payable %

6. Basic Concepts 3. Contribution Period and Benefits Period:-
(Regulation 4 of ESI (Gen) Regulation 1950)
Sickness Benefits can be availed after expiry of 9 months from the date of insurable employment
CONTRIBUTION PERIOD
BENEFIT PERIOD
APRIL – to- SEPTEMBER
JANUARY-to-JUNE
OCTOBER-to MARCH
JULY-to DECEMBER

7. Registration Employer: Employees:
Under Regulation 10-B, Employer to whom this Act applies should complete registration within 15 days from the applicability.
Employees:
Under Regulation 12 and 14, Employer to ensure all Employees are registered immediately and not later than 10 days.
(Details of family, Nominee, Bank Details, Adhar No to be taken)
Registration to be done Online at
No Documentation needed.

8. BENEFITS Medical Benefits Sickness Benefits Disablement Benefits
Dependents Benefits
Maternity Benefits
Unemployment Allowance (RGSKY)
Confinement Expenses
Funeral Expenses
Vocational Training
Rehabilitation Expenses
Artificial limbs

9. BENEFITS-Important Definitions
Employee: (Section 2(9) )
Person employed for wages upto Rs 21000/- pm
Directly by the Company or Through Contractor.
Part time, Daily wages, Piece rated,
Working in all the departments(Factory, Admn, Sales etc)
Insured Person : (Section 2(14) )
Any person who was or is an Employee
For whom any contribution were paid or payable
Who is entitled to any of the benefits under the Act.

10. BENEFITS-Important Definitions
Family: Section 2(11)
Spouse
Minor legitimate/Adopted child
Dependant child upto age of 21 years if studying/ unmarried daughters
Infirm Child dependant on the IP irrespective of age.
Dependant Parents whose income is less than the limit prescribed.
For Unmarried IP, if his/her parents not alive, then dependant minor brothers and sisters.
The family particulars as per above will be entered in the ID particulars of the IP and they will be eligible for medical facilities.

11. BENEFITS-Important Definitions
Dependants: Section 2(6-A)
Widow,
Son upto age of 25 years
Daughters till marriage
Widowed Mothers
Infirm Son/Daughters dependent on the Income of IP even if age More than 25 years
The dependents are eligible for Dependents benefits in case of death of IP due to employment injury.

12. Important Definitions
Definition of Wages:
All Component except Washing Allowance
Over time to be excluded for deciding coverage but to be included for payment of Contribution.
For employee getting salary less than Rs.130/- per day, only employer share of contribution to be paid.
Employee covered at the start of any Contribution Period will stand to be covered till the end of that CPE even if his wages exceed the limit. Contribution will be paid on the higher amount.

13. BENEFITS MEDICAL BENEFITS:
Responsibility for Medical Benefits belongs to State Government.
There are following 3 types of Medical benefits:
Primary and Secondary treatment available to IP and family from 1st day of employment.
TYPE
NATURE OF PROBLEMS
PROVIDED AT
PRIMARY
BASIC AILMENTS
ESIS DISPENSARY/
INSURED MEDICAL PRCTIONERS
SECONDARY
BASIC HOSPITALIZATION, INCLUDING SURGERIES
GIVEN AT ESIS HOSPITAL
TERTIARY
(SST)
HIGHER TREATMENT/SURGERIES
AT ESIC HOSPITALS/PRIVATE TIE UP HOSPITALS

14. Conditions for Super Specialty Treatment:
BENEFITS
MEDICAL BENEFITS:
Conditions for Super Specialty Treatment:
Continuous employment for 2 years on date of diagnosis
At least 156 days of Contribution paid during immediate 4 CP.
Should be eligible for Sickness Benefits in at least 2 Benefit Period.
Treatment would be cashless after getting Referral letter from Medical Superintendant ESIS Chikalthana Hospital.
In emergency can be directly taken to any of the Tie-up Hospital for treatment and the formality of Referral can be taken later.
Note:
In case of Employment Injury IP will be eligible for SST treatment from the first day itself.

15. BENEFITS SICKNESS BENEFITS: NAME OF BENEFITS CONTRIBUTORY CONDITION
DURATION
RATE
SICKNESS
78 days Contribution to be paid in relevant CPE
Upto 91 days in 2 consecutive Benefit period
70 % of average wages
ENHANCED SB
SAME AS ABOVE
07 Days for Men
14 days for Women
100 % wages
EXTENDED SB
For 34 specified long term disease.
2 year Continuous Employment and 156 days Contribution in 4 CPE
Maximum upto 730 days.
80 % of wages

16. BENEFITS DISABLEMENT BENEFITS: NAME OF BENEFITS CONTRIBUTORY CONDITION
DURATION
RATE
TEMPORARY
DISABLEMENT
DAY 1 of Insurable Employment for employment Injury cases
As long as Temporary disablement last
90 % of last wages
PERMANENT
For Whole Life
As per loss of Earning Capacity calculated by Medical Board

17. BENEFITS DEPENDENTS BENEFIT: NAME OF BENEFITS CONTRIBUTORY CONDITION
DURATION
RATE
DEPENDENT BENEFIT
DAY 1 of Insurable Employment for employment Injury cases
For Widows whole life or re-marriage.
Son upto age of 25 years
Daughter till marriage
Widowed mother dependent whole life
90 % of wages subject to the defined ratio of dependents.

18. CONTRIBUTORY CONDITION
BENEFITS
MATERNITY BENEFIT:
NAME OF BENEFITS
CONTRIBUTORY CONDITION
DURATION
RATE
MATERNITY BENEFIT
70 DAYS CONTRIBUTIONS TO BE PAID BY THE INSURED WOMEN IN 2 PREVIOUS CONTRIBUTION PERIODS
UPTO 26 WEEKS
1 month more for sickness arising out of pregnancy duly certified by the doctor
100 % of wages

19. BENEFITS OTHER BENEFIT: NAME OF BENEFITS CONTRIBUTORY CONDITION
DURATION
RATE
CONFINEMENT EXPENSES
IW/Wife of IP is eligible if confinement takes place at location where ESI Hospital is not available.
For 2 confinement only
Rs. 5000/- per case.
FUNERAL EXPENSES
From Day 1 of Insurable employment
For funeral expenses on death of IP
Maximum of Rs 10000/-.

20. CONTRIBUTORY CONDITION Unemployment Allowance
BENEFITS
OTHER BENEFIT:
NAME OF BENEFITS
CONTRIBUTORY CONDITION
DURATION
RATE
Unemployment Allowance
For Loss of Employment due to :
Closure of Factory/Retrenchment/Permanent Disablement due to Non-Employment Injury.
Contribution to be paid for minimum 2 years
Maximum 24 month.
0-12 Months:
50 % of Last Average Wages
Months:
25 % of Last Average Wages.

21. EMPLOYER: Duties and Responsibilities
Register your Factory/Establishment immediately as per Reg.
Ensure all your Employees (including Contractors) are registered immediately on date of joining.
Pay Contribution within 21 days as specified.
Ensure compliance of Contractor employees as well.
Notify the changes in Company Particulars online.
Get the unit inspected within 3 days upon marking by the Unified Web Portal.
File the Accident Reports within time limit.

22. Employment Injury:
The Employment Injury should satisfy all the 4 conditions:
Personal Injury to an Employee.
Caused by an Accident or Occupational Disease.
Arising out of employment in a covered Factory/Estt.
In the course of employment in covered factory/Estt.
In case of Commuting Accident:
Apart from the above 4 conditions, there should be Nexus established between circumstances, time and place in which the accident occurred and the Employment

23. PENAL ACTION FOR NON COMPLIANCE
Non Payment/Delayed Payment of Contribution:
Assessment as per Sec 45-A will be done.
Interest will be 12 % pa
Damages will be upto maximum of 25 %
Criminal and Civil Prosecution will be initiated under Sec 85 (a) to (g) which will attract fine and imprisonment upto 3 year maximum.
Recovery Action like attachment of Bank accounts, Property and Arrest could be initiated for non payment.
For Delaying Registration of IP’s, Prosecution of violation of Reg 12 to 14 will be taken along with recovery of any benefit payment made to Ips/Dependents under Sec 68.

24. Revenue Generation and Sharing Expenditure on Medical Care
Revenue is Generated only by way of Contribution.
As per Sec 58 of the Act the State Govt to provide Medical Arrangement.
Expdt on Medical Care is shared by ESIC with State Govt in Ratio 7/8th to 1/8th within the Ceiling.
The Ceiling limit was Rs 1500/- pa per IP family which has been increased to Rs 2150/- for year (43 % UP)
No of Registered Ips in SRO Aurangabad.
Ceiling Limit
Amount
(IP*Ceiling limit)
7/8th Share paid by ESIC to State Govt.
1.5 lakh
Rs 1500/-
22.5 crores
19.70 crores
Rs 2150/-
32.25 crores
28.22 crores

25. Statistical Data All India Data regarding Revenue and Expenditure:
% of Administrative Expenditure is around 8.9 % of Revenue which is less than the limit of 15 % fixed by Government
Head of A/c
% Growth
Income
9632 crore
10870 crore
13 %`
Medical Expdt
4860 crore
5715 crore
18 %
Cash Benefits
599 crore
685 crore
15 %
Share of Medical Expdt
50 %
53 %

26. NEW INITIATIVES TAKEN FOR IMPROVEMENT
All the transaction done in IT Enabled Environment.
Employers have been empowered totally.
No documentation asked for registration of employers/Ips
Only E-payment through Net Banking by Employer leading to real-time credit of contribution.
Single Insurance No which is valid in entire India for IP’s.
All benefit payment directly deposited to the account of Ips.
No ESI related record to be kept manually as all will be available in system.
No manual filing of 6 monthly Returns.
Simplified Inspection Policy with transparent system generated marking through Labour Ministry UWP.

27. NEW INITIATIVES TAKEN FOR IMPROVEMENT
Liberal Improvements in Cash benefits
Definition of family and dependents modified
Eligibility criteria reduced from 3 years to 2 year for RGSKY.
Period of benefits in RGSKY and Maternity benefits increased.
Amnesty to reduce Litigation was launched.
District wise implementation of scheme initiated.
Coverage limit increased to Rs 21000/-
New scheme by name of SPREE launched from 20/12/16.
LIN (Labour Identification Number ) verification being done.
Migrating to One Unit Identifier concept.

28. NEW INITIATIVES TAKEN FOR IMPROVEMENT
Action for Improving Medical Services:
From onwards the Ceiling amount raised to Rs 3000/- from the present Rs /- (40% more funds for Medical)
Upgradation of dispensaries to mini 6 bedded centres.
ESIS dispensaries to be shifted to new modern locations and rent to be paid by ESIC.
ESIC is involved in improving the infrastructure of ESIS Hospital through Hospital Development Committees.
ESIC is exploring to provide directly through PPP Model for
Dialysis, Path Labs, X-ray, Dental services.
ICU, Ultra Sound, Oncology,
Engagement of Hospital Manager, IT Manager/Assistant for ESIS Hospitals.
ESIC is also providing Manpower on Contract basis (Medical Officers and Para- medics) to tide over the shortage in the ESIS Hospitals
ESIC is requesting the State Governments to establish Subsidiary State Level Corporation for running Medical Services.

29. INITIATIVES At SRO Aurangabad
Pendency in Benefit Settlement:
Death Cases
12 cases we have settled within 3 months and balance we will be settling in the next days.
Permanent Disablement Cases
As on date we have cases lined up for reference to Medical board.
SSMC has constituted Medical Board at local level in ESIS Hospital itself.
Examples of Dependents Benefits being provided:
Insurance No
Name of IP
Contribution Paid
DB Rate Sanctioned
Dilip Bornare
Rs 1776/-
Rs 338/-per day (Rs 10140)
Rahul Choudahri
Rs 200/-
Rs 291/- pd (Rs 8730/-)
Yunus Gani Sk
Rs 500/-
Rs. 408/- pd (Rs /-)
Kaka Rakhunde
Rs. 2933/-
Rs 342/- pd (Rs /-)

30. THANK YOU ALL