Dear All,
I am working in a PSU that provides very good medical facilities for myself and my wife. My wife works in the private sector and is covered by ESI benefits. I would like my wife to utilize the medical benefits offered by my company as they are much better than the benefits she receives from ESIC. Therefore, even though her contributions are deducted monthly, and she is required to comply with ESIC regulations as per statute, can she choose to opt out of ESIC benefits by providing a self-declaration to her organization and instead receive medical benefits from my organization?
Please advise.
Rgds,
DG
From India, Calcutta
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1I am working in a PSU that provides very good medical facilities for myself and my wife. My wife works in the private sector and is covered by ESI benefits. I would like my wife to utilize the medical benefits offered by my company as they are much better than the benefits she receives from ESIC. Therefore, even though her contributions are deducted monthly, and she is required to comply with ESIC regulations as per statute, can she choose to opt out of ESIC benefits by providing a self-declaration to her organization and instead receive medical benefits from my organization?
Please advise.
Rgds,
DG
From India, Calcutta
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Dear DG, Your wife can opt from your organisation, but at the same time she can’t claim from ESIC. Regards Praveen
From India, Bangalore
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From India, Bangalore
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Dear DG,
It is illegal. You cannot apply for both at the same time since in both cases, original bills have to be produced for the claim. Also, you declare in both cases that you are not claiming the amount through a different source.
Moreover, she can get the maternity benefits under ESI in a specified ESI dispensary/hospital only where the Insurance Medical Officer signs all the forms.
From India, Mumbai
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It is illegal. You cannot apply for both at the same time since in both cases, original bills have to be produced for the claim. Also, you declare in both cases that you are not claiming the amount through a different source.
Moreover, she can get the maternity benefits under ESI in a specified ESI dispensary/hospital only where the Insurance Medical Officer signs all the forms.
From India, Mumbai
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Is your wife able to get 84 days of maternity leave from your organization? No, that means for maternity leave, she should have ESI. It is immaterial whether she takes treatment from an ESI Hospital or not; therefore, she can seek medical assistance from your hospital while covered by ESI. If the PSU medical facilities being provided to dependents are irrespective of their dependency, why don't you choose to take the eligible leave from ESI and get her treated in the hospital of the PSU?
Regards, Madhu.T.K
From India, Kannur
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Regards, Madhu.T.K
From India, Kannur
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@DG:
Your wife has no option. ESIC is compulsory whether you avail benefits or not. Almost 40% of the insured persons under ESI do not avail any benefit. If PSU has a condition that your wife has to give a declaration, she cannot give any such declaration. What Madhu has suggested is the best way, if possible under the rules you are governed by.
From India, Coimbatore
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Your wife has no option. ESIC is compulsory whether you avail benefits or not. Almost 40% of the insured persons under ESI do not avail any benefit. If PSU has a condition that your wife has to give a declaration, she cannot give any such declaration. What Madhu has suggested is the best way, if possible under the rules you are governed by.
From India, Coimbatore
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Dear DG,
You may get some clues from the following and the attachment:
Exemptions:
The provisions of the ESI Act are not applicable to factories or establishments run by the State Governments / Central Government, whose employees are otherwise in receipt of social security benefits substantially similar or superior to the benefits provided under the ESI Act. The case of each such Public Sector Undertaking is decided on merit by comparing the quality and quantity of benefits being provided to the employees by the concerned managements with those admissible under the ESI Act.
The "Appropriate Government" may grant or renew exemption under Section 87 of the ESI Act in respect of a Factory/Establishment or class of factories or establishments in any specified area from the operation of the Act for a period not exceeding one year at a time.
Exemption Under Section 88 of the Act is granted by the "Appropriate Government" to employees or class of employees who remain away from their Hqrs. for more than 7 months in a year, and those employees who are posted in non-implemented areas.
No exemption under Section 87 or Section 88 can be granted unless a reasonable opportunity has been given to the Corporation to make any representation and the same is considered by the "appropriate Government".
Exemption Under Section 90 can be granted to a factory/establishment belonging to any local authority such as a Municipality/Corporation, etc. if employees in any such factory/establishment are otherwise in receipt of benefits substantially similar or superior to the benefit provided under the Act.
You may try by applying to your wife's office with documents showing she is covered by your medical scheme. We have provided such exemptions to some VRS employees from defense who are covered by Army hospitals.
Caution:
Think about her leave eligibility and possible catches under your medical scheme for dependents.
Regards,
Kumar.S.
From India, Bangalore
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You may get some clues from the following and the attachment:
Exemptions:
The provisions of the ESI Act are not applicable to factories or establishments run by the State Governments / Central Government, whose employees are otherwise in receipt of social security benefits substantially similar or superior to the benefits provided under the ESI Act. The case of each such Public Sector Undertaking is decided on merit by comparing the quality and quantity of benefits being provided to the employees by the concerned managements with those admissible under the ESI Act.
The "Appropriate Government" may grant or renew exemption under Section 87 of the ESI Act in respect of a Factory/Establishment or class of factories or establishments in any specified area from the operation of the Act for a period not exceeding one year at a time.
Exemption Under Section 88 of the Act is granted by the "Appropriate Government" to employees or class of employees who remain away from their Hqrs. for more than 7 months in a year, and those employees who are posted in non-implemented areas.
No exemption under Section 87 or Section 88 can be granted unless a reasonable opportunity has been given to the Corporation to make any representation and the same is considered by the "appropriate Government".
Exemption Under Section 90 can be granted to a factory/establishment belonging to any local authority such as a Municipality/Corporation, etc. if employees in any such factory/establishment are otherwise in receipt of benefits substantially similar or superior to the benefit provided under the Act.
You may try by applying to your wife's office with documents showing she is covered by your medical scheme. We have provided such exemptions to some VRS employees from defense who are covered by Army hospitals.
Caution:
Think about her leave eligibility and possible catches under your medical scheme for dependents.
Regards,
Kumar.S.
From India, Bangalore
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The exemption is meant for the units not for the individuals employees of the units covered under the Act
From India, Coimbatore
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From India, Coimbatore
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ESIC Benefits.pdf
Esic Benefits.docx