Hello,
I have a few questions regarding ESIC benefits. Please check and help me with your valuable answers.
1. When will employees and their dependents be eligible to receive hospital treatment after registration?
2. Do employees have to visit the nearest ESIC hospital for treatment, or can they go to any ESIC hospitals?
3. Can an employee directly visit an ESIC hospital without being referred by any panel doctors?
Looking forward to your valuable feedback.
Thanks,
Sandip Kumar Ghosh
Accounts Administrator
From India, Kolkata
I have a few questions regarding ESIC benefits. Please check and help me with your valuable answers.
1. When will employees and their dependents be eligible to receive hospital treatment after registration?
2. Do employees have to visit the nearest ESIC hospital for treatment, or can they go to any ESIC hospitals?
3. Can an employee directly visit an ESIC hospital without being referred by any panel doctors?
Looking forward to your valuable feedback.
Thanks,
Sandip Kumar Ghosh
Accounts Administrator
From India, Kolkata
1. The ESIC-covered employee is entitled to ESIC benefits from the very beginning in case of an accident.
2. After three months, the employee may avail family benefits. He/she can visit an ESIC hospital and, if necessary facilities are not available there, may be referred to other hospitals.
3. Yes.
From India, undefined
2. After three months, the employee may avail family benefits. He/she can visit an ESIC hospital and, if necessary facilities are not available there, may be referred to other hospitals.
3. Yes.
From India, undefined
Dear member, as soon as a person becomes an "employee" within the meaning of the ESI Act, 1948, and obtains a TIC or Identity Card under the said Act from the appropriate ESIC office, then he/she and his family members become entitled to medical treatment (referred to as Medical Benefit) from the ESIS dispensary/Panel Doctor they are attached to. The employee or their family members must first report to the ESIS dispensary or an ESIC Panel Doctor, as only these institutions or Panel Doctors can recommend the case to an ESIC Hospital or any authorized private hospital. If the employee directly goes to an authorized private hospital, I believe the treatment will not be free, and it may be difficult to obtain reimbursement from ESIC in the end. I think the ESI Hospital will not accommodate the employee (except in emergency cases) without a referral slip from the concerned ESIS Dispensary or Panel Doctor.
ESIC has formulated and enforced its referral policy for medical treatment in such cases from private authorized hospitals/ESI Hospitals. Every insured person/covered employee should comply with the instructions before seeking treatment from higher hospitals. Copies of such referral policy instructions were uploaded by me in some other threads earlier. If needed, you can confirm the position from the ESIC Branch Office, as well as from the ESIS dispensary or Panel Doctor you are attached to for such benefits.
From India, Noida
ESIC has formulated and enforced its referral policy for medical treatment in such cases from private authorized hospitals/ESI Hospitals. Every insured person/covered employee should comply with the instructions before seeking treatment from higher hospitals. Copies of such referral policy instructions were uploaded by me in some other threads earlier. If needed, you can confirm the position from the ESIC Branch Office, as well as from the ESIS dispensary or Panel Doctor you are attached to for such benefits.
From India, Noida
Dear Sandip, Please find the attached document for detailed benefits and eligibility criteria for ESI Thanks, Murali 9440706968
From India, Gurgaon
From India, Gurgaon
Dear Harsh Kumar Mehta,
Our employee's right hand has been fractured during working hours. Hence, he is unable to perform his duty.
Please clarify how to get him admitted to ESI Hospital and the required forms and procedures to be followed for the same. Also, clarify that since he is unable to perform his duty, how much cash benefit he will get from ESI and for how long. However, his gross salary is 12700 PM.
Please guide, it's urgent.
Thanks,
Amit
From India, Jaipur
Our employee's right hand has been fractured during working hours. Hence, he is unable to perform his duty.
Please clarify how to get him admitted to ESI Hospital and the required forms and procedures to be followed for the same. Also, clarify that since he is unable to perform his duty, how much cash benefit he will get from ESI and for how long. However, his gross salary is 12700 PM.
Please guide, it's urgent.
Thanks,
Amit
From India, Jaipur
Dear Amit ji, thank you for contacting me through citeHR.
I would like to emphasize that if you are an employer, HR personnel, or a relevant individual in your establishment or factory, please ensure initially that the employee who experienced an accident possesses all necessary documents, such as their ESIC Identity Card. Additionally, confirm that your organization has submitted an Accident Report to the appropriate Branch Office of ESIC and the concerned ESIC dispensary. It is crucial to verify that your establishment has made timely contributions and that the employee is eligible for the benefits. The Incharge of the concerned ESI dispensary (Dr.) is the authorized person who can recommend an employee for treatment at an ESIC or other approved hospital. The ESIC Branch Office plays a vital role as it disburses Benefits (excluding medical treatment) to the insured individual based on essential documents, including the accident report, contribution data received from the employer, and medical certificates from the relevant ESIS dispensary/hospital.
You may consider generating the Accident Report online and submitting it to the appropriate offices as mentioned earlier, if deemed suitable at this point.
The critical issue is not the injured employee's ability to perform duties but whether they have obtained medical certification from the appropriate ESIS dispensary. If the employee has undergone a medical examination or treatment at the said dispensary, it can be presumed that the doctor has issued the necessary medical certificates. Only with such medical documentation from the ESI dispensary or a referred hospital can the employee claim benefits such as Temporary Disablement Benefit (TDB) or Permanent Disablement Benefit (PDB) if certified by an ESIC Medical Board.
The current rate of TDB, as indicated above, amounts to 90% of the average daily wages of the employee, calculated in accordance with the ESI (General) Regulations or Central Rules, 1950. I trust that your establishment and the employee can contact the designated offices mentioned above if any ESI Act, 1948 benefits are required. Best wishes.
From India, Noida
I would like to emphasize that if you are an employer, HR personnel, or a relevant individual in your establishment or factory, please ensure initially that the employee who experienced an accident possesses all necessary documents, such as their ESIC Identity Card. Additionally, confirm that your organization has submitted an Accident Report to the appropriate Branch Office of ESIC and the concerned ESIC dispensary. It is crucial to verify that your establishment has made timely contributions and that the employee is eligible for the benefits. The Incharge of the concerned ESI dispensary (Dr.) is the authorized person who can recommend an employee for treatment at an ESIC or other approved hospital. The ESIC Branch Office plays a vital role as it disburses Benefits (excluding medical treatment) to the insured individual based on essential documents, including the accident report, contribution data received from the employer, and medical certificates from the relevant ESIS dispensary/hospital.
You may consider generating the Accident Report online and submitting it to the appropriate offices as mentioned earlier, if deemed suitable at this point.
The critical issue is not the injured employee's ability to perform duties but whether they have obtained medical certification from the appropriate ESIS dispensary. If the employee has undergone a medical examination or treatment at the said dispensary, it can be presumed that the doctor has issued the necessary medical certificates. Only with such medical documentation from the ESI dispensary or a referred hospital can the employee claim benefits such as Temporary Disablement Benefit (TDB) or Permanent Disablement Benefit (PDB) if certified by an ESIC Medical Board.
The current rate of TDB, as indicated above, amounts to 90% of the average daily wages of the employee, calculated in accordance with the ESI (General) Regulations or Central Rules, 1950. I trust that your establishment and the employee can contact the designated offices mentioned above if any ESI Act, 1948 benefits are required. Best wishes.
From India, Noida
Respected Sans,
My query is related to ESIC benefits: One of the employees who has contributed to ESIC for more than 20 years, and for the last two years, he was out of the ESIC contribution limit salary (drawing more than 15K). Now, he has come under the preview of ESIC contribution again as his salary is less than 21K (01/01/2017). He is suffering from a heart problem, and the doctor has advised him to undergo surgery.
Please clarify, will he get ESIC benefits?
Highly thankful for your valuable advice.
Regards
From Japan
My query is related to ESIC benefits: One of the employees who has contributed to ESIC for more than 20 years, and for the last two years, he was out of the ESIC contribution limit salary (drawing more than 15K). Now, he has come under the preview of ESIC contribution again as his salary is less than 21K (01/01/2017). He is suffering from a heart problem, and the doctor has advised him to undergo surgery.
Please clarify, will he get ESIC benefits?
Highly thankful for your valuable advice.
Regards
From Japan
1. Sir, since the employee has again re-entered ESIC coverage w.e.f. 01/01/2017, hence at present, he will be entitled to Medical Benefit only (i.e., medical treatment from ESIS hospitals, dispensaries, etc., which, in my opinion, will also include reimbursement of expenses incurred in ESI-authorized hospitals if referred by ESIC as per their referral policy).
2. However, the said insured person/employee will not be entitled to cash benefits (which are called Sickness Benefits) because his benefit period has not yet started, and perhaps due to his illness, his contributing days will be fewer.
3. I suggest asking the concerned employee to firstly obtain a Permanent Identity Card (if not already obtained) from the respective ESIC Branch Office and also discuss the issue of his entitlement to medical treatment from ESIC institutions, including treatment, if required, in ESIC-sponsored other hospitals.
4. The respective ESIC Branch Office as well as the ESIS dispensary are the appropriate offices/authorities that can certify and provide local guidance regarding the entitlement or otherwise of the employee/insured person about his eligibility/entitlement to any type of benefits and medical treatment under the said Act. Therefore, I believe it is in the interest of the concerned employee/insured person to stay in touch with such offices.
From India, Noida
2. However, the said insured person/employee will not be entitled to cash benefits (which are called Sickness Benefits) because his benefit period has not yet started, and perhaps due to his illness, his contributing days will be fewer.
3. I suggest asking the concerned employee to firstly obtain a Permanent Identity Card (if not already obtained) from the respective ESIC Branch Office and also discuss the issue of his entitlement to medical treatment from ESIC institutions, including treatment, if required, in ESIC-sponsored other hospitals.
4. The respective ESIC Branch Office as well as the ESIS dispensary are the appropriate offices/authorities that can certify and provide local guidance regarding the entitlement or otherwise of the employee/insured person about his eligibility/entitlement to any type of benefits and medical treatment under the said Act. Therefore, I believe it is in the interest of the concerned employee/insured person to stay in touch with such offices.
From India, Noida
Dear Mehta sir, Pls enlighten me the difference between sick benefit and medical benefit? Regds Amit
From India, Jaipur
From India, Jaipur
Sir, Sickness Benefit is a benefit paid in cash from the ESIC Branch Office, whereas, as you know, Medical Benefit provides medical treatment/facilities and is therefore provided in kind. There are eligibility conditions for various cash benefits in the ESI Act, 1948, and the rules/regulations framed thereunder.
For further details, I hope you will download the necessary information from the website of ESIC for guidance on the subject, if required. The online link is also mentioned below:
[Information - Benefits | Employee's State Insurance Corporation, Ministry of Labour & Employment, Government of India](http://esic.nic.in/page.php?pid=NzU=)
From India, Noida
For further details, I hope you will download the necessary information from the website of ESIC for guidance on the subject, if required. The online link is also mentioned below:
[Information - Benefits | Employee's State Insurance Corporation, Ministry of Labour & Employment, Government of India](http://esic.nic.in/page.php?pid=NzU=)
From India, Noida
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