Employees State Insurance Act 1948 Presentation PDF

EMPLOYEES STATE INSURANCE ACT 1948 Chandini S Pillai Roll no 20 IV BHMS  The ESI Act passed in 1948 (amended in 1975, 1984, 1989, 2010, 2019 and 2022) is an important measure of social security and health in...

EMPLOYEES STATE INSURANCE ACT 1948 Chandini S Pillai Roll no 20 IV BHMS  The ESI Act passed in 1948 (amended in 1975, 1984, 1989, 2010, 2019 and 2022) is an important measure of social security and health insurance in this country. It provides for certain cash and medical benefits to industrial employees in case of sickness, maternity and employment injury. SCOPE The Act extends to the whole of India.The ESI Act of 1948 covered all power-using factories other than seasonal factories wherein 10 or more persons were employed (excluding mines, railways and defence establishments).The provisions of the ESI (Amendment) Act of 1975 were extended to the following new classes of establishments:  A) Small factories employing 10 or more persons, whether power is used in the process of manufacturing or not. B) Shops, c) Hotels and restaurants; d) Cinemas and theatres; e) Road-motor transport establishments f) newspaper establishment g) private medical and educational institutions employing 20 or more persons in some states With  With effect from 1.5.2010 the Act covers all employees manual, clerical, supervisory and technical getting upto Rs.15,000 per month. This has been further revised to Rs.21,000 per month as per notification of ESIC on 6.9.2016.The provisions of the Act can be extended to any other agricultural or commercial establishment.  ADMINISTRATION The administration of the ESI Scheme under the Act is entrusted to an autonomous body called the ESI Corporation The Union Minister for Labour-Chairman, Secretary to Govt. of India Ministry of Labour - Vice- Chairman of this corporation. Consists of members representing Central and State Governments, employers and employees’ organizations, medical profession and Parliament A Standing Committee, constituted from the members of the Corporation - executive body for th administration of the Scheme.  The chief executive officer of the Corporation is the Director General- assisted by four Principal Officers (1) Insurance Commissioner (2) Medical Commissioner (3) Financial Commissioner (4) Actuary. Medical Benefit Council , headed by the Director General of Health Services, Government of India assisted by the Medical Commissioner in all matters relating to medical relief. Besides the head office in New Delhi, the corporation has 24 regional offices and 39 sub-regional offices at 1 divisional office, 2 camp offices, and 592 branch offices,  FIN AN CE Run by contributions by employees and employers and grants from central and state govt. Employer-3.25%of total wage bill Employee -0.75%of wage Employees getting daily wage below Rs 176 are exempted. State govt share -1/8 of total cost of medical care. ESI corporation ‘s share – 7/8 of total cost of medical care.  BENEFITS TO EMPLOYEES The Act has made provision for the following benefits to insured persons or, to other dependants as the case may be (1) Medical benefit (2) Sickness benefit (3) Maternity benefit (4) Disablement benefit (5) Dependant’s benefit (6) Funeral expenses (7) Rehabilitation allowance.  1.MEDICAL BENEFIT Full medical care –hospitalisation,free of cost, to insured persons in case of sickness, employment injury and maternity. SERVICE (1) out-patient care. (2) supply of drugs and dressings (3) specialist services (all branches). (4) radiological investigations. (5) domiciliary services. (6) antenatal, natal and postnatal services (7) immunization services (8) family planning services (9) emergency services (10) ambulance services (11) health-education (12) in-patient treatment. Complicated cases where specialised treatment necessary, patient sent for institutional treatment even outside their state at the expense of ESI corporation.  Medical care –directly –agency of ESI hospital &dispensaries Indirectly –insurance medical practitioners. DIRECT PATTERN –areas ,conc of 1000 or more employees family unit – full time medical and para medical personnel.avg,dr attends 80 case in op / day 1 home visit a day. Employees less than 750 – part time ESI dispensary established. Residential conc of employees scattered over long distance – mobile dispensary INDIRECT PATTERN –panel system. Registered medical practitioner designated as insurance medical practitioner appointed  Extended to family of workers where requisite arrangement could be made. Restricted medical care – only out patient care. Expanded medical care- full medical care short of hospitalization given. OTHER MEDICAL FACILITIES –dentures,spectacles, hearing aid – free- pts, incapacitated due to employment injury. Artificial limbs- free- insured persons – emploment injury or otherwise. Special appliances- hernia belt, walking calipers surgical boots,spinal braces, jackets – prescribed by specialist.  COST OF MEDICAL BENEFIT Per capita cost – steadily increasing. 23.79 in 1961-62, 58.91 in 1969-70 67.53in 1973-74 406.78 in 1992-93 905in 2002-02 Expenditure on medical benefit Rs4058 crores in 2012-13,Rs 9368 crores in 2020 and Rs 9530 crores by 2022.  2.SICKNESS BEN EFIT Consists of periodical cash payment to an insured person in case of sickness is his sicknesses dury certified by an insurance medical officer or insurance medical practicener. Benefit maximum period of 91 days. In any continuous period of 365 days daily write being about 70% of the average daily wages. In order to qualify for sickness benefit the insured person is required to contribute for 78 days in a contribution period of 6 month. In certain long term disease the sickness benefit is entitled to extended sickness benefit for maximum period of 2 years.  34 diseases - extended sickness benefit with effec I. Infectious Diseases 1 Tuberculosis. 2. Leprosy 3. Chronic empyema. 4. AIDS. II. Neoplasms 5. Malignant diseases. III. Endocrine, Nutritional and Metabolic Disorders 6. Diabetes mellitus with proliferative retinopathy/ Diabetic foot/Nephropathy.  IV Disorders of Nervous Systems 7. Monoplegia. 8. Hemiplegia. 9. Paraplegia. 10. Hemiparesis. 11. Intracranial space occupying lesion. 12. Spinal Cord compression. 13. Parkinson’s disease. 14. Myasthenia Gravis/Neuromuscular dystrophy  Immature cataract with vision 6/60 or leas 15 16. Detachment of retina. 17. Glaucoma. V. Diseases of Cardiovascular System 8. Coronary Artery Disease a. Unstable angina. B. Myocardial infarction with ejection less than 45% 19. Congestive Heart Failure – Left, Right 20. Cardiac valvular diseases with fallure/complications 21. Cardiomyopathies. 22. Heart disease with surgical intervention slongwith complications.  VI. Chest Diseases 23 Bronchiectasis 24. Interstitial Lung Disease. 25. Chronic Obstructive Lung Diseases (COPD) with congestive heart failure (Cor Pulmonale). VII. Diseases of the Digestive System 26. Cirrhosis of liver with ascities/chronic active hepatitis. VIII. Orthopaedic Diseases 27. Dislocation of vertebra/prolapse of intervertebral disc 28. Non union or delayed union of fracture. 29. Post Traumatic Surgical amputation of lower extremity. 30. Compound fracture with chronic osteomyelitis.  IX. Psychosis 31. Sub-group under this head are listed for clarification a. Schizophrenia. B. Endogenous depression. C. Manic Depressive Psychosis (MDP) D.dementia X. COVID-19 32.The insured person and/or his family member- can avail free of cost medical care in which has been declared as COVID-19 dedicated hospital. Presently 21 ESIC hospitals run directly by ESIC with 3676 COVID isolation beds, 229 ICU beds and 163 ventilator beds and 26 ESI scheme hospitals run by State Govts, having 2023 beds are functioning as COVID-19 dedicated hospitals.  XI. Others 33. More than 20% burns with infection/complication 34. Chronic renal failure. 35. Reynaud’s disease/Burger’s disease. The insured person is protected from dismissal or discharge from service by the employer during the period of sickness Cash benefit is also payable to insured persons in the productive age group for undergoing sterilisation operation, viz. vasectomy/tubectomy. Enhanced sickness benefit is payable to insured women for 14 days for tubectomy and for 7 days in case of vasectomy in respect of male Ips. The amount payable is double the standard sickness benefit rate, that is, equal to full wages.  3. MATERNITY BENEFITS Payable in cash – insured women-confinement / miscarriage/ sickness arising out of pregnancy/confinement/premature birth of child/ miscarriage. Confinement duration of benefit -26 weeks ,miscarriage -6 week, four sickness arising out of confinement 30 days. Benefit allowed at about full wages. Rate of confinement expenses increase from RS 5000 to Rs 7500 per confinement.  4.DISABLEMENT BEN EFIT Provide cash payment - in the event of temporary or permanent disablement – employment injury as well as occupational diseases. Rate of temporary disablement benefit 90 % of the wages as long as temporary display disablement last. Total permanent disablement- insured person- Life pension worked out on the basis of loss of earning capacity determined by a medical board Partial permanent disablement a personal fitness granted as Life pension.  5. DEPENDENT’S BENEFIT. In case of death- employment injury dependent of an insured person are eligible for periodical payment. Pension at rate of 90% of wages is payable –shared by dependents in fixed ratio on monthly basis in accordance with the prescribed share An eligible son or daughter entitled to dependent benefit up to age of 18 ,benefit withdrawn if the daughter marriage earlier.  6. FUNERAL EXPENSES Benefit in cash payment payable on the death of an insured person towards the expenses on his amount not exceeding Rs 15000. Monthly payment of Rs 10 insured person and his family members continue to get the medical treatment after permanent disablement or retirement. ESI scheme has been implemented in 35 States /union territories. Scheme by 31.03.21 covered 2.46 crores employee including 61.63 lakh women and total number of beneficiaries around 13.16 crores.  BENEFITS TO EMPLOYERS 1. Excemption from the applicability of workmen’s compensation at 1923 2. Exemption from the maternity benefit 1961 3. Exemption from payment of medical allowance to employees and their dependence or arranging for the medical care 4. Rebate and the income tax act on contribution deposited in the ESI account 5. Healthy work force.  RAJIV GANDHI SHRAMIK KALYAN YOJNA Came into effect from 1 st April 2005 Launched by ESI corporation for employees covered under ESI scheme. Provides an unemployment allowance for the employees covered under ESI scheme who are rendered unemployed involuntary due to retrenchment /closed of factory etc after full feeling certain eligibility condition. As per this scheme, an insured person going out of Insurable employment involuntarily, on account of closure of a factory or establishment, retrenchment, or permanent Invalidity arising out of non-employment injury, after rendering insurable employment and having contributed under the scheme for two or more years, is entitled to claim unemployment allowance equal to 50% of wage for a maximum period of upto two years during the lifetime.  During the period for which a person is entitled for unemployment allowance, he is also eligible for medical care for himself and his/her family from ESI dispensaries, ESI panel clinics and ESI hospitals to which he/she was attached prior to the date of loss of employment.