Dear HR Seniors,
Please solve my few doubts:
Q. 1: What is the maximum age limit for dependents to avail ESI benefit?
Q. 2: What is the standard rate under the ESIC Act?
Q. 3: What is the provision to avail the facility of hospitals other than ESI hospitals?
Q. 4: What kinds of diseases are covered under ESI, and who is entitled?
Q. 5: How can expenses incurred for hospitalization bills be recovered?
Q. 6: What is the provision to change a dispensary?
Regards
From India, Mumbai
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9Please solve my few doubts:
Q. 1: What is the maximum age limit for dependents to avail ESI benefit?
Q. 2: What is the standard rate under the ESIC Act?
Q. 3: What is the provision to avail the facility of hospitals other than ESI hospitals?
Q. 4: What kinds of diseases are covered under ESI, and who is entitled?
Q. 5: How can expenses incurred for hospitalization bills be recovered?
Q. 6: What is the provision to change a dispensary?
Regards
From India, Mumbai
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There is no age limit for the insured employees or their dependents. This scheme is unique as it does not consider the age or pre-existing conditions of the beneficiaries. No conditions are attached to diseases; thus, all diseases are treated, including existing ones when you join ESI. Additionally, if an employee is undergoing treatment for a specific disease and loses ESI coverage, they will continue to receive medical benefits until the treatment is no longer needed for that disease.
Standard rates apply to employees, not dependents. These rates are the wages paid during sick leave and vary case by case. For on-duty accidents, full salary is provided, while for other cases, it may be 70% or other percentages.
If required treatment is unavailable at the ESI hospital, the ESI will refer the patient to other hospitals, potentially including super-specialty hospitals.
At ESI-affiliated hospitals, treatment is free. If treatment is sought at other hospitals, the incurred costs will be reimbursed by the ESIC at a later date.
To change the dispensary, request HR to make the change online.
Madhu.T.K
From India, Kannur
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Standard rates apply to employees, not dependents. These rates are the wages paid during sick leave and vary case by case. For on-duty accidents, full salary is provided, while for other cases, it may be 70% or other percentages.
If required treatment is unavailable at the ESI hospital, the ESI will refer the patient to other hospitals, potentially including super-specialty hospitals.
At ESI-affiliated hospitals, treatment is free. If treatment is sought at other hospitals, the incurred costs will be reimbursed by the ESIC at a later date.
To change the dispensary, request HR to make the change online.
Madhu.T.K
From India, Kannur
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Dear sir;
Q. 7: How many family members are covered for ESIC benefits. Q. 8: Are parents of employees covered for ESIC benefits? What are the conditions? Q. 9: What are the provisions for medical facilities in higher facilitated hospitals? Q. 10: What benefits are given to dependents in case of the death of an employee? To whom, for how many dependents, what percentage of benefits, and up to which age? Q. 11: Are dependents entitled to funeral expenses in the case of the death of an employee other than on the job/work? Q. 12: Does the company grant leave salary if an employee is hospitalized? If not, for how many days does ESIC provide salary for leave? What is the rate? Q. 13: What is rehabilitation allowance?
Regards
From India, Mumbai
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Q. 7: How many family members are covered for ESIC benefits. Q. 8: Are parents of employees covered for ESIC benefits? What are the conditions? Q. 9: What are the provisions for medical facilities in higher facilitated hospitals? Q. 10: What benefits are given to dependents in case of the death of an employee? To whom, for how many dependents, what percentage of benefits, and up to which age? Q. 11: Are dependents entitled to funeral expenses in the case of the death of an employee other than on the job/work? Q. 12: Does the company grant leave salary if an employee is hospitalized? If not, for how many days does ESIC provide salary for leave? What is the rate? Q. 13: What is rehabilitation allowance?
Regards
From India, Mumbai
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Hi
please find below the required details for your reference.
For question no.1 - What is the maximum age limit for dependent to avail ESI benefit.
According to the act :
Family means all or any of the following relatives of an insured person, namely :
(i) A spouse ;
(ii) A minor legitimate or adopted child dependent upon the insured person ;
(iii) A child who is wholly dependent on the earnings of the insured person and who is
(a) Receiving education, till he or she attains the age of twenty-one years,
(b) An unmarried daughter;
(iv) A child who is infirm by reason of any physical or mental abnormality or injury and is wholly dependent on the earnings of the insured person, so long as the infirmity continues ;
(v) Dependant parents, whose income from all sources does not exceed such income as may be prescribed by the Central Government ;
(vi) In case the insured person is unmarried and his or her parents are not alive, a minor brother or sister wholly dependant upon the earnings of the insured person ;
For question no.2 - What is standard rate under ESIC act
The ceiling is max of Rs.15000
Average daily wages are Standard benefit rate (in Rs)
1. Below Rs.28 Rs. 14 or full average daily wage whichever is less
2. Rs.28 and above but below Rs. 32 16
3. Rs.32 and above but below Rs.36 18
4. Rs.36 and above but below Rs.40 20
5. Rs.40 and above but below Rs.48 24
6. Rs.48 and above but below Rs.56 28
7. Rs.56 and above but below Rs.60 30
8. Rs.60 and above but below Rs.64 32
9. Rs.64 and above but below Rs.72 36
10. Rs.72 and above but below Rs.76 38
11. Rs.76and above but below Rs.80 40
12. Rs.80 and above but below Rs.88 44
13. Rs.88 and above but below Rs.96 48
14. Rs.96 and above but below Rs.106 53
15. Rs.106 and above but below Rs.116 58
16. Rs.116 and above but below Rs.126 63
17. Rs.126 and above but below Rs.136 68
18. Rs.136 and above but below Rs.146 73
19. Rs.146 and above but below Rs.156 78
20. Rs.156 and above but below Rs.166 83
21. Rs.166 and above but below Rs.176 88
22. Rs.176 and above but below Rs.186 93
23. Rs.186 and above but below Rs.196 98
24. Rs.196 and above but below Rs.206 103
25. Rs.206 and above but below Rs.216 108
26. Rs.216 and above but below Rs.226 113
27. Rs.226 and above but below Rs.236 118
28. Rs.236 and above but below Rs.250 125
29. Rs.250 and above but below Rs.260 130
30. Rs.260 and above but below Rs.270 135
31. Rs.270 and above but below Rs.280 140
32. Rs.280 and above but below Rs. 290 145
33. Rs.290 and above but below Rs. 300 150
34. Rs.300 and above but below Rs. 310 155
35. Rs.310 and above but below Rs. 320 160
36. Rs.320 and above but below Rs. 330 165
37. Rs.330 and above but below Rs. 340 170
38. Rs.340 and above but below Rs. 350 175
39. Rs.350 and above but below Rs. 360 180
40. Rs.360 and above but below Rs. 370 185
41. Rs.370 and above but below Rs. 380 190
42. Rs.380 and above 195
For question no.3 -What is the provision to avail facility of Hospital other than ESI hospitals.
Procedure to be followed by the ESI beneficiaries to avail Super specialty medical treatment
- The insured person shall approach the ESI Dispensary to which he/she is attached, and the Medical Officer shall issue a referral letter to the IP to approach the concerned empanelled medical institution.
- If the IP/beneficiary need medical attention during the non working hours of the concerned ESI Dispensary, they may directly approach the nearest ESI Hospital for getting referral letter. If there is no ESI Hospital situation nearer to the IP’s place of living, the IP shall approach the nearest Govt. Hospital for getting referral letter.
- In the case of an emergency the IP/beneficiary can get Medical attention just by producing his/her ESI identity card at the designated private medical institution, shall produce necessary referral letter and other relevant documents within 48 hours. (If any case referral letter is a must to avail treatment under package deal
- The IP/beneficiary shall produce the referral letter along with the ESI Identity Card at the designated private medical institution and avail the treatment without paying any amount from out of his/her pocket. However any facility, other than the items included in the package deal shall be borne by the IP/beneficiary.
- While referring the IP/beneficiary to the concerned Empanelled Medical institution, Medical Officer incharge has to verify whether the IP/beneficiary is eligible for treatment.
- The IP shall produce all the relevant documents demanded by the designated hospital and extend his/her co-operation to the hospital authorities.
- The designated hospital after imparting treatment to the IP/beneficiary shall raise the claim bill directly to the Directorate where it will be settled.
For question no.4 - What kind of disease are covered under ESI & who are entitled.
The enactment of Employees’ State Insurance Act, 1948 in Indian Parliament envisaged the requirement for a comprehensive, integrated and need based social insurance scheme that would go a long-way in providing protection in the interest of workers. This ESIC would be beneficial in ever-pervading risks lurking in each and every corner of human lives especially in contingencies comprising of sickness, temporary or permanent physical disablement, maternity, death due to employment injury thereby resulting in loss of wages or earning capacity. This Act facilitates medical care to all employees (workers) including their immediate family dependants, devoid of any discrimination or prejudice which is reasonably satisfactory in nature.
For question no.5 - How to recover expense incured for hospitalisation bills.
You have to submit the actual bills to local dispensary and the same will be forwarded to the regional office which will directed to the directorate for scrutiny and the reimbursement will be done. its a lengtheir process.
For question no.5 - What is the provision to change dispensary.
it can be done in online itself.
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please find below the required details for your reference.
For question no.1 - What is the maximum age limit for dependent to avail ESI benefit.
According to the act :
Family means all or any of the following relatives of an insured person, namely :
(i) A spouse ;
(ii) A minor legitimate or adopted child dependent upon the insured person ;
(iii) A child who is wholly dependent on the earnings of the insured person and who is
(a) Receiving education, till he or she attains the age of twenty-one years,
(b) An unmarried daughter;
(iv) A child who is infirm by reason of any physical or mental abnormality or injury and is wholly dependent on the earnings of the insured person, so long as the infirmity continues ;
(v) Dependant parents, whose income from all sources does not exceed such income as may be prescribed by the Central Government ;
(vi) In case the insured person is unmarried and his or her parents are not alive, a minor brother or sister wholly dependant upon the earnings of the insured person ;
For question no.2 - What is standard rate under ESIC act
The ceiling is max of Rs.15000
Average daily wages are Standard benefit rate (in Rs)
1. Below Rs.28 Rs. 14 or full average daily wage whichever is less
2. Rs.28 and above but below Rs. 32 16
3. Rs.32 and above but below Rs.36 18
4. Rs.36 and above but below Rs.40 20
5. Rs.40 and above but below Rs.48 24
6. Rs.48 and above but below Rs.56 28
7. Rs.56 and above but below Rs.60 30
8. Rs.60 and above but below Rs.64 32
9. Rs.64 and above but below Rs.72 36
10. Rs.72 and above but below Rs.76 38
11. Rs.76and above but below Rs.80 40
12. Rs.80 and above but below Rs.88 44
13. Rs.88 and above but below Rs.96 48
14. Rs.96 and above but below Rs.106 53
15. Rs.106 and above but below Rs.116 58
16. Rs.116 and above but below Rs.126 63
17. Rs.126 and above but below Rs.136 68
18. Rs.136 and above but below Rs.146 73
19. Rs.146 and above but below Rs.156 78
20. Rs.156 and above but below Rs.166 83
21. Rs.166 and above but below Rs.176 88
22. Rs.176 and above but below Rs.186 93
23. Rs.186 and above but below Rs.196 98
24. Rs.196 and above but below Rs.206 103
25. Rs.206 and above but below Rs.216 108
26. Rs.216 and above but below Rs.226 113
27. Rs.226 and above but below Rs.236 118
28. Rs.236 and above but below Rs.250 125
29. Rs.250 and above but below Rs.260 130
30. Rs.260 and above but below Rs.270 135
31. Rs.270 and above but below Rs.280 140
32. Rs.280 and above but below Rs. 290 145
33. Rs.290 and above but below Rs. 300 150
34. Rs.300 and above but below Rs. 310 155
35. Rs.310 and above but below Rs. 320 160
36. Rs.320 and above but below Rs. 330 165
37. Rs.330 and above but below Rs. 340 170
38. Rs.340 and above but below Rs. 350 175
39. Rs.350 and above but below Rs. 360 180
40. Rs.360 and above but below Rs. 370 185
41. Rs.370 and above but below Rs. 380 190
42. Rs.380 and above 195
For question no.3 -What is the provision to avail facility of Hospital other than ESI hospitals.
Procedure to be followed by the ESI beneficiaries to avail Super specialty medical treatment
- The insured person shall approach the ESI Dispensary to which he/she is attached, and the Medical Officer shall issue a referral letter to the IP to approach the concerned empanelled medical institution.
- If the IP/beneficiary need medical attention during the non working hours of the concerned ESI Dispensary, they may directly approach the nearest ESI Hospital for getting referral letter. If there is no ESI Hospital situation nearer to the IP’s place of living, the IP shall approach the nearest Govt. Hospital for getting referral letter.
- In the case of an emergency the IP/beneficiary can get Medical attention just by producing his/her ESI identity card at the designated private medical institution, shall produce necessary referral letter and other relevant documents within 48 hours. (If any case referral letter is a must to avail treatment under package deal
- The IP/beneficiary shall produce the referral letter along with the ESI Identity Card at the designated private medical institution and avail the treatment without paying any amount from out of his/her pocket. However any facility, other than the items included in the package deal shall be borne by the IP/beneficiary.
- While referring the IP/beneficiary to the concerned Empanelled Medical institution, Medical Officer incharge has to verify whether the IP/beneficiary is eligible for treatment.
- The IP shall produce all the relevant documents demanded by the designated hospital and extend his/her co-operation to the hospital authorities.
- The designated hospital after imparting treatment to the IP/beneficiary shall raise the claim bill directly to the Directorate where it will be settled.
For question no.4 - What kind of disease are covered under ESI & who are entitled.
The enactment of Employees’ State Insurance Act, 1948 in Indian Parliament envisaged the requirement for a comprehensive, integrated and need based social insurance scheme that would go a long-way in providing protection in the interest of workers. This ESIC would be beneficial in ever-pervading risks lurking in each and every corner of human lives especially in contingencies comprising of sickness, temporary or permanent physical disablement, maternity, death due to employment injury thereby resulting in loss of wages or earning capacity. This Act facilitates medical care to all employees (workers) including their immediate family dependants, devoid of any discrimination or prejudice which is reasonably satisfactory in nature.
For question no.5 - How to recover expense incured for hospitalisation bills.
You have to submit the actual bills to local dispensary and the same will be forwarded to the regional office which will directed to the directorate for scrutiny and the reimbursement will be done. its a lengtheir process.
For question no.5 - What is the provision to change dispensary.
it can be done in online itself.
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Dear Sir(s),
I believe the Standard Benefit Rate (Table), which has been mentioned by one of the members in the above remarks, has been changed or deleted effective from 01/07/2011 by omitting Rule 54 of ESI (Central) Rules, 1950. The rates of benefits under the ESI Act/rules/regulations, which are paid in cash, have now been modified effective from 01/07/2011.
From India, Noida
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I believe the Standard Benefit Rate (Table), which has been mentioned by one of the members in the above remarks, has been changed or deleted effective from 01/07/2011 by omitting Rule 54 of ESI (Central) Rules, 1950. The rates of benefits under the ESI Act/rules/regulations, which are paid in cash, have now been modified effective from 01/07/2011.
From India, Noida
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There is age limit for dependents benefit and for children to be eligible family members . Varghese Mathew
From India, Thiruvananthapuram
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From India, Thiruvananthapuram
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No age limit for spouse and parents.Limit only for children. VARGHESE MATHEW HR/Labor Law Adviser.Trivandrum. 09961266966
From India, Thiruvananthapuram
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From India, Thiruvananthapuram
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Oops, so many questions in one go. First of all, let us know whether you are an HR professional and why you require this information. Have you ever referred to the ESIC Act? Please go through the Act; most of the questions will be answered. If you find it difficult to understand any few items, let the forum know to advise accordingly. It is noticed here that you want a ready platter to be served at your table without much effort. I am sorry for using such harsh words, but it is for your benefit only.
From India, Ahmadabad
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From India, Ahmadabad
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ESI contribution rates lowering.pdf