Employees’ State Insurance Fund, Combination, Benefits

ESI Fund is a public fund established under the Employees’ State Insurance Act, 1948. It is constituted by the contributions from covered employers and employees, contributions from the Central and State Governments (in some cases), and any other income, such as interest or penalties. The fund is managed by the Employees’ State Insurance Corporation (ESIC) and is used exclusively for fulfilling the objectives of the ESI Act, including the payment of various benefits, administrative expenses, and the setup and maintenance of necessary medical and healthcare infrastructure.

Combination of Contributions

• Employer Contributions:

Employers contribute a specified percentage of the total monthly wage bill of all covered employees. The exact rate is prescribed by the government and can vary over time.

• Employee Contributions:

Employees earning wages up to a certain ceiling (which is subject to periodic revision) contribute a smaller percentage of their wages to the ESI Fund. Employees earning above this ceiling are exempt from making contributions but are also not covered by the scheme.

• Government Contributions:

The Central and State Governments may contribute to the ESI Fund, especially for certain benefits like medical benefit expansions or to support the scheme in newly implemented areas or specific sectors.

Benefits Provided by the ESI Scheme

The ESI Fund facilitates a variety of benefits, broadly categorized into two: cash benefits and medical benefits.

Cash Benefits

1. Sickness Benefit:

A periodic cash payment to insured workers during periods of certified sickness lasting for a minimum specified period.

2. Maternity Benefit:

Payable to insured women in cases of confinement or miscarriage or related sickness.

3. Disablement Benefit:

A monthly payment in the case of temporary or permanent disablement resulting from an employment injury or occupational disease.

4. Dependents’ Benefit:

A monthly payment to the dependents of a deceased insured person, where the death occurred due to an employment injury or occupational disease.

Medical Benefits

1. Medical Care:

Comprehensive medical care is provided to an insured person and their family members. This includes all aspects of healthcare, ranging from primary to tertiary care, including drugs, hospitalization, and specialist services.

2. Extended Sickness Benefit:

For certain long-term diseases, insured persons may be eligible for extended sickness benefits.

3. Enhanced Sickness Benefit:

Provided for certain specified surgeries or conditions, offering an enhanced rate of payment to compensate for loss of wages during the recovery period.

Additional Benefits

• Rehabilitation Allowance:

For insured persons undergoing vocational rehabilitation.

• Funeral Expenses:

A lump-sum payment towards the expenditure on the funeral of a deceased insured person.

• Confinement Expenses:

Payable to women who could not avail maternity services of the ESIC due to certain reasons.