Published by: OurTaxPartner.com | Get Expert Help with ESI Registration & Compliance
Introduction
In a country like India where out-of-pocket healthcare expenses can be financially crippling for low-income workers, the Employees’ State Insurance (ESI) scheme plays a crucial role in providing health security and medical benefits to employees and their families. Enacted under the Employees’ State Insurance Act, 1948, this social security scheme is administered by the Employees’ State Insurance Corporation (ESIC), an autonomous body under the Ministry of Labour and Employment.
In this detailed blog, we explore the health benefits offered under the ESI scheme, eligibility, contribution structure, and how it supports both employees and employers. For seamless ESI registration, return filing, and advisory, OurTaxPartner.com offers dedicated services across India.
Who Is Covered Under the ESI Scheme?
- Employees working in establishments with 10 or more workers (20 in some states like Maharashtra and Chandigarh).
- Employees earning a gross monthly salary of ₹21,000 or less (₹25,000 for persons with disabilities).
- Once registered, workers receive a unique Insurance Number and a Pehchan Card to access medical services.
ESI Contribution Structure (FY 2024–25)
- Employer Contribution: 3.25% of employee’s gross wages
- Employee Contribution: 0.75% of gross wages
- Contribution is mandatory and monthly via the ESIC portal
Major Health Benefits Under ESI
1. Comprehensive Medical Care
From primary consultations to advanced surgery, the ESI scheme offers cashless treatment in ESIC dispensaries and hospitals. Services include:
- Outpatient consultations
- Inpatient care and surgeries
- Diagnostics, medicines, and follow-up treatments
- Specialty treatments through empaneled hospitals
2. Sickness Benefit (Cash Compensation)
If an insured employee falls ill and is unable to work, they receive cash compensation at 70% of average daily wages for up to 91 days in a year, provided the employee has contributed for a minimum of 78 days in the contribution period.
3. Maternity Benefit
Female employees covered under ESI are entitled to 26 weeks of paid maternity leave (extendable under complications), at 100% of their wages. Medical care and pre-natal/post-natal services are also provided.
4. Disability Benefit
- Temporary Disability: 90% of wages is paid as compensation till the disability lasts.
- Permanent Disability: Monthly pension based on the degree of disablement.
5. Dependent Benefit
In case of death of an insured person due to employment-related injury or illness, dependents receive 90% of the wage as monthly pension. Eligible dependents include spouse, children, and dependent parents.
6. Medical Benefits for Family
Family members of the insured person also get free or subsidized medical treatment in ESI hospitals and clinics. This includes medicines, diagnostics, and hospital care.
7. Super Specialty Treatment
For serious health conditions requiring specialized treatment (like cancer, cardiac surgery, or dialysis), ESI covers referral-based treatment in private empaneled super-specialty hospitals without burdening the employee financially.
8. Funeral Expenses
A sum of up to ₹15,000 is paid toward funeral expenses of a deceased insured person to the eldest surviving family member or nominee.
9. Vocational Rehabilitation
Insured persons who suffer permanent disablement receive access to rehabilitation centers for skill retraining and alternative employment preparation.
10. Confinement Expenses
If an insured woman or the dependent wife of a male insured person gives birth at home (instead of an ESI hospital), confinement expenses of ₹5,000 are reimbursed.
How to Access ESI Medical Services
- Employees must register via the employer’s ESI portal after joining.
- An Insurance Number and Pehchan Card is issued.
- Insured persons can visit nearby ESIC dispensaries or hospitals using this ID.
- ESI benefits can be accessed by presenting the Pehchan card at the time of treatment.
Key Advantages for Employers
- ✔ Legal compliance with reduced litigation risk
- ✔ Reduced burden of providing medical reimbursements in-house
- ✔ Improved employee satisfaction, retention, and productivity
- ✔ Eligibility for government tenders and certifications
Click here to register your business for ESI with OurTaxPartner.com
Frequently Asked Questions (FAQs)
Is ESI applicable to all employees?
No. ESI is mandatory only for employees earning ₹21,000/month or less (₹25,000 for disabled) in applicable areas and eligible establishments.
Can employees get treatment in private hospitals?
Yes. In case of emergency or referrals, ESIC covers treatment through empaneled private hospitals for super-specialty care.
What if my company has less than 10 employees?
ESI is not mandatory. However, you can consider alternate health insurance until ESI becomes applicable.
Are medicines and diagnostics covered under ESI?
Yes. All approved medicines, diagnostic tests, and treatments are provided free at ESIC centers.
Conclusion
The ESI scheme is a lifeline for millions of workers and their families. It offers a complete healthcare package that ensures financial protection, medical access, and social security—all with minimal cost to the employee. For employers, it builds trust, improves retention, and ensures statutory compliance.
Want to register your organization or streamline monthly ESI compliance? Reach out to OurTaxPartner.com for comprehensive support today.
Quick Link: Register for ESI – Start Now
