Employee State Insurance (ESI) Benefits in India: What Workers Should Know

Employee State Insurance (ESI) scheme is the Indian statutory social insurance of workers in covered establishments, which aims to provide income shocks against sickness, maternity and disability and employment injury and cover medical care for the family. In eligible establishments, the coverage usually extends to employees whose monthly earnings are up to ₹21000 (₹25000 to persons with disability) and both employer and employee pay monthly contributions. Upon enrolment, workers are given a permanent insurance number and e-PeHchan card which empowers them to treat cashless within ESIC dispensary, hospitals and empaneled facilities and referral to higher centers whenever necessary. Stay informed — explore our Labour Rights section for the latest news and policy updates.

Medical plans begin on the first day of insurable employment and cover dependants with no specified maximum amount of money that is allowed to take care of the required treatment services at specific facilities. Insured individuals might be entitled to a sickness benefit illness when they are unable to work, which is periodic cash payments, usually approximately 70% of wages, during up to 91 days within a contribution period, within conditions of medical certification and contribution. Where there is a defined period of long-term sickness, Extended Sickness Benefit may be enhanced in terms of both the length of time and the proportion, which is aware of the greater cost of chronic illnesses. Maternity benefits allow a full wage replacement, which lasts statutory period, in case of miscarriage and adoption, which is provided in deserving situations, to provide earnings continuity during very critical family occasions.

The cause of work injuries results in disablement benefits: temporary disablement is based on the high percentage payment of wages during certified incapity, whereas permanent disablement is based on the provision of a life-long pension that is associated with the evaluated loss of earning potential. In the event of death of a worker as a result of employment injury, the dependants qualify to receive a monthly pension based on a percentage of the wages. The scheme also covers funeral bills, confinement bills in the event that no ESIC facility is available and rehabilitation, including prosthetics and vocational training, to enable workers resume gainful employment.

ESI offers welfare benefits in the form of unemployment insurance under special programs in the event of involuntary loss of jobs or closure of factories and it is a combination of financial assistance and medical assistance as well as skill training over a stretch within a restricted time. ESI is a long-lasting safety net against a mobile workforce since its benefits are job-portable provided that the contribution and wage rules are met. To easily claim entitlements, workers ought to make sure they make regular KYC, report their wages correctly, and keep payslips and medical certificates, and referral systems when they need to get care- in order to ensure the protections offered on paper become real support when life events strike.