Practical Guide to Employees' State Insurance- Act, Rules & Regulations

The Employees’ State Insurance Act (popularly known as ESI Act) is the first major legislation on social security for lower paid employees in India. The scheme, as per provisions of the Act, is devised so as to provide social protection to employees in contingencies such as illness, long-term sickness or any other health risks due to exposure to employment injury or occupational hazards. Under the provisions of the scheme, medical facilities are also made available to the legal dependants of insured persons as well as for retired insured persons. After a span of seven years, the Employees’ State Insurance Corporation has raised the monthly wage threshold to Rs 21,000 from the current Rs 15,000 for coverage under its health insurance scheme.* The Employees’ State Insurance Corporation board also decided to give an option to existing insured persons to continue membership even if their basic wage breaches the ceiling of Rs 21,000 per month. At present, all those insured under the Employees’ State Insurance Corporation scheme lose their membership of Employees’ State Insurance Corporation as well as that of the insurance cover if their basic wage overshoots the ceiling.

Both the decisions are to be implemented from 1 October, 2016. The Labour Minister added that the move of raising the threshold will help bring in an additional 50 lakh members to the Employees’ State Insurance Corporation. As of September 2016, the ESIC has 2.6 crore insured persons, which covers over 10 crore people, assuming four members of a family.

The Labour Minister also launched the first phase of telemedicine services whereby Employees’ State Insurance Corporation Model Hospital, Basaidarapur, New Delhi, got connected with three ESI dispensaries at Rudrapur (Uttrakhand), Unnao (Uttar Pradesh) and Kathiyar (Bihar). ESIs have been providing health care and other social security benefits to workers of a specified wage group for the last 65 years as a labour welfare measure. Under these new initiatives, ESIC has launched a project of telemedicine services at 11 ESI locations in coordination with Health Informatics and Electronics Division (HIED), C-DAC, Mohali, under the Digital India programme.

The launch of these services will lead to provision of specified healthcare services to the Employees’ State Insurance Corporation beneficiaries residing/working at different locations with limited medicine specialist services. While revising this edition, lengthy references to the case-law have been deliberately avoided. It is only fair to mention that in respect of complicated problems, though answers are available in the book, but it is advisable to obtain expert legal advice on the subject, since the labour laws are being amended rapidly and the governments have also been issuing notifications from time to-time. The courts are also interpreting the legal provisions in their judgments and some of the earlier judgments are either not followed or even over-ruled in applying the law to the facts of each case. That does not mean that the utility of the book will, in any way, be affected.

This book will enable the readers to ask their lawyer/advisor the appropriate questions and deal with them with greater confidence. This, in turn, will generally result in getting better professional service.