Dear HR Seniors
Pls, solve my Few doubts.
Q. 1: What is the maximum age limit for dependents to avail ESI benefit.
Q. 2: What is the standard rate under the ESIC act.
Q. 3: What is the provision to avail facility of hospitals other than ESI hospitals.
Q. 4: What kind of disease are covered under ESI & who are entitled.
Q. 5: How to recover expenses incurred for hospitalization bills.
Q. 6: What is the provision to change dispensary.
Regards
From India, Mumbai
6Pls, solve my Few doubts.
Q. 1: What is the maximum age limit for dependents to avail ESI benefit.
Q. 2: What is the standard rate under the ESIC act.
Q. 3: What is the provision to avail facility of hospitals other than ESI hospitals.
Q. 4: What kind of disease are covered under ESI & who are entitled.
Q. 5: How to recover expenses incurred for hospitalization bills.
Q. 6: What is the provision to change dispensary.
Regards
From India, Mumbai
There is no age limit either for the insured employees or for the dependants. This is probably the only scheme which does not take into account the age of beneficiaries and their existing diseases. There is no condition attached to diseases and as such you will get treatment for all diseases even if it is an existing one when you become a member of ESI. Moreover, if an employee is getting treatment for a particular disease and if in the meanwhile he gets out of ESI cover, then he will continue to get medical benefits till he requires medical attention for that particular disease.
Standard rate is applicable to employees and not for dependants. Standard rates is the wages payable for the absence from work due to sickness and it will depend upon case to case; that in the case of accidents while on duty, the rate is full salary whereas for some other cases it is 70% and so on.
If facility to required for treatment is not available at ESI hospital, the ESI will refer the matter to other hospitals. It may also include super speciality hospital.
In the case of ESI attached hospitals, the treatment will be free of cost whereas if taken treatment from other hospitals, the cost incurred by the IP will be reimbursed on a later date by the ESIC.
In order to change the dispensary, ask the HR to do it online.
Madhu.T.K
From India, Kannur
Standard rate is applicable to employees and not for dependants. Standard rates is the wages payable for the absence from work due to sickness and it will depend upon case to case; that in the case of accidents while on duty, the rate is full salary whereas for some other cases it is 70% and so on.
If facility to required for treatment is not available at ESI hospital, the ESI will refer the matter to other hospitals. It may also include super speciality hospital.
In the case of ESI attached hospitals, the treatment will be free of cost whereas if taken treatment from other hospitals, the cost incurred by the IP will be reimbursed on a later date by the ESIC.
In order to change the dispensary, ask the HR to do it online.
Madhu.T.K
From India, Kannur
Dear sir;
Q. 7: How many family members are covered for ESIC benefits.
Q. 8: Are parents of employee covered for ESIC benifit. What are the conditions.
Q. 9: What are the provisions for medical facilities in higher facilited hospitals.
Q. 10: What is the benefit given to dependent in case of death of employee. To whom & for how many dependent & % of benifit and up to which age.
Q. 11: Is dependent entitle for funeral expenses in case of death of employee other than on job/work.
Q. 12: Does company grant leave salary if employee is hospitalised & if not for how many days ESIC gives salary of leave. What is the rate.
Q. 13: What is rehabilitation allowance.
Regards
From India, Mumbai
Q. 7: How many family members are covered for ESIC benefits.
Q. 8: Are parents of employee covered for ESIC benifit. What are the conditions.
Q. 9: What are the provisions for medical facilities in higher facilited hospitals.
Q. 10: What is the benefit given to dependent in case of death of employee. To whom & for how many dependent & % of benifit and up to which age.
Q. 11: Is dependent entitle for funeral expenses in case of death of employee other than on job/work.
Q. 12: Does company grant leave salary if employee is hospitalised & if not for how many days ESIC gives salary of leave. What is the rate.
Q. 13: What is rehabilitation allowance.
Regards
From India, Mumbai
Hi
please find below the required details for your reference.
For question no.1 - What is the maximum age limit for dependent to avail ESI benefit.
According to the act :
Family means all or any of the following relatives of an insured person, namely :
(i) A spouse ;
(ii) A minor legitimate or adopted child dependent upon the insured person ;
(iii) A child who is wholly dependent on the earnings of the insured person and who is
(a) Receiving education, till he or she attains the age of twenty-one years,
(b) An unmarried daughter;
(iv) A child who is infirm by reason of any physical or mental abnormality or injury and is wholly dependent on the earnings of the insured person, so long as the infirmity continues ;
(v) Dependant parents, whose income from all sources does not exceed such income as may be prescribed by the Central Government ;
(vi) In case the insured person is unmarried and his or her parents are not alive, a minor brother or sister wholly dependant upon the earnings of the insured person ;
For question no.2 - What is standard rate under ESIC act
The ceiling is max of Rs.15000
Average daily wages are Standard benefit rate (in Rs)
1. Below Rs.28 Rs. 14 or full average daily wage whichever is less
2. Rs.28 and above but below Rs. 32 16
3. Rs.32 and above but below Rs.36 18
4. Rs.36 and above but below Rs.40 20
5. Rs.40 and above but below Rs.48 24
6. Rs.48 and above but below Rs.56 28
7. Rs.56 and above but below Rs.60 30
8. Rs.60 and above but below Rs.64 32
9. Rs.64 and above but below Rs.72 36
10. Rs.72 and above but below Rs.76 38
11. Rs.76and above but below Rs.80 40
12. Rs.80 and above but below Rs.88 44
13. Rs.88 and above but below Rs.96 48
14. Rs.96 and above but below Rs.106 53
15. Rs.106 and above but below Rs.116 58
16. Rs.116 and above but below Rs.126 63
17. Rs.126 and above but below Rs.136 68
18. Rs.136 and above but below Rs.146 73
19. Rs.146 and above but below Rs.156 78
20. Rs.156 and above but below Rs.166 83
21. Rs.166 and above but below Rs.176 88
22. Rs.176 and above but below Rs.186 93
23. Rs.186 and above but below Rs.196 98
24. Rs.196 and above but below Rs.206 103
25. Rs.206 and above but below Rs.216 108
26. Rs.216 and above but below Rs.226 113
27. Rs.226 and above but below Rs.236 118
28. Rs.236 and above but below Rs.250 125
29. Rs.250 and above but below Rs.260 130
30. Rs.260 and above but below Rs.270 135
31. Rs.270 and above but below Rs.280 140
32. Rs.280 and above but below Rs. 290 145
33. Rs.290 and above but below Rs. 300 150
34. Rs.300 and above but below Rs. 310 155
35. Rs.310 and above but below Rs. 320 160
36. Rs.320 and above but below Rs. 330 165
37. Rs.330 and above but below Rs. 340 170
38. Rs.340 and above but below Rs. 350 175
39. Rs.350 and above but below Rs. 360 180
40. Rs.360 and above but below Rs. 370 185
41. Rs.370 and above but below Rs. 380 190
42. Rs.380 and above 195
For question no.3 -What is the provision to avail facility of Hospital other than ESI hospitals.
Procedure to be followed by the ESI beneficiaries to avail Super specialty medical treatment
- The insured person shall approach the ESI Dispensary to which he/she is attached, and the Medical Officer shall issue a referral letter to the IP to approach the concerned empanelled medical institution.
- If the IP/beneficiary need medical attention during the non working hours of the concerned ESI Dispensary, they may directly approach the nearest ESI Hospital for getting referral letter. If there is no ESI Hospital situation nearer to the IP’s place of living, the IP shall approach the nearest Govt. Hospital for getting referral letter.
- In the case of an emergency the IP/beneficiary can get Medical attention just by producing his/her ESI identity card at the designated private medical institution, shall produce necessary referral letter and other relevant documents within 48 hours. (If any case referral letter is a must to avail treatment under package deal
- The IP/beneficiary shall produce the referral letter along with the ESI Identity Card at the designated private medical institution and avail the treatment without paying any amount from out of his/her pocket. However any facility, other than the items included in the package deal shall be borne by the IP/beneficiary.
- While referring the IP/beneficiary to the concerned Empanelled Medical institution, Medical Officer incharge has to verify whether the IP/beneficiary is eligible for treatment.
- The IP shall produce all the relevant documents demanded by the designated hospital and extend his/her co-operation to the hospital authorities.
- The designated hospital after imparting treatment to the IP/beneficiary shall raise the claim bill directly to the Directorate where it will be settled.
For question no.4 - What kind of disease are covered under ESI & who are entitled.
The enactment of Employees’ State Insurance Act, 1948 in Indian Parliament envisaged the requirement for a comprehensive, integrated and need based social insurance scheme that would go a long-way in providing protection in the interest of workers. This ESIC would be beneficial in ever-pervading risks lurking in each and every corner of human lives especially in contingencies comprising of sickness, temporary or permanent physical disablement, maternity, death due to employment injury thereby resulting in loss of wages or earning capacity. This Act facilitates medical care to all employees (workers) including their immediate family dependants, devoid of any discrimination or prejudice which is reasonably satisfactory in nature.
For question no.5 - How to recover expense incured for hospitalisation bills.
You have to submit the actual bills to local dispensary and the same will be forwarded to the regional office which will directed to the directorate for scrutiny and the reimbursement will be done. its a lengtheir process.
For question no.5 - What is the provision to change dispensary.
it can be done in online itself.
please find below the required details for your reference.
For question no.1 - What is the maximum age limit for dependent to avail ESI benefit.
According to the act :
Family means all or any of the following relatives of an insured person, namely :
(i) A spouse ;
(ii) A minor legitimate or adopted child dependent upon the insured person ;
(iii) A child who is wholly dependent on the earnings of the insured person and who is
(a) Receiving education, till he or she attains the age of twenty-one years,
(b) An unmarried daughter;
(iv) A child who is infirm by reason of any physical or mental abnormality or injury and is wholly dependent on the earnings of the insured person, so long as the infirmity continues ;
(v) Dependant parents, whose income from all sources does not exceed such income as may be prescribed by the Central Government ;
(vi) In case the insured person is unmarried and his or her parents are not alive, a minor brother or sister wholly dependant upon the earnings of the insured person ;
For question no.2 - What is standard rate under ESIC act
The ceiling is max of Rs.15000
Average daily wages are Standard benefit rate (in Rs)
1. Below Rs.28 Rs. 14 or full average daily wage whichever is less
2. Rs.28 and above but below Rs. 32 16
3. Rs.32 and above but below Rs.36 18
4. Rs.36 and above but below Rs.40 20
5. Rs.40 and above but below Rs.48 24
6. Rs.48 and above but below Rs.56 28
7. Rs.56 and above but below Rs.60 30
8. Rs.60 and above but below Rs.64 32
9. Rs.64 and above but below Rs.72 36
10. Rs.72 and above but below Rs.76 38
11. Rs.76and above but below Rs.80 40
12. Rs.80 and above but below Rs.88 44
13. Rs.88 and above but below Rs.96 48
14. Rs.96 and above but below Rs.106 53
15. Rs.106 and above but below Rs.116 58
16. Rs.116 and above but below Rs.126 63
17. Rs.126 and above but below Rs.136 68
18. Rs.136 and above but below Rs.146 73
19. Rs.146 and above but below Rs.156 78
20. Rs.156 and above but below Rs.166 83
21. Rs.166 and above but below Rs.176 88
22. Rs.176 and above but below Rs.186 93
23. Rs.186 and above but below Rs.196 98
24. Rs.196 and above but below Rs.206 103
25. Rs.206 and above but below Rs.216 108
26. Rs.216 and above but below Rs.226 113
27. Rs.226 and above but below Rs.236 118
28. Rs.236 and above but below Rs.250 125
29. Rs.250 and above but below Rs.260 130
30. Rs.260 and above but below Rs.270 135
31. Rs.270 and above but below Rs.280 140
32. Rs.280 and above but below Rs. 290 145
33. Rs.290 and above but below Rs. 300 150
34. Rs.300 and above but below Rs. 310 155
35. Rs.310 and above but below Rs. 320 160
36. Rs.320 and above but below Rs. 330 165
37. Rs.330 and above but below Rs. 340 170
38. Rs.340 and above but below Rs. 350 175
39. Rs.350 and above but below Rs. 360 180
40. Rs.360 and above but below Rs. 370 185
41. Rs.370 and above but below Rs. 380 190
42. Rs.380 and above 195
For question no.3 -What is the provision to avail facility of Hospital other than ESI hospitals.
Procedure to be followed by the ESI beneficiaries to avail Super specialty medical treatment
- The insured person shall approach the ESI Dispensary to which he/she is attached, and the Medical Officer shall issue a referral letter to the IP to approach the concerned empanelled medical institution.
- If the IP/beneficiary need medical attention during the non working hours of the concerned ESI Dispensary, they may directly approach the nearest ESI Hospital for getting referral letter. If there is no ESI Hospital situation nearer to the IP’s place of living, the IP shall approach the nearest Govt. Hospital for getting referral letter.
- In the case of an emergency the IP/beneficiary can get Medical attention just by producing his/her ESI identity card at the designated private medical institution, shall produce necessary referral letter and other relevant documents within 48 hours. (If any case referral letter is a must to avail treatment under package deal
- The IP/beneficiary shall produce the referral letter along with the ESI Identity Card at the designated private medical institution and avail the treatment without paying any amount from out of his/her pocket. However any facility, other than the items included in the package deal shall be borne by the IP/beneficiary.
- While referring the IP/beneficiary to the concerned Empanelled Medical institution, Medical Officer incharge has to verify whether the IP/beneficiary is eligible for treatment.
- The IP shall produce all the relevant documents demanded by the designated hospital and extend his/her co-operation to the hospital authorities.
- The designated hospital after imparting treatment to the IP/beneficiary shall raise the claim bill directly to the Directorate where it will be settled.
For question no.4 - What kind of disease are covered under ESI & who are entitled.
The enactment of Employees’ State Insurance Act, 1948 in Indian Parliament envisaged the requirement for a comprehensive, integrated and need based social insurance scheme that would go a long-way in providing protection in the interest of workers. This ESIC would be beneficial in ever-pervading risks lurking in each and every corner of human lives especially in contingencies comprising of sickness, temporary or permanent physical disablement, maternity, death due to employment injury thereby resulting in loss of wages or earning capacity. This Act facilitates medical care to all employees (workers) including their immediate family dependants, devoid of any discrimination or prejudice which is reasonably satisfactory in nature.
For question no.5 - How to recover expense incured for hospitalisation bills.
You have to submit the actual bills to local dispensary and the same will be forwarded to the regional office which will directed to the directorate for scrutiny and the reimbursement will be done. its a lengtheir process.
For question no.5 - What is the provision to change dispensary.
it can be done in online itself.
Dear Sir(s),
I think the Standard Benefit Rate (Table), which has been been mentioned by one of member in above remarks has been changed/deleted w.e.f. 01/07/2011 by omitting Rule 54 of ESI (Central) Rules, 1950.
The rates of benefits under ESI Act/rules/regulations which are paid in cash have now been modified w.e.f. 01/07/2011.
From India, Noida
I think the Standard Benefit Rate (Table), which has been been mentioned by one of member in above remarks has been changed/deleted w.e.f. 01/07/2011 by omitting Rule 54 of ESI (Central) Rules, 1950.
The rates of benefits under ESI Act/rules/regulations which are paid in cash have now been modified w.e.f. 01/07/2011.
From India, Noida
There is age limit for dependents benefit and for children to be eligible family members . Varghese Mathew
From India, Thiruvananthapuram
From India, Thiruvananthapuram
No age limit for spouse and parents.Limit only for children. VARGHESE MATHEW HR/Labor Law Adviser.Trivandrum. 09961266966
From India, Thiruvananthapuram
From India, Thiruvananthapuram
Oops so many questions in one go, first of all let us know whether you are a HR guy and why do you require this, have you ever referred the ESIC Act.
Please go through the Act, most of the question will be answered, wherein if you find difficult in understanding any few items let the forum know to advise accordingly, it is noticed herein that you want a ready platter to be served at your table without much pain, I am sorry for using such Harsh words but it is for your benefit only.
From India, Ahmadabad
Please go through the Act, most of the question will be answered, wherein if you find difficult in understanding any few items let the forum know to advise accordingly, it is noticed herein that you want a ready platter to be served at your table without much pain, I am sorry for using such Harsh words but it is for your benefit only.
From India, Ahmadabad
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ESI contribution rates lowering.pdf