esi scheme

11

EMPLOYEES’ STATE INSURANCE SCHEMEEMPLOYEES’ STATE INSURANCE SCHEME

A TOTAL SOCIAL SECURITY SCHEME FOR A TOTAL SOCIAL SECURITY SCHEME FOR WORKING POPULATION OF THE INDUSTRIESWORKING POPULATION OF THE INDUSTRIES

BYBYAdditional Commissioner and Regional DirectorAdditional Commissioner and Regional Director

Employees’ State Insurance CorporationEmployees’ State Insurance CorporationWest Bengal RegionWest Bengal Region

Tel.: 2225 9236Tel.: 2225 9236 Website: Website: www.esic.org.in

www.esiswestbengal.orgwww.esiswestbengal.org

Fax: 2225 9236Fax: 2225 9236 E-Mail: [email protected]: [email protected]

22

WHAT IS SOCIAL SECURITY?WHAT IS SOCIAL SECURITY?

SocialSocialSuggests relationship to Society in a particular Culture, Suggests relationship to Society in a particular Culture, historical and geographical settings.historical and geographical settings.

SecuritySecurityImplies protection against risks. It is defined as the Implies protection against risks. It is defined as the protection which Society provides for its members protection which Society provides for its members through a series of public measures, against the through a series of public measures, against the economic and social distress that otherwise would be economic and social distress that otherwise would be caused by the stoppage of substantial reduction of caused by the stoppage of substantial reduction of earnings resulting from sickness, maternity, disablement, earnings resulting from sickness, maternity, disablement, old age and death. It incorporate provisions of medical old age and death. It incorporate provisions of medical care, and the provision of subsidies for families including care, and the provision of subsidies for families including children.children.

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PATTERN OF SOCIAL SECURITYPATTERN OF SOCIAL SECURITYTECHNIQUES TO PROVIDETECHNIQUES TO PROVIDE

NEED FOR MEDICAL CARE FOR SELF AND NEED FOR MEDICAL CARE FOR SELF AND DEPENDENT FAMILYDEPENDENT FAMILY

SECURITY AGAINST SUSPENSION, LOSS ORSECURITY AGAINST SUSPENSION, LOSS OR

SUBSTANTIAL REDUCTION OF INCOME DUE TOSUBSTANTIAL REDUCTION OF INCOME DUE TO

SICKNESS (SHORT TERM/LONG TERM)SICKNESS (SHORT TERM/LONG TERM) MATERNITYMATERNITY EMPLOYMENT RELATED ACCIDENTS AND EMPLOYMENT RELATED ACCIDENTS AND

DISEASESDISEASES DISABLEMENT (TEMPORARY & PERMANENT DISABLEMENT (TEMPORARY & PERMANENT

TOTAL/PARTIAL)TOTAL/PARTIAL) DEATH OF BREAD EARNERDEATH OF BREAD EARNER REHABILITATION REHABILITATION OLD AGE CAREOLD AGE CARE

44

FIVE PILLARS OF SOCIAL SECURITYFIVE PILLARS OF SOCIAL SECURITY

SOCIAL ASSISTANCESSOCIAL ASSISTANCES

SOCIAL INSURANCESOCIAL INSURANCE

EMPLOYER’S LIABILITY TO FUND THE EMPLOYER’S LIABILITY TO FUND THE SCHEMESCHEME

STATE FUNDINGSTATE FUNDING

BENEFITS FUNDED FROM GENERAL BENEFITS FUNDED FROM GENERAL REVENUEREVENUE

55

INTERNATIONAL LABOUR ORGANISATIONINTERNATIONAL LABOUR ORGANISATIONSTANDARD OF SOCIAL SECURITYSTANDARD OF SOCIAL SECURITY

MEDICAL CARE MEDICAL CARE SICKNESS BENEFIT SICKNESS BENEFIT OLD AGE BENEFITOLD AGE BENEFIT UN-EMPLOYMENT BENEFITUN-EMPLOYMENT BENEFIT MATERNITY BENEFITMATERNITY BENEFIT INVALID BENEFIT INVALID BENEFIT DEPENDANTS’ BENEFITDEPENDANTS’ BENEFIT EMPLOYMENT INJURY BENEFIT EMPLOYMENT INJURY BENEFIT FAMILY BENEFIT (FREE & FULL MEDICAL CARE)FAMILY BENEFIT (FREE & FULL MEDICAL CARE)

66

APPLICABILITYAPPLICABILITY

The ESI Act 1948, in the first instance, applied to The ESI Act 1948, in the first instance, applied to non-seasonal factories using:non-seasonal factories using:

A.A. Power in the manufacturing process and Power in the manufacturing process and employing employing 10 10 or more persons and;or more persons and;

B.B. Non-power using factories or establishments Non-power using factories or establishments employing 20 or more persons for wages. employing 20 or more persons for wages.

It is proposed to amend the provisions to include all It is proposed to amend the provisions to include all units (Factories and Establishments) irrespective of units (Factories and Establishments) irrespective of use of power, employing 10 or more persons.use of power, employing 10 or more persons.

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The provisions of the Act are being The provisions of the Act are being implemented area wise by stages. The implemented area wise by stages. The Act contains an enabling provision under Act contains an enabling provision under which the "Appropriate Government" is which the "Appropriate Government" is empowered to extend the provisions of empowered to extend the provisions of the Act to other classes of the Act to other classes of establishments - industrial, commercial, establishments - industrial, commercial, agricultural or otherwise. Under these agricultural or otherwise. Under these provisions most of the State provisions most of the State Governments have extended the Governments have extended the provisions of the ESI Act to the following provisions of the ESI Act to the following classes of establishments.classes of establishments.

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1.1. Shops, hotels, restaurants, cinemas including preview Shops, hotels, restaurants, cinemas including preview theatres, road motor transport agencies and newspaper theatres, road motor transport agencies and newspaper establishments, etc employing 20 or more employees.establishments, etc employing 20 or more employees.

2.2. Power using Beedi manufacturing units in the Power using Beedi manufacturing units in the implemented area employing 10 or more employees and implemented area employing 10 or more employees and non-power beedi establishments employing 20 or more non-power beedi establishments employing 20 or more employees attract coverage under the Act. A few States employees attract coverage under the Act. A few States have even extended the provisions of the Act to non-have even extended the provisions of the Act to non-power using Beedi manufacturing units employing less power using Beedi manufacturing units employing less than ten persons.than ten persons.

3.3. Slate pencil-manufacturing units employing one or more Slate pencil-manufacturing units employing one or more employees have also been brought under the coverage employees have also been brought under the coverage of the Act in a few States.of the Act in a few States.

4.4. Employees of the aforesaid factories and establishments Employees of the aforesaid factories and establishments in receipt of wages not exceeding Rs.10,000/- per month in receipt of wages not exceeding Rs.10,000/- per month (excluding remuneration for over time) are covered (excluding remuneration for over time) are covered under the Act w.e.f. 1.10.2006.under the Act w.e.f. 1.10.2006.

5.5. All Private Medical & Educational Institutions employing All Private Medical & Educational Institutions employing 20 or more w.e.f. 22.8.2006.20 or more w.e.f. 22.8.2006.

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APPLICABILITYAPPLICABILITYFINANCES:FINANCES:

The scheme is primarily funded by contributions raised from The scheme is primarily funded by contributions raised from insured employees of covered factories and establishments insured employees of covered factories and establishments and their employers in the implemented areas as a small but and their employers in the implemented areas as a small but specified percentage of wages payable to such employees.specified percentage of wages payable to such employees.

The rates of contribution were last revised by the Corporation The rates of contribution were last revised by the Corporation from 1from 1st st January, 1997 and are still in vogue. These rates of January, 1997 and are still in vogue. These rates of contribution are:-contribution are:-1.1. Employees' ContributionEmployees' Contribution -- 1.75 percent of the 1.75 percent of the wageswages2.2. Employers' ContributionEmployers' Contribution -- 4.75 percent of the 4.75 percent of the wageswages

TotalTotal -- 6.50 percent of the wages6.50 percent of the wages

Employees in receipt of an average daily wage of Rs.70/- or Employees in receipt of an average daily wage of Rs.70/- or less, are exempted from payment of their share of less, are exempted from payment of their share of contribution (w.e.f. 1.4.2007) but are entitled to all social contribution (w.e.f. 1.4.2007) but are entitled to all social security benefits under the Scheme.security benefits under the Scheme.

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The State Govts., as per provision of the Act, The State Govts., as per provision of the Act, contribute 12.5% of expenditure on Medical Care contribute 12.5% of expenditure on Medical Care on ESI Beneficiaries in their respective states on ESI Beneficiaries in their respective states within the ceiling of Rs.1000/- per Insured Person within the ceiling of Rs.1000/- per Insured Person family unit per annum.family unit per annum.

Any expenditure over and above this ceiling is Any expenditure over and above this ceiling is borne entirely by the State Govts.borne entirely by the State Govts.

The contributions paid by employees and The contributions paid by employees and employers are deposited in a common pool employers are deposited in a common pool known as the ESI Fund A/C No. 1 that is utilized known as the ESI Fund A/C No. 1 that is utilized for payment of cash benefits to the insured for payment of cash benefits to the insured persons and their dependants, as well as, for persons and their dependants, as well as, for providing medical facilities to the beneficiaries. providing medical facilities to the beneficiaries. The administrative and other expenses of the The administrative and other expenses of the Corporation are also met from this fund.Corporation are also met from this fund.

1111


It is also well-known that due to lack of social It is also well-known that due to lack of social security protection, a sense of insecurity and fear for security protection, a sense of insecurity and fear for future in respect of self and family creates an future in respect of self and family creates an amount of uncertainty among any individual, which amount of uncertainty among any individual, which is one of the causes for increasing industrial is one of the causes for increasing industrial accidents, and unrest among the working class. accidents, and unrest among the working class. Once this fear and uncertainty is removed from their Once this fear and uncertainty is removed from their minds, through this comprehensive Social Insurance minds, through this comprehensive Social Insurance Scheme administered by a statutory and Scheme administered by a statutory and independent organization of the state, the employer, independent organization of the state, the employer, get a more contended work-force, less prone to get a more contended work-force, less prone to accidents, which paves the way for an increased accidents, which paves the way for an increased production.production.

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BENEFITS ADMISSIBLE UNDER E.S.I. SCHEMEBENEFITS ADMISSIBLE UNDER E.S.I. SCHEME

MEDICAL BENEFIT

(Admissible from the date of entry of Insured Person into insurable employment)

Full range of Medical, Surgical & Obstetric treatment to the Insured Person & his family (Spouse, minor legitimate or adopted dependent children, infirm children, unmarried daughter & dependent children upto the age of 21 years if they are receiving education).

1. Out-patient treatment2. Domiciliary Treatment (treatment by visits at their residence)3. Specialist consultation 4. In-patient treatment5. Super-Specialty treatment like heart surgery, Neuro surgery, bone marrow transplant, kidney Transplant etc.

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5. Free supply of medicines, drugs, dressings, artificial limbs, aids and appliances.

6. X-ray, pathological & clinical investigations7. Specialized investigations like CAT scan, MRI,

Angiographies etc.8. Vaccination & preventive inoculations.9. Family Welfare operations.10. Health check up camps in colonies and dispensaries.11. Antenatal care, confinement & Post natal care.12. Ambulance service or conveyance charges for going

to hospitals, diagnostic Centers etc. & Treatment for occupational diseases.

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Five Occupational Diseases Centres are functioning at Delhi, Chinchawd (Pune), Nagda (M.P.), Joka (West Bengal) and Chennai (Tamil Nadu). It is also proposed to convert some ESI Hospitals as Model Hospitals. In areas where ESI Hospitals are not available, hospitalization is provided through bed reservation in teaching hospitals (Govt./Private Hospitals). Where a particular kind of medical care is not available, the Corporation and the State Govt. is arranging this Medical treatment in other hospitals including private hospitals providing super speciality treatment.

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Medical care after retirement & leaving employment

The above medical care is also admissible to retired Insured Persons and Insured Persons leaving the job due to permanent Disablement, for self and spouse on a nominal advance payment of Rs.120/- per annum.

An Insured Person and his family members are entitled to this medical care even after leaving his employment till the end of the corresponding benefit period.

If a beneficiary is in receipt of medical treatment, he continues to be entitled to such medical care till he is cured notwithstanding the fact that he becomes disentitled for other reasons.

1616

CASH BENEFITS & CONTRIBUTORY CONDITIONSCASH BENEFITS & CONTRIBUTORY CONDITIONS

BenefitBenefit Contributory Contributory ConditionsConditions

DurationDuration Rate Rate

11 22 33 44

1. a) 1. a) SICKNESS SICKNESS BENEFITBENEFIT

Payment for at Payment for at least 78 days in least 78 days in the relevant the relevant contribution contribution periodperiod

91 days in any two 91 days in any two consecutive benefit consecutive benefit periodsperiods

Standard Benefit Standard Benefit Rate (50% of Rate (50% of wages)wages)

b) b) EXTENDED EXTENDED SICKNESS SICKNESS BENEFITBENEFIT

(for 34 specified (for 34 specified long term diseases.)long term diseases.)

Continuous Continuous employment for a employment for a period of two period of two years.years.

a.a. Upto 309 daysUpto 309 days

b.b. Duration has Duration has been extended been extended beyond 400 beyond 400 days (91 days days (91 days S.B. plus 309 S.B. plus 309 days E.S.B.) to days E.S.B.) to two years in two years in deserving cases deserving cases duly certified by duly certified by a Medical a Medical Board.Board.

140% of the 140% of the standard benefit standard benefit rate (about 70% of rate (about 70% of the wages)the wages)

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c) c) ENHANCED ENHANCED SICKNESS BENEFITSICKNESS BENEFIT

(for undergoing (for undergoing sterilization sterilization operation for family operation for family welfare)welfare)

Same as for Same as for Sickness Benefit Sickness Benefit at (a) above.at (a) above.

7 days for 7 days for Vasectomy and 14 Vasectomy and 14 days for days for Tubectomy Tubectomy extendable in extendable in cases of post-cases of post-operative operative complication etc.complication etc.

Twice the Standard Twice the Standard Benefit RateBenefit Rate

(Full wages)(Full wages)

2. 2. DISABLEMENT DISABLEMENT BENEFITBENEFIT

(Employment Injury (Employment Injury or occupational or occupational disease)disease)

a)a) Temporary Temporary Disablement Disablement BenefitBenefit

b)b) Permanent Permanent Disablement Disablement BenefitBenefit

No conditionNo condition

No conditionNo condition

Till the incapacity Till the incapacity lastslasts

For lifeFor life

140% of the 140% of the standard benefit standard benefit raterate

Upto 140% of the Upto 140% of the Standard Sickness Standard Sickness Benefit Rate.Benefit Rate.

3. 3. DEPENDANTS’ DEPENDANTS’ BENEFITBENEFIT

(For death due to (For death due to employment injury employment injury or occupational or occupational disease)disease)

No conditionNo condition To immediate To immediate dependantsdependants

140% of the 140% of the standard sickness standard sickness benefit rate.benefit rate.

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4.4. MATERNITY MATERNITY BENEFITBENEFIT

Payment of Payment of contribution for 70 contribution for 70 days in immediately days in immediately preceding two preceding two consecutive consecutive contribution periods.contribution periods.

12 weeks of which not 12 weeks of which not more than six can more than six can precede the expected precede the expected date of confinement; date of confinement; 6 weeks for 6 weeks for miscarriage.miscarriage.

One month for One month for sickness arising out of sickness arising out of pregnancy.pregnancy.

Double the Double the standard benefit standard benefit rate (not less than rate (not less than full wages)full wages)

SameSame

5. 5. MEDICAL MEDICAL BENEFITBENEFIT

No condition No condition (Insured person and (Insured person and his family is eligible his family is eligible from the date of from the date of entry of insured entry of insured person into insurable person into insurable employment)employment)

To start with for a To start with for a period of 3 months or period of 3 months or till the spell of till the spell of treatment lasts treatment lasts whichever is later and whichever is later and thereafter based on thereafter based on payment of payment of contributioncontribution

Full Medical Care Full Medical Care (all) facilities (all) facilities including including Hospitalization for Hospitalization for insured persons insured persons and members of and members of their family.their family.

6. 6. OTHER OTHER BENEFITSBENEFITS

a) a) Funeral Funeral ExpensesExpenses

No condition (i.e. No condition (i.e. merely by virtue of merely by virtue of being an insured being an insured person)person)

Actual expenditure Actual expenditure on funeral not on funeral not exceeding exceeding Rs.2,500/- w.e.f. Rs.2,500/- w.e.f. 1.10.20001.10.2000

bb) ) Rehabilitation Rehabilitation

AllowanceAllowance

No conditionNo condition For each day on which For each day on which insured person insured person remains admitted in remains admitted in Artificial Limb Centre Artificial Limb Centre for fixation/repair or for fixation/repair or replacement of replacement of artificial limb.artificial limb.

Double the Double the standard benefit standard benefit rate but not less rate but not less than full wages.than full wages.

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c) c) Vocational & Vocational & RehabilitationRehabilitation

Insurable Insurable employment upto employment upto 40% permanent 40% permanent disablement and disablement and below 45 years agebelow 45 years age

Till such training Till such training lasts at a lasts at a recognized recognized centre/institutecentre/institute

d) d) Medical Medical Benefit Benefit to to Retired and Retired and Disabled insured Disabled insured

personspersons

On payment @ On payment @ Rs.10/- per month Rs.10/- per month in lumpsum for one in lumpsum for one year in advance:year in advance:

i) To insured i) To insured persons who leave persons who leave insurable insurable employment on employment on attaining the age attaining the age of superannuation of superannuation after being insured after being insured for not less that for not less that five years.five years.

Period for which Period for which contribution is contribution is paid.paid.

Full medical care Full medical care for self and spouse for self and spouse only.only.

ii) To insured ii) To insured persons who cease persons who cease to be in insurable to be in insurable employment on employment on account of account of permanent permanent disablement due to disablement due to an employment an employment injury.injury.

Period for which Period for which contribution is contribution is paid, till attaining paid, till attaining the age of the age of superannuation.superannuation.

2020

ee) ) Confinement Confinement ExpensesExpenses

No condition other No condition other than insurable than insurable employment of employment of self/spouseself/spouse

Rs.1000/- is paid as Rs.1000/- is paid as a lumpsum grant a lumpsum grant towards towards confinement confinement expenses to an expenses to an insured woman, insured woman, wife of insured wife of insured person. (w.e.f. person. (w.e.f. 1.4.2003)1.4.2003)

At places where At places where necessary medical necessary medical facilities are not facilities are not available under the available under the ESI Scheme.ESI Scheme.

7.7.UNEMPLOYMET UNEMPLOYMET ALLOWANCEALLOWANCE

(On account of (On account of closure, closure, retrenchment and retrenchment and permanent permanent invalidity arising invalidity arising out of non-out of non-employment injury)employment injury)

1.1. An insured An insured person on the person on the date of loss of date of loss of insurable insurable employmentemployment

2.2. Should have Should have contributed for contributed for a minimum a minimum period of 5 period of 5 years in ESI years in ESI Scheme prior to Scheme prior to loss of loss of employmentemployment

3.3. Should be Should be entitled to S.B. entitled to S.B. in the last four in the last four contribution contribution period.period.

Six monthsSix months Standard Benefit Standard Benefit Rate (50% of Rate (50% of wages)wages)

2121

THE ESI SCHEME AT A GLANCE IN WEST BENGALTHE ESI SCHEME AT A GLANCE IN WEST BENGAL

The ESI Scheme was first implemented in Kolkata and Howrah in 1955. Presently, the Scheme is providing coverage to around 5.23 lakh IP family units, serving a total of 26.73 Lakhs beneficiaries covering 10 districts of Kolkata, North and South 24 Pgs, Nadia, Burdwan, Darjeeling, Jalpaiguri, Howrah, Hooghly and East Midnapore.

The ESI Corporation has an infrastructure of a Regional Office, a Sub- Regional Office and 67 Branch Offices and 23 Inspectorate Offices.

2222

THE ESI SCHEME AT A GLANCE IN WEST THE ESI SCHEME AT A GLANCE IN WEST BENGALBENGAL

On the Medical Side, the Scheme is administered On the Medical Side, the Scheme is administered by State Govt. through a Directorate headed by by State Govt. through a Directorate headed by the Director, ESI (MB) Scheme who is assisted by the Director, ESI (MB) Scheme who is assisted by Administrative Medical Officer, Additional Administrative Medical Officer, Additional Administrative Medical Officers. The Directorate Administrative Medical Officers. The Directorate is controlling 13 hospitals and 38 dispensaries is controlling 13 hospitals and 38 dispensaries and 865 IMP Clinics spread all over the state. and 865 IMP Clinics spread all over the state. Individual hospitals are controlled by respective Individual hospitals are controlled by respective Medical Superintendents and cluster of Medical Superintendents and cluster of Dispensaries are under respective Administrative Dispensaries are under respective Administrative Medical Officers. The Medical Supdts. And Medical Officers. The Medical Supdts. And Administrative Medical Officers directly report to Administrative Medical Officers directly report to Director, ESI (MB) Scheme for all administrative Director, ESI (MB) Scheme for all administrative purpose. Besides hospitals and dispensaries, purpose. Besides hospitals and dispensaries, one diagnostic centre and 865 panel clinics are one diagnostic centre and 865 panel clinics are also functioning to provide Medical Care.also functioning to provide Medical Care.

2323


The services for Cardiology, Hand Surgery and Dialysis The services for Cardiology, Hand Surgery and Dialysis are available at Manicktala ESI Hospital. Important are available at Manicktala ESI Hospital. Important diagnostic facilities like Ultrasonography, Auto diagnostic facilities like Ultrasonography, Auto Analyser, Treadmill System, Computerized Eye Testing, Analyser, Treadmill System, Computerized Eye Testing, Endoscopy and Cardiac Monitor are also available Endoscopy and Cardiac Monitor are also available there. Two specialised hospitals at Belur and Bandel there. Two specialised hospitals at Belur and Bandel are for treatment of Tuberculosis. Tie-up arrangements are for treatment of Tuberculosis. Tie-up arrangements for specialised/super-specialised treatment exist with for specialised/super-specialised treatment exist with important institutions which are detailed below:important institutions which are detailed below:

Peerless Hospital and B.K.Roy Research Centre, Peerless Hospital and B.K.Roy Research Centre, KolkataKolkata R.N.Tagore International Institute of Cardiac Sciences, R.N.Tagore International Institute of Cardiac Sciences,

KolkataKolkata Suraksha Hospital, KolkataSuraksha Hospital, Kolkata Anandalok Hospital, SiliguriAnandalok Hospital, Siliguri Sunrise Hospital, SiliguriSunrise Hospital, Siliguri

2424


Paramount Hospital, SiliguriParamount Hospital, Siliguri Suraksha Eye Hospital & Diagnostic Centre, SiliguriSuraksha Eye Hospital & Diagnostic Centre, Siliguri Bimal Arogya Nketan, KharagpurBimal Arogya Nketan, Kharagpur

At present there are 3777 beds in ESI Hospitals.At present there are 3777 beds in ESI Hospitals.

(A ratio of 5.50 beds per 1000 IP Families)(A ratio of 5.50 beds per 1000 IP Families)

ESI Hospital, Joka is a 200-bedded Hospital located in ESI Hospital, Joka is a 200-bedded Hospital located in the heart of an industrial suburban town of the heart of an industrial suburban town of Thakurpukur, Kolkata. ESI Hospital, Joka is also Thakurpukur, Kolkata. ESI Hospital, Joka is also functioning as Occupational Disease Centre and functioning as Occupational Disease Centre and started functioning w.e.f. 1995.started functioning w.e.f. 1995.

2525

TIE UP ARRANGEMENTS WITH HOSPITALSTIE UP ARRANGEMENTS WITH HOSPITALS

Tie-up arrangements for superspeciality treatment is available to insured persons and their family members in reputed corporate and Government Hospitals in various states provided such insured persons are eligible for sickness benefits.

2626

ESIC lends helping hands to ESIC lends helping hands to dependants dependants

as torch bearer of social securityas torch bearer of social securityA few cases where Revolving Fund financed/advanced A few cases where Revolving Fund financed/advanced

to the IP/IW and their family for Medical Treatmentto the IP/IW and their family for Medical Treatment

Date of Date of paymepaymentnt

IP/IWIP/IW Ins. No.Ins. No. CompanCompany Codey Code

B.O.B.O. TreatmTreatment in ent in r/or/o

DiagnosisDiagnosis AmounAmountt

(Rs.)(Rs.)

Name of Name of the the hospitalhospital

12.1.012.1.055

Bharati Bharati SahaSaha

1006081006083232

13003A13003A Dal Dal SqrSqr

SelfSelf Annal Annal SphiterSphiter

3,00,03,00,00000

Global Global Hospital, Hospital, HyderabadHyderabad

18.2.018.2.055

Raj Raj Kumar Kumar SantraSantra

97028997028922

10451045 BauriBauriaa

SonSon ThanetonThanetonee

1,23,91,23,95050

R.N.Tagore R.N.Tagore InternationInternational Institute al Institute of Cardiac of Cardiac ResearchResearch

2.3.052.3.05 SukantSukanta a DasgupDasguptata

1127581127586363

34063406 Tolly Tolly gungegunge

FatherFather DiabetisDiabetis 1,13,41,13,47777

2727

IP/IWIP/IW Ins. No.Ins. No. Company Company CodeCode

DiagnosisDiagnosis AmountAmount

(Rs.)(Rs.)Name of the Name of the hospitalhospital

Suresh ShowSuresh Show 82022618202261 41-504741-5047 Renal Renal TransplantatioTransplantationn

220590220590 Woodlands Woodlands Medical Centre Medical Centre Pvt. Ltd.Pvt. Ltd.

Arun BanerjeeArun Banerjee 1128966611289666 2251622516 Acc. Burn Acc. Burn injuryinjury

260000260000 Jain Hospital & Jain Hospital & Research CentreResearch Centre

A. AliA. Ali 97798819779881 10471047 DVR, ARC MCDVR, ARC MC 225000225000 Peerless HospitalPeerless Hospital

S.L. BanerjeeS.L. Banerjee 98319569831956 87478747 Renal Renal TransplantatioTransplantationn

375000375000 C.M.C. Hospital, C.M.C. Hospital, VelloreVellore

S. DasS. Das 1130195011301950 20052005 B.M.T.B.M.T. 790000790000 -Do--Do-

S. ShowS. Show 82022618202261 50475047 Renal Renal TransplantatioTransplantationn


P. MondalP. Mondal 51950475195047 3035430354 Renal Renal TransplantatioTransplantationn


S. MishraS. Mishra 51437455143745 2110921109 AML-MAML-M22 400000400000 A.I.I.M.S.A.I.I.M.S.

Sanjib NandySanjib Nandy 1131544011315440 2857928579 Renal Renal TransplantatioTransplantationn


2828

Dhirendra Nath Dhirendra Nath PatraPatra

1151495115149511

2116121161 CABGCABG 125000125000 R.N. Tagore R.N. Tagore International Institute International Institute of Cardiac Researchof Cardiac Research

D. TalapatraD. Talapatra 52581405258140 3051930519 HepatitiHepatitiss

174000174000 R.N. Tagore R.N. Tagore International Institute International Institute of Cardiac Researchof Cardiac Research

R. SenguptaR. Sengupta 65122636512263 1377813778 CancerCancer 500000500000 Medical College Medical College KolkataKolkata

Dhirendra Nath Dhirendra Nath SantraSantra

99524319952431 52745274 AVRAVR 125000125000 R.N. Tagore R.N. Tagore International Institute International Institute of Cardiac Researchof Cardiac Research

Tarak Nath MallickTarak Nath Mallick 96836869683686 2139121391 DVRDVR 175000175000 Sushruta Clinic & Sushruta Clinic & Research InstituteResearch Institute

Arabinda GhoshArabinda Ghosh 89960708996070 3187-A3187-A MVRMVR 175000175000 R.N. Tagore R.N. Tagore International Institute International Institute of Cardiac Researchof Cardiac Research

2929

COMPARISON BETWEEN PUBLIC SECTOR COMPARISON BETWEEN PUBLIC SECTOR INSURANCE COMPANIES AND E.S.I.C. INSURANCE COMPANIES AND E.S.I.C.

IN REGARD TO MEDICAL BENEFITIN REGARD TO MEDICAL BENEFIT

The ESI Scheme is more beneficial and cost affective when compared to any other similar Schemes provided by Public Sector Insurance Companies in India. On overall assessment, the Medical Benefit under the ESI Scheme is far superior, most economical and not comparable to any other schemes.

3030

COMPARISON BETWEEN PUBLIC SECTOR COMPARISON BETWEEN PUBLIC SECTOR INSURANCE COMPANIES AND E.S.I.C. INSURANCE COMPANIES AND E.S.I.C.

IN REGARD TO MEDICAL BENEFITIN REGARD TO MEDICAL BENEFIT

Medical Benefit in ESI covers all Medical Benefit in ESI covers all ailments including super specialty ailments including super specialty treatment for Heart, Kidney and treatment for Heart, Kidney and Blood cancer etc. It covers Blood cancer etc. It covers treatment for AIDS also.treatment for AIDS also.

Medi-claim did not cover all Medi-claim did not cover all diseases of all ages and it did not diseases of all ages and it did not cover AIDS at all. cover AIDS at all.

No such condition. The day he joins No such condition. The day he joins in the insurable employment he and in the insurable employment he and his family members get the free his family members get the free medical treatment for self and medical treatment for self and family even without making any family even without making any contributions in the first instance. contributions in the first instance.

One year premium has to be paid in One year premium has to be paid in advance. advance.

ESI treatment is free of cost. ESI treatment is free of cost. Insured person need not spend any Insured person need not spend any amount for Medical treatment in amount for Medical treatment in the first instance except the the first instance except the monthly contributions paid by him. monthly contributions paid by him.

There is no cashless transaction. It There is no cashless transaction. It is only reimbursement of is only reimbursement of expenditure. The insurer has to expenditure. The insurer has to bear the Medical expenditure first, bear the Medical expenditure first, then claim for re-imbursement. then claim for re-imbursement.

E.S.I. CORPORATIONE.S.I. CORPORATIONPUBLIC SECTOR INSURANCE PUBLIC SECTOR INSURANCE COMPANIESCOMPANIES

3131

PUBLIC SECTOR INSURANCE PUBLIC SECTOR INSURANCE COMPANIESCOMPANIES

E.S.I. CORPORATIONE.S.I. CORPORATION

By payment of Annual premium By payment of Annual premium in advance the insurer will get in advance the insurer will get treatment through a limited treatment through a limited network of Hospitals.network of Hospitals.

The insured person will get The insured person will get Medical treatment through a Medical treatment through a wide network of panel wide network of panel clinics/Dispensaries/ clinics/Dispensaries/ Hospitals/Super Speciality Hospitals/Super Speciality Hospitals where tie-up is there.Hospitals where tie-up is there.

If the cost of the Medical If the cost of the Medical treatment is over and above the treatment is over and above the ceiling limit of the policy the ceiling limit of the policy the insurer has to bear the insurer has to bear the additional expenditure by additional expenditure by himself only. himself only.

No ceiling in the Medical No ceiling in the Medical treatment. In case the IP gets treatment. In case the IP gets emergency treatment through emergency treatment through other sources he will get the re-other sources he will get the re-imbursement of the expenditure imbursement of the expenditure as per Rules.as per Rules.

Minimum premium per year is Minimum premium per year is Rs.1438/-. which includes 5.5% Rs.1438/-. which includes 5.5% TPA + 5% service Tax, for the TPA + 5% service Tax, for the insurer of 25 years age for self insurer of 25 years age for self only.only.

Minimum premium is Rs.741/- Minimum premium is Rs.741/- irrespective of the age, if we irrespective of the age, if we consider the daily wage is consider the daily wage is Rs.50/-.Rs.50/-.

3232

PUBLIC SECTOR INSURANCE PUBLIC SECTOR INSURANCE COMPANIESCOMPANIES

E.S.I. CORPORATIONE.S.I. CORPORATION

By paying 1438/- the insurer will By paying 1438/- the insurer will get Medical treatment for self get Medical treatment for self only upto a limit of Rs.1 Lakh. only upto a limit of Rs.1 Lakh.

By contributing Rs.741/- the By contributing Rs.741/- the Insured Person including his Insured Person including his family members will get Medical family members will get Medical treatment without any ceiling on treatment without any ceiling on cost.cost.

Rate of premium depends on age Rate of premium depends on age and sum assured. If we consider and sum assured. If we consider a family of 4 members the a family of 4 members the premium cost would be premium cost would be Rs.5752/-.Rs.5752/-.

Rate of contribution depends on Rate of contribution depends on wages earned. No additional wages earned. No additional contribution is payable for contribution is payable for treatment of family members. treatment of family members.

Single premium paid annually in Single premium paid annually in advance. No other benefits advance. No other benefits included. included.

Single premium paid monthly. Single premium paid monthly. Multiple benefits against single Multiple benefits against single payment.payment.

Health shield is designed to offer Health shield is designed to offer complete MT for himself and complete MT for himself and family. The lowest premium is family. The lowest premium is 1599.60 per 1 Lakh and the 1599.60 per 1 Lakh and the highest is Rs.3321/-.highest is Rs.3321/-.

MB under ESIC is always for self MB under ESIC is always for self and family members including and family members including parents. Lowest premium is parents. Lowest premium is 741/- and highest premium is 741/- and highest premium is Rs.5850/- (1575±4275) if we Rs.5850/- (1575±4275) if we consider the maximum wage is of consider the maximum wage is of Rs.7500/- with out any ceiling on Rs.7500/- with out any ceiling on cost of MT and also includes cost of MT and also includes other cash benefits.other cash benefits.

3333

MEDICLAIM COVER’S COVER-UPS

‘Claim rejected as treatment was for a pre-existing condition’. This has been the bane of those claiming under mediclaim policies from PSU insurers. However, there is a disturbing truth which insiders often share: on a number of cases state-owned firms accommodate clients with right contacts in getting expensive treatment abroad for even pre-existing ailments. The trick is to issue an overseas mediclaim policy without declaring the pre-existing condition. Since the treatment is overseas there is very little chance of an investigation into whether the ailment was indeed pre-existing.

Source: The Economic Times dt. 06-07-06

3434

OVER 55? YOU MAY NOT GET MEDICLAIM

If you are over 55 and looking to buy Mediclaim health insurance cover, you’re in for a shock. In a circular issued to its agents, Oriental Insurance has told them they will not earn any commission on renewals or fresh sale of Mediclaim

policies to people in that age bracket. What this means is that agents selling these policies will have no incentive to sell them to you. And if you’re between 45 and 55, the company will accept your premium rather reluctantly. That’s why agents selling policies to people in this age bracket will have to be content with a 10% commission as against the 15% they would have earned earlier.

3535


Assuming you do have a policy, stop expecting calls from the agent who sold it to you in the first place and reminded you to pay the annual premium. According to sources, three other public sector general insurance companies – New India Assurance, Undia India and National Insurance are also likely to come out with similar circulars.

All the four public sector insurance companies have been struggling to manage huge losses on account of Mediclaim policies due to a higher claims ratio. Currently they range between 120% - 170%.

3636


A source in the industry said that by disincentivising the sales force from selling or renewing policies to people in the older age bracket, companies are hoping to cut their losses.

Theoretically though, you don’t need an insurance agent as an intermediary to buy the policy. You could go to the company and buy one directly.

However, a source said steps are being taken to make even this difficult. Customers will be put through a battery of medical tests to make sure they don’t suffer from any ailment before policies are issued to them.

Source: The Times of India dt. 20-07-06

3737

INSURANCE OF SIXTY PLUSNational Insurance is also planning to restructure existing medical policies to check misuse of insurance money. People often get themselves admitted to hospital for the smallest of ailments to avail of the insurance cover.

“The claim ratio in medical insurance is as high as 128 per cent. We have noticed that 56 per cent of this goes towards paying hospital room charges. So, we have decided to put sub-limits for different expenditure heads, including room rent,” Burman said.

A proposal to make the insured person bear a part of the bill is also doing the rounds, he said. “Since hiking the premium may adversely impact our policy sales, we are planning to make insured persons bear a part of the total medical bill so that misuse of insurance money is minimized.

3838

INSURANCE OF SIXTY PLUS

Oriental Insurance, too, is mulling such changes.

“Another problem is that hospitals and medical service providers indulge in over-billing once they know a patient is insured,” said Nayan C.Shah, Managing Director of Paramount Health Services Pvt. Ltd., which provides third party administrator (liasion) services to insurance companies.

To get around this, talks are on to standardize medical costs. At present, estimates given by third-party administrators and hospitals and doctors differ by 20 per cent.

Source: The Telegraph

3939

AN ANALYSIS OF INSURANCE SCHEMES AN ANALYSIS OF INSURANCE SCHEMES OFFERED BY L.I.C./G.I.C.OFFERED BY L.I.C./G.I.C.

The limitations suffered by Insurance Schemes like The limitations suffered by Insurance Schemes like Medi-claim policy and non-life insurance schemes Medi-claim policy and non-life insurance schemes offered by Public Sector Insurance Companies like offered by Public Sector Insurance Companies like National Insurance and General Insurance and by National Insurance and General Insurance and by private insurers through third party administrators private insurers through third party administrators are as follows:-are as follows:-

1.1. Diseases prior to taking the policy are not Diseases prior to taking the policy are not covered covered and certain diseases of critical nature and certain diseases of critical nature for which no for which no insurance coverage is existing.insurance coverage is existing.

2.2. In some life insurance policies, the benefit is In some life insurance policies, the benefit is paid paid only on the death of the insured person and only on the death of the insured person and also also comes with a rider that there is a waiting comes with a rider that there is a waiting period of 3 period of 3 to 6 months.to 6 months.

4040

3.3. The amount to be received depends on the sum The amount to be received depends on the sum insured on the life cover and there is no scope for insured on the life cover and there is no scope for revising/increasing the critical illness cover with the revising/increasing the critical illness cover with the changing needs of the insured.changing needs of the insured.

4.4. Policy like Medi-claim where the Member has to first Policy like Medi-claim where the Member has to first pay and then claim reimbursement and also pay and then claim reimbursement and also expenses like donor expenses incurred during expenses like donor expenses incurred during transplant surgery are not payable under Medi-transplant surgery are not payable under Medi-claim.claim.

5.5. Under Medi-claim, the insured person has to survive Under Medi-claim, the insured person has to survive for minimum 30 days from the date of diagnosis to for minimum 30 days from the date of diagnosis to get the benefit of the policy after which the insured get the benefit of the policy after which the insured will get a lumpsum amount equal to the sum will get a lumpsum amount equal to the sum assured.assured.

6.6. Such policies have an age restriction from 6 to 60 Such policies have an age restriction from 6 to 60 years, restriction of sum assured, restriction on the years, restriction of sum assured, restriction on the maturity value.maturity value.

4141

II. II. The so-called new system of cashless Medi-claim The so-called new system of cashless Medi-claim through 3through 3rdrd party administrators, who are managing party administrators, who are managing Health Insurance business suffer from the following Health Insurance business suffer from the following defects:-defects:-

A.A. Most of the complaints are in relation to the Most of the complaints are in relation to the services provided by TPAs. These include being services provided by TPAs. These include being unresponsive to telephone calls, failure to issue unresponsive to telephone calls, failure to issue identity cards and arbitrarily rejecting claims identity cards and arbitrarily rejecting claims without explanation.without explanation.

B.B. The biggest hassle with the TPAs is facing The biggest hassle with the TPAs is facing inadequate funding by the Insurance Company for inadequate funding by the Insurance Company for settlement of bills with Hospitals.settlement of bills with Hospitals.

C.C. The communication network with the hospital, I.e., The communication network with the hospital, I.e., online authorization is not being implemented in online authorization is not being implemented in that hospitals are questioning, who will do the that hospitals are questioning, who will do the investments in information technology system.investments in information technology system.

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III. The Universal Health Insurance Scheme recently III. The Universal Health Insurance Scheme recently launched by the Government of India suffers from the launched by the Government of India suffers from the following defects:-following defects:-

A)A) Under the policy, medical reimbursement is provided Under the policy, medical reimbursement is provided for hospitalization expenses upto Rs.30,000/- subject for hospitalization expenses upto Rs.30,000/- subject to room restriction, diseases restriction etc.to room restriction, diseases restriction etc.

B) B) All diseases contracted during the first 30 days from All diseases contracted during the first 30 days from the commencement date of policy are not covered the commencement date of policy are not covered and moreover some of the diseases such as cataract, and moreover some of the diseases such as cataract, benign prostatic hypertrophy, hysterectomy, hernia, benign prostatic hypertrophy, hysterectomy, hernia, hydrocele, fistula in anus, piles, sinusitis, congenital hydrocele, fistula in anus, piles, sinusitis, congenital internal disease are not covered in the first year of internal disease are not covered in the first year of the policy.the policy.

4343

C)C)Other diseases not covered are -- corrective, cosmetic Other diseases not covered are -- corrective, cosmetic or aesthetic dental surgery or treatment, cost of or aesthetic dental surgery or treatment, cost of spectacles, contact lens and hearing aid, vaccination, spectacles, contact lens and hearing aid, vaccination, inoculation, change of life or cosmetic treatment or inoculation, change of life or cosmetic treatment or surgery, HIV, AIDS, sterility, venereal disease, surgery, HIV, AIDS, sterility, venereal disease, intentional self injury, use of intoxicating intentional self injury, use of intoxicating drugs/alcohol, primarily diagnostic expenses not drugs/alcohol, primarily diagnostic expenses not related to sickness/injury and treatment for related to sickness/injury and treatment for pregnancy, childbirth, miscarriage, abortion etc.pregnancy, childbirth, miscarriage, abortion etc.

With above analysis, can we argue that there is life With above analysis, can we argue that there is life insurance? It can only best be called insurance with insurance? It can only best be called insurance with limited purpose and restriction but not at all a social limited purpose and restriction but not at all a social security like ESI having multiple benefits security like ESI having multiple benefits simultaneously like provision of medical care, simultaneously like provision of medical care, hospitalisation, super speciality treatment and hospitalisation, super speciality treatment and simultaneously cash benefit payment with only a simultaneously cash benefit payment with only a single contribution without the disadvantage of single contribution without the disadvantage of restriction as enumerated above.restriction as enumerated above.

(Source:The Economic Times, Hyderabad, dated 7th Sept. (Source:The Economic Times, Hyderabad, dated 7th Sept. 03)03)

4444

LATEST IMPROVEMENTS IN E.S.I. SCHEMELATEST IMPROVEMENTS IN E.S.I. SCHEME

A revolving fund created and maintained by Regional A revolving fund created and maintained by Regional Directors to disburse advance towards costly Medical Directors to disburse advance towards costly Medical Treatment immediately against sanction received from Treatment immediately against sanction received from State Govt.State Govt.

Tie-up arrangements made with super speciality Tie-up arrangements made with super speciality hospitals in Govt. and in private managements for quick hospitals in Govt. and in private managements for quick and easy references from ESI Dispensaries/Hospitals in and easy references from ESI Dispensaries/Hospitals in needy cases. Six hospitals have been identified to needy cases. Six hospitals have been identified to extend such facilities in West Bengal.extend such facilities in West Bengal.

Medical Specialists are empanelled on part time basis Medical Specialists are empanelled on part time basis for ESI Dispensaries/Hospitals.for ESI Dispensaries/Hospitals.

Created a special fund for AIDS Control Activities Created a special fund for AIDS Control Activities among beneficiariesamong beneficiaries

4545

LATEST IMPROVEMENTS IN E.S.I. SCHEMELATEST IMPROVEMENTS IN E.S.I. SCHEME

Employees in receipt of average daily wages upto Rs.70/- Employees in receipt of average daily wages upto Rs.70/- are exempted from payment of employees’ share of are exempted from payment of employees’ share of contribution.contribution.

Contributory condition for Sickness Benefit/Enhanced Contributory condition for Sickness Benefit/Enhanced Sickness Benefit/Maternity Benefit has been further Sickness Benefit/Maternity Benefit has been further liberalized.liberalized.

Enhanced Sickness Benefit is now admissible for 34 diseases Enhanced Sickness Benefit is now admissible for 34 diseases for a period upto 2 years.for a period upto 2 years.

All Permanent Disablement Benefit/Dependants’ Benefit All Permanent Disablement Benefit/Dependants’ Benefit rates have been substantially increased with reference to rates have been substantially increased with reference to price index upto 1998.price index upto 1998.

Rehabilitation allowance to the disabled insured persons for Rehabilitation allowance to the disabled insured persons for going to ‘Artificial Limb Centre’ for fixation or repair of going to ‘Artificial Limb Centre’ for fixation or repair of artificial limb has been doubled to the extent of one’s daily artificial limb has been doubled to the extent of one’s daily wages.wages.

4646

Branch Managers have now been empowered to Branch Managers have now been empowered to admit Employment Injury/Death cases to further cut admit Employment Injury/Death cases to further cut down delay.down delay.

New methodology of inspection has been introduced. New methodology of inspection has been introduced. Inspector shall not visit factory (except majors) if Inspector shall not visit factory (except majors) if employer is regular in payment.employer is regular in payment.

During the period of strike and suspension of work, During the period of strike and suspension of work, sickness benefit shall not be paid to insured persons.sickness benefit shall not be paid to insured persons.

Employers now submit return of contribution to the Employers now submit return of contribution to the Branch Office instead of to Regional Office.Branch Office instead of to Regional Office.

System of Photo Identity Card has since been System of Photo Identity Card has since been introduced for Insured Persons/Family members.introduced for Insured Persons/Family members.

4747

Enhancement of amount of Funeral Expenses from Enhancement of amount of Funeral Expenses from Rs.1,500/- to Rs.2,500/- w.e.f. 1.10.2000.Rs.1,500/- to Rs.2,500/- w.e.f. 1.10.2000.

A Committee for redressal of grievances on Medical Care A Committee for redressal of grievances on Medical Care has been formed under the Chairmanship of the Secretary has been formed under the Chairmanship of the Secretary to State Govts.to State Govts.

The widowed mother of the deceased insured person has The widowed mother of the deceased insured person has been brought under first category of dependants and she is been brought under first category of dependants and she is entitled to Dependant Benefit @ 2/5th of full rate w.e.f entitled to Dependant Benefit @ 2/5th of full rate w.e.f 1.10.2000.1.10.2000.

Retired insured persons, who have been in insurable Retired insured persons, who have been in insurable employment for at least 5 years before superannuation and employment for at least 5 years before superannuation and disabled insured persons are entitled for medical care for disabled insured persons are entitled for medical care for self and spouse only on payment of Rs.120/- as annual self and spouse only on payment of Rs.120/- as annual contribution.contribution.

Enhancement of Ceiling limit of benefit payment in Cash at Enhancement of Ceiling limit of benefit payment in Cash at Branch Office from Rs.1,000/- to Rs.2,000/- w.e.f. Branch Office from Rs.1,000/- to Rs.2,000/- w.e.f. 17.7.2001.17.7.2001.

4848

Fixed Conveyance allowance floating out of wage to Fixed Conveyance allowance floating out of wage to be treated as wages both for the purpose of coverage be treated as wages both for the purpose of coverage under Section 2(9) and for payment of contribution under Section 2(9) and for payment of contribution under Section 2(22) of ESI Act w.e.f. 1.4.2002.under Section 2(22) of ESI Act w.e.f. 1.4.2002.

The Corporation has taken a decision to develop one The Corporation has taken a decision to develop one of ESI Hospitals in the few States as Model Hospital, of ESI Hospitals in the few States as Model Hospital, which should become the ‘Bench Mark’.which should become the ‘Bench Mark’.

A Revolving Fund is created w.e.f. 1.4.2003 for A Revolving Fund is created w.e.f. 1.4.2003 for purchase of drugs and dressings to be kept with the purchase of drugs and dressings to be kept with the Regional Director by Hqrs. Office.Regional Director by Hqrs. Office.

Opening of Regional Offices at Jammu & Kashmir, Opening of Regional Offices at Jammu & Kashmir, Himachal Pradesh, Uttaranchal, Chattishgarh and Himachal Pradesh, Uttaranchal, Chattishgarh and Jarkhand.Jarkhand.

4949

Amendment to Regulation 76-B -- Enhancement of daily Amendment to Regulation 76-B -- Enhancement of daily benefit rate for Commutation from Rs.1.50 to Rs.5/- and benefit rate for Commutation from Rs.1.50 to Rs.5/- and the maximum commuted value of Rs.10,000/- to the maximum commuted value of Rs.10,000/- to Rs.30,000/-.Rs.30,000/-.

Increase in Medical Bonus to Insured Women and wives of Increase in Medical Bonus to Insured Women and wives of Insured Persons for confinement outside ESI institutions Insured Persons for confinement outside ESI institutions from existing Rs.250/- to Rs.1,000/-.from existing Rs.250/- to Rs.1,000/-.

Increase in ceiling limit on Medical Care by Rs.100/- Increase in ceiling limit on Medical Care by Rs.100/- making Rs.1000/- per Insured Person per unit as against making Rs.1000/- per Insured Person per unit as against Rs.900/-.Rs.900/-.

The Govt. of India has clarified that the Educational The Govt. of India has clarified that the Educational Institutions are covered under the definition of Industry Institutions are covered under the definition of Industry and accordingly the ESI Scheme has since been and accordingly the ESI Scheme has since been implemented to Educational Institutions.implemented to Educational Institutions.

5050

Separate Identity Cards for families of IPs, who reside Separate Identity Cards for families of IPs, who reside separately in other States will be issued so as to enable separately in other States will be issued so as to enable the families to avail the Medical Benefit.the families to avail the Medical Benefit.

Recognition of Private Nursing Home as Panel Clinics Recognition of Private Nursing Home as Panel Clinics for implementation of ESI Scheme in new centers.for implementation of ESI Scheme in new centers.

Employers/Employees’ Training/Awareness Programs in Employers/Employees’ Training/Awareness Programs in each implemented centre.each implemented centre.

5151

Releasing pocket size booklets for insured persons and Releasing pocket size booklets for insured persons and employers as out effort towards right of information to employers as out effort towards right of information to beneficiaries and employers covered under the ESI beneficiaries and employers covered under the ESI Scheme.Scheme.

Unemployment Allowance: Payment of unemployment Unemployment Allowance: Payment of unemployment allowance to IPs for six months at the Standard Benefit allowance to IPs for six months at the Standard Benefit Rate per day in case of retrenchment, loss of job due to Rate per day in case of retrenchment, loss of job due to look-out and non-employment injury.look-out and non-employment injury.

It is also proposed to extend the provisions of Act to It is also proposed to extend the provisions of Act to Medical Institutions run by Private/Corporate Bodies.Medical Institutions run by Private/Corporate Bodies.

RIGHT TO INFORMATION ACT, 2005 has been RIGHT TO INFORMATION ACT, 2005 has been adopted by the ESI Corporation, details of which adopted by the ESI Corporation, details of which are available in all the Regional Offices and are available in all the Regional Offices and Branch Offices throughout the country.Branch Offices throughout the country.

5252

UNIQUENESS OF E.S.I. SCHEMEUNIQUENESS OF E.S.I. SCHEME

1. It covers all types of employees – permanent, temporary, casual, whether employed directly by the principal employer or through contractors in covered factory/establishment.

2. It covers from day 1 of his employment, irrespective of whether he/she has paid contribution which enables receipt of medical benefit (including for family members), disablement benefit and dependent benefit.

5353


3. Single contribution but multiple benefits – Medical care (including for family members), sickness benefit arising out of loss of wage due to abstention from work in the form of cash benefit, conveyance expenses for ambulatory services or for attending medical boards, disablement benefit arising out of injuries/accident while working – temporary and permanent, dependent benefit, various other benefits in cash/kind like maternity benefit, funeral expenses, vocational training for permanently disabled cases requiring change of job and latest benefit introduced w.e.f. 01/04/05, i.e. Unemployment Benefit.

5454


4. Scale of Medical Care – both outdoor and indoor treatment, all kinds of investigation and pathological tests, supply of medicines and super speciality treatment in tie-up hospitals like AIIMS, Shankar Netralaya, (Chennai), Apollo, Peerless Hospital, extended sickness benefit for long term diseases.

5. No pre-medical examination for registration as a beneficiary under the scheme.

6. Medical care for retired/permanent disabled IPs who have rendered at least 5 years of insurable employment.

7. Occupational disease related treatment and cash compensation with Corporation presently having 5 occupational disease centres at Pune, Delhi, Kolkata, Chennai and Nagda (Madhya Pradesh).

5555


8. Medical treatment and cash benefit for loss of wage during sickness/disablement are available simultaneously to the Insured Person/Insured Women.

All the above benefits vis-a-vis contribution paid/payable by the employee covered under the Act is based on the principle “pay as per capacity, take benefit as per requirement.”

5656

PERFORMANCE INDICATORSPERFORMANCE INDICATORS

PHYSICAL PERFORMANCE2004-05

2005-06 2006-07No. of outdoor treatment: 1,17,130

1,25,253 1,50,304No. of impatient treatment: 24,174

26,177 31,412No. of specialist treatment: 19,500

21,553 25,863No. of super speciality treatment: 1,943

3,472 6,344No. of permanent disable benefit 26,463 27,279

26,399Eligible for paymentNo. of dependent benefit cases 4,251 4,461

6,321Eligible for paymentOccupancy rates in hospitals: …….…....40-80%

……....…

5757


FINANCIAL PERFORMANCE 2004-052005-06 2006-

07Revenue income (In crores) 161.56 158.66 171.14Revenue recovery (In crores) 26.00 23.02 40.14Medical benefit expenditure 5695.87 5060.72

3534.40Cash benefit expenditure 6212.65 4564.58

3128.49Administrative expenditure 2197.67 2452.85

2419.91Repair & maintenance 542.62 721.51

81.40expenditureDetails of cash benefit expenditure: Sickness benefit 3311.34 2211.63

1143.48 Temporary disablement 1016.00 801.14

463.17benefit

5858


2004-05 2005-062006-07

Permanent disablement 1266.55 903.53 799.95Benefit:

Maternity Benefit: 13.76 12.96 11.46

Dependent Benefit: 326.65 319.97 241.65

Super Speciality Treatment 183.61 344.11 1300.84

Expenditure:Per capita expenditure:

I. On medical care: 873.46 1030.97 626.40II. On cash benefits: 952.76 1010.89 663.71III. Cost per bed per day: Ranges from Rs.340/- to Rs.765/-

5959

HOW WE DELIVER OUR SERVICESHOW WE DELIVER OUR SERVICES

ESIC INFRASTRUCTURE

No. of Regional Offices:

1No. of Sub-Regional Offices:

1No. of Branch Offices:

67No. of Inspection Offices:

26No. of Model Hospitals:

1No. of Occupational Disease Centres:

1

6060


MEDICAL INFRASTRUCTURE

No. of Service Dispensaries

38No. of IMP Clinics

1052No. of Hospitals

14No. of Annex

1No. of beds

3777No. of Diagnostic Centres

2No. of Insurance Medical Officers

363No. of Insurance Medical Practitioner

1052No. of Specialists

128No. of nursing staff

840No. of para-medical staff

484No. of specialist centres

428No. of nursing training centres

1No. of blood banks

1No. of medical referees

13

6161


WHO ARE OUR STAKE HOLDERS OF THE SCHEME

No. of Implemented centres: 14No. of employees covered: 6,16,043 No. of Insured Person covered:6,86,523No. of total beneficiaries: 26.08 lakhs

6262

1. Get your factory/establishment registered within 15 days after the Act becomes applicable. Submit 'Form 01' to the Regional Office for this purpose. Obtain Employer's Code No. for use in all ESIC Forms/documents and correspondence with the offices of the ESI Corporation.

2. Fill up Declaration Forms in respect of all coverable employees and submit the same to the Regional Office/Branch Office of the Corporation well before the 'Appointed Day' and obtain Insurance Numbers from the concerned Branch/Regional Office. In respect of newly appointed employees, fill up the Declaration Form soon after appointment of such employees and submit the same to the Branch Office concerned.

OBLIGATIONS OF THE EMPLOYERS-IOBLIGATIONS OF THE EMPLOYERS-I

6363

OBLIGATIONS OF THE EMPLOYERS-IIOBLIGATIONS OF THE EMPLOYERS-II

3.3. Pending receipt of identity cards/identity Pending receipt of identity cards/identity certificates you may issue 'Certificate of certificates you may issue 'Certificate of Employment' in Form 86 to the covered Employment' in Form 86 to the covered employee(s) enabling them to avail employee(s) enabling them to avail cash/medical benefits. cash/medical benefits.

4.4. Pay ESI contributions (Employers' share @ Pay ESI contributions (Employers' share @ 4.75% of the wages and the employees' share 4.75% of the wages and the employees' share @ 1.75% of the wages) within 21 days of the @ 1.75% of the wages) within 21 days of the month following, in which the wages fall due.month following, in which the wages fall due.

6464

5. Maintain an 'Accident Book' as prescribed under the Factory Act/ESI Act.

6. Submit an "Accident Report" to the Branch Office/.ESI Dispensary concerned immediately in respect of accidents that could result in death or disablement and within 24 hours of its occurrence otherwise. Minor accidents, which do not cause absence from work, need not be reported.

7. Grant leave to insured employees on the basis of sickness certificates issued by any authorized ESI doctor.

OBLIGATIONS OF THE EMPLOYERS-IIIOBLIGATIONS OF THE EMPLOYERS-III

6565

8. Maintain the following records/registers properly for purpose of inspection:-i) Attendance register in respect of all the employees including employees engaged through immediate employer/ contractor;ii) Wage register;iii) Register under Regulation-32;iv) Accident Book;v) Cash Book/.Books of Account, Ledgers, Petty Cash Book including bills and vouchers;vi) Other relevant records to show the labour charges paid to the labour engaged in construction, repair & maintenance etc.;vii) Inspection Book;

OBLIGATIONS OF THE EMPLOYERS-IVOBLIGATIONS OF THE EMPLOYERS-IV

6666

OBLIGATIONS OF THE EMPLOYERS-VOBLIGATIONS OF THE EMPLOYERS-V

9. Submit return of contribution within 42 days of the expiry

10. Furnish any requisite information promptly

11. Facilitate proper inspection of factory/establishment by any authorized Officer of the Corporation and produce before him all relevant records on demand.

12. Intimate the date of closure or shifting (temporary or permanent) of the factory/establishment to the Regional Office/Branch Office within 7 days of its closure or shifting.

6767

OBLIGATIONS OF THE EMPLOYERS-VIOBLIGATIONS OF THE EMPLOYERS-VI

13. Promptly report any change in the business activity, ownership of the concern or its management.

14. Ascertain the liability towards ESI dues, while taking over the ownership of any factory/establishment by purchase, gift, lease or license or in any other manner whatsoever, as new owner is liable to discharge the past liabilities, if any.

15. Maintain proper sanitation for a hygienic and healthy environment within the workplace and in residential quarters, if allotted to the insured persons.

6868

WHAT TO DO WHENWHAT TO DO WHEN

- Tips for Employers -- Tips for Employers -

To ensure smooth flow of ESI Benefits to Insured Employees:To ensure smooth flow of ESI Benefits to Insured Employees:

1.1. Declaration Forms in Form-I to be filled in properly Declaration Forms in Form-I to be filled in properly for registration of employees. The Form should for registration of employees. The Form should contain all relevant information asked for in respect contain all relevant information asked for in respect of each coverable employee and submitted to the of each coverable employee and submitted to the Local Office concerned within ten days of entry into Local Office concerned within ten days of entry into insurable employment. Before filling Declaration insurable employment. Before filling Declaration Form it should be ensured that the worker was not Form it should be ensured that the worker was not insured under the ESI Scheme in the past. If so, insured under the ESI Scheme in the past. If so, the old Insurance No. should be indicated in the the old Insurance No. should be indicated in the Form. (Name of IMP/Service Dispensary to be filled Form. (Name of IMP/Service Dispensary to be filled up to ensure medical treatment)up to ensure medical treatment)

6969


2.2. All fresh entrants into the insurable All fresh entrants into the insurable employment should be advised to furnish two employment should be advised to furnish two post card size family photographs (of IP and post card size family photographs (of IP and dependants only) with the Declaration Form to dependants only) with the Declaration Form to the appropriate Local Office.the appropriate Local Office.

3.3. Temporary Identification Certificate annexed to Temporary Identification Certificate annexed to the Declaration Form may be obtained from the the Declaration Form may be obtained from the Local Office Manager with his seal and signature Local Office Manager with his seal and signature and issued to the insured employee forthwith.and issued to the insured employee forthwith.

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4.4. On receipt of Permanent Identity Cards from the On receipt of Permanent Identity Cards from the Local Office, the same should be passed on to Local Office, the same should be passed on to the insured employees without delay.the insured employees without delay.

5.5. In order to facilitate a newly insured person to In order to facilitate a newly insured person to avail medical benefit under the Scheme in avail medical benefit under the Scheme in absence of an identity certificate/identity card, absence of an identity certificate/identity card, a ‘Certificate of Employment’ may be issued to a ‘Certificate of Employment’ may be issued to the insured person in Form 86. This certificate, the insured person in Form 86. This certificate, issued by the employer, remains valid for three issued by the employer, remains valid for three months bur can be revalidated for a further months bur can be revalidated for a further period not exceeding 3 months.period not exceeding 3 months.

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6.6. Whenever events, such as, marriage, birth or death Whenever events, such as, marriage, birth or death entails any additions or deletions in the family entails any additions or deletions in the family particulars of an insured person, the requisite particulars of an insured person, the requisite information has to be conveyed by the employer in information has to be conveyed by the employer in ‘Form 1-B’ to the Local Office within 15 days from ‘Form 1-B’ to the Local Office within 15 days from the occurrence of such a change.the occurrence of such a change.

7.7. On re-entry of a person into insurable employment On re-entry of a person into insurable employment or, where an insured person had been disentitled to or, where an insured person had been disentitled to medial benefit due to non-submission of Return of medial benefit due to non-submission of Return of Contribution, the employer may issue a ‘Certificate Contribution, the employer may issue a ‘Certificate of re-employment’ or ‘continuing employment’ to of re-employment’ or ‘continuing employment’ to such person in Form ESIC-37. This certificate will such person in Form ESIC-37. This certificate will enable the Insured Person to avail medical benefit enable the Insured Person to avail medical benefit from the date of issuance.from the date of issuance.

8.8. If an insured employee needs a change of If an insured employee needs a change of dispensary due to any valid reasons an application dispensary due to any valid reasons an application may be made in Form ESIC-53.may be made in Form ESIC-53.

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9.9. Accident Report in respect of an insured employee Accident Report in respect of an insured employee may be submitted immediately in case of death or may be submitted immediately in case of death or serious injury and in other chases within 24 hours of serious injury and in other chases within 24 hours of an accident. For this Form 16-B filled up in triplicate an accident. For this Form 16-B filled up in triplicate and one copy each forwarded to the Branch Office and and one copy each forwarded to the Branch Office and Dispensary. Form 32 may also be submitted alongwith Dispensary. Form 32 may also be submitted alongwith the Accident Report, in case an accident has occurred the Accident Report, in case an accident has occurred prior to the commencement of the first Benefit Period prior to the commencement of the first Benefit Period of the IP to enable the Branch Office determine the of the IP to enable the Branch Office determine the rate of Disablement Benefit.rate of Disablement Benefit.

10.10. Whenever an Insured Person goes out of station on Whenever an Insured Person goes out of station on duty or leave, he may be issued a Certificate in Form duty or leave, he may be issued a Certificate in Form ESIC 105. This will enable him and his family to avail ESIC 105. This will enable him and his family to avail Medical Treatment in ESI Dispensaries/Hospitals Medical Treatment in ESI Dispensaries/Hospitals elsewhere, if available at such outstation.elsewhere, if available at such outstation.

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11.11. If any Insured Person is in need of a duplicate If any Insured Person is in need of a duplicate identity card, an application may be made to identity card, an application may be made to the Branch Office Manager in Form ESIC 72.the Branch Office Manager in Form ESIC 72.

12.12. Return of Contribution may be submitted in Return of Contribution may be submitted in time with al relevant particulars neatly filled up time with al relevant particulars neatly filled up against all Insured Persons with Insurance Nos. against all Insured Persons with Insurance Nos. in ascending order. Remember, any in ascending order. Remember, any inadvertent deletion may debar an Insured inadvertent deletion may debar an Insured Person from availing benefit due to him/her.Person from availing benefit due to him/her.

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13.13. Employers may assist or guide individual Employers may assist or guide individual employees, for claiming any lawful benefit under employees, for claiming any lawful benefit under the Scheme, and also educate them properly the Scheme, and also educate them properly about their rights and responsibilities under the about their rights and responsibilities under the ESI Scheme. The usefulness of the Scheme in the ESI Scheme. The usefulness of the Scheme in the face of an untoward event resulting in loss of face of an untoward event resulting in loss of wages or earning capacity could be explained to wages or earning capacity could be explained to the employees.the employees.

14.14. For clarification of any doubt vis-a-vis your rights For clarification of any doubt vis-a-vis your rights and responsibilities under the ESI Act, it is and responsibilities under the ESI Act, it is advisable to get in touch with the responsible ESIC advisable to get in touch with the responsible ESIC Official rather than depend for advice on self Official rather than depend for advice on self proclaimed consultants or any other unauthorized proclaimed consultants or any other unauthorized persons.persons.

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ADVANTAGES TO EMPLOYERSADVANTAGES TO EMPLOYERS

Employers who come under the purview of the ESI Act Employers who come under the purview of the ESI Act 1948, derive the following benefits from the Scheme:1948, derive the following benefits from the Scheme:

1.1. Employers are absolved of all their liabilities of Employers are absolved of all their liabilities of providing medical facilities to employees and their providing medical facilities to employees and their dependants in kind or in the form of fixed cash dependants in kind or in the form of fixed cash allowance, reimbursement of actual expenses, lump allowance, reimbursement of actual expenses, lump sum grant or opting for any other medical insurance sum grant or opting for any other medical insurance policy of limited scope unless it is a contractual policy of limited scope unless it is a contractual obligation of the employer.obligation of the employer.

2.2. Employers are exempted from the applicability of the:Employers are exempted from the applicability of the:a)a) Maternity Benefit Act,Maternity Benefit Act,b)b) Workmens’ Compensation Act in respect of Workmens’ Compensation Act in respect of

employees covered under the ESI Schemeemployees covered under the ESI Scheme

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ADVANTAGES TO EMPLOYERSADVANTAGES TO EMPLOYERS

3.3. Employers have, at their disposal, a productive well Employers have, at their disposal, a productive well secured workforce an essential ingredient for better secured workforce an essential ingredient for better productivity.productivity.

4.4. Employers are absolved of any responsibility in Employers are absolved of any responsibility in times of physical distress of workers such as times of physical distress of workers such as sickness, employment injury or physical disablement sickness, employment injury or physical disablement resulting in loss of wages, as the responsibility of resulting in loss of wages, as the responsibility of paying cash benefits shifts to the Corporation in paying cash benefits shifts to the Corporation in respect of Insured Employees.respect of Insured Employees.

5.5. Any sum paid by way of contribution under the ESI Any sum paid by way of contribution under the ESI Act is deducted in computing ‘income’ under the Act is deducted in computing ‘income’ under the Income Tax Act.Income Tax Act.

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FUNCTIONING OF FUNCTIONING OF GRIEVANCE REDRESSAL MACHINERYGRIEVANCE REDRESSAL MACHINERY

The Govt. of India, Cabinet Secretariat has vide Notification No.A.11013/1/88-Ad.-I dated 2.6.1998, extended the jurisdiction of Directorate of Public Grievances to ESI Hospitals and Dispensaries directly managed by the ESI Corporation under the Ministry of Labour.

Accordingly, the ESI Corporation has set up the Public Grievances Redressal System at Corporate/Head Office as well as Regional Offices, ESI Hospitals and Dispensaries levels. To ensure expeditious disposal of complaints and grievances under ESI Scheme, various measures have been taken up by the Corporation.

7878

Further in each Regional Office, Branch Office, ESI Hospital and Dispensary, a designated Grievance Officer has been nominated to ensure prompt and effective Redressal of grievances.

Detailed guidelines have also been issued by the Hqrs. Office vide Memo. No.Z-14/11/4/98-Ins.I dated 8.5.1998 to all concerned to look into the public grievances of the beneficiaries and settle them within the stipulated time frame.


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A Public Grievance Cell has been set up in ESIC, A Public Grievance Cell has been set up in ESIC, Head office which is headed by a Senior Officer of Head office which is headed by a Senior Officer of the level of Additional Commissioner who has the level of Additional Commissioner who has been designated as Director (Public Grievances).been designated as Director (Public Grievances).

This Cell monitors the grievance Redressal This Cell monitors the grievance Redressal machinery in the entire ESI set-up comprising 22 machinery in the entire ESI set-up comprising 22 Regional Offices, Sub Regional Offices, Branch Regional Offices, Sub Regional Offices, Branch Offices, ESI Hospitals and ESI Dispensaries Offices, ESI Hospitals and ESI Dispensaries directly managed by the ESI Corporation.directly managed by the ESI Corporation.

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HOW DEFAULTERS ARE DEALT WITHHOW DEFAULTERS ARE DEALT WITH(Under Section 85)(Under Section 85)

Punishment for failure to pay contributionsPunishment for failure to pay contributions

Fails to pay contribution due:

a) Not less than one year imprisonment in case of failure to pay the employees’ contribution deducted from employees’ wages and/or fine of Rs.10,000/-.

b) Not less than six months imprisonment, in any other case and/or fine of Rs.5,000/-

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A.A. Deducts employer’s contribution Deducts employer’s contribution from the employees’ wagesfrom the employees’ wages

B.B. Reduces the wages or benefits Reduces the wages or benefits admissible to an employee.admissible to an employee.

C.C. Dismisses, discharges, reduces Dismisses, discharges, reduces or otherwise punishes an or otherwise punishes an employee while under treatmentemployee while under treatment

D.D. Fails or refuses to submit returns Fails or refuses to submit returns or makes a false return.or makes a false return.

E.E. Obstructs any Inspector or other Obstructs any Inspector or other official in the discharge of his official in the discharge of his duties.duties.

F.F. Any other contravention of or Any other contravention of or non-compliance in respect of non-compliance in respect of which no special penalty is which no special penalty is provided.provided.

Commits offenceunder Section 85(b) to (g) withimprisonment for a term whichmay extend to oneyear or with finewhich may extend toRs.4,000/- or both.

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SECTION 85-ASECTION 85-A

Enhanced Enhanced punishment in punishment in certain cases certain cases after previous after previous conviction by conviction by Court:Court:

A. Punishment with imprisonment for a term which may extend to 2 years and with fine of Rs.5,000/-.

B. If subsequent offence is for failure to pay contribution which under the Act is liable to pay for every such subsequent offence, be punishable with imprisonment for a term which may extend to 5 years but which shall not be less than 2 years and also liable to fine of Rs.25,000/-.

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PROVISION FOR ADJUDICATION PROVISION FOR ADJUDICATION OF DISPUTES (SECTION 75)OF DISPUTES (SECTION 75)

The employers and employees have The employers and employees have

a forum in the form of E.I. Court to a forum in the form of E.I. Court to

get redressal for any of their disputes get redressal for any of their disputes

or grievances subject to the condition or grievances subject to the condition

that a deposit of 50% dues is made that a deposit of 50% dues is made

(unless waived for reasons at the (unless waived for reasons at the

discretion of the Hon’ble Court.)discretion of the Hon’ble Court.)

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ACTION UNDER SECTION 138 OF N.I. ACTACTION UNDER SECTION 138 OF N.I. ACT

Bouncing of cheques for reasons of insufficiency of funds etc.:Bouncing of cheques for reasons of insufficiency of funds etc.:

Imprisonment upto one year or with fine which may Imprisonment upto one year or with fine which may extend to twice the amount of cheque or with both.extend to twice the amount of cheque or with both.

ACTION UNDER SECTION 405/406/409 OF I.P.C.

Criminal Breach of Trust:

For non-payment of employees’ contribution which is deducted from the wages of the employees but not paid.Punishment :- Imprisonment which may extend to 3 years or with fine or both.

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REVENUE RECOVERY ACTIONREVENUE RECOVERY ACTION

The entire Recovery procedure is based on the The entire Recovery procedure is based on the provisions of the 2nd and 3rd Schedule to the provisions of the 2nd and 3rd Schedule to the Income Tax Act, 1961 (43 of 1961) and the Income Income Tax Act, 1961 (43 of 1961) and the Income Tax (Certificate Proceedings) Rules, 1962. Tax (Certificate Proceedings) Rules, 1962.

SECTION 45-CSECTION 45-C : :

1. 1. Attachment and sale of the movable/immovable Attachment and sale of the movable/immovable property of the employer (attachment of Bank property of the employer (attachment of Bank Account is included).Account is included).

2. 2. Arrest of the employer and his civil detention in Arrest of the employer and his civil detention in prison.prison.

3.3. Appointing a Receiver for the management of the Appointing a Receiver for the management of the movable/immovable properties of the employer.movable/immovable properties of the employer.

SECTION 45-GSECTION 45-G : Issue of Garnishee Orders : Issue of Garnishee Orders

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USER FRIENDLY MEASURES-IUSER FRIENDLY MEASURES-I

The Corporation is maintaining utmost friendly relations with The Corporation is maintaining utmost friendly relations with their beneficiaries. The age-old lengthy and complicated their beneficiaries. The age-old lengthy and complicated procedures have been modified to the maximum extent. procedures have been modified to the maximum extent.

Under new methodology of inspection policy, there will not be Under new methodology of inspection policy, there will not be any inspection (except major employers) if the compliance any inspection (except major employers) if the compliance under the provisions of the Act is made within the time limit. under the provisions of the Act is made within the time limit. This is like self-assessment. This is like self-assessment.

Maintenance of minimum records. A single register prescribed Maintenance of minimum records. A single register prescribed under Regulation 32 called Form-7 is sufficient for making under Regulation 32 called Form-7 is sufficient for making payment of monthly challan and submission of half-yearly payment of monthly challan and submission of half-yearly returns.returns.

Photo Identity Card for every Insured Person has been Photo Identity Card for every Insured Person has been introduced for easy access to avail medical as well as cash introduced for easy access to avail medical as well as cash benefits both at dispensary and branch office.benefits both at dispensary and branch office.

8787

Now the submission of return of contribution (RC) in Form-6 has been de-centralized. Now they can be submitted to branch office concerned, which is located nearer to the factory/establishment.

Preparation of Live List for availing the benefits has been de-centralized. Now the Branch Offices concerned are preparing the Live Lists which enabling the Insured Persons for speedy drawal of the benefits (to be extended). The Corporation has established its own Website http://esic.nic.in and www.esic.org.in, wherein all the relevant Information/forms to be used are placed, which can be downloaded easily. This will avoid the visit of employers to local office for getting forms and stationery.

USER FRIENDLY MEASURES-IIUSER FRIENDLY MEASURES-II

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USER FRIENDLY MEASURES-IIIUSER FRIENDLY MEASURES-III

Complaint/Grievance Redressal Machinery is functioning at Complaint/Grievance Redressal Machinery is functioning at each branch office/dispensary/hospital/regional office/DIMS each branch office/dispensary/hospital/regional office/DIMS office. The officers therein will be pleased to entertain the office. The officers therein will be pleased to entertain the complaints of any nature and help for their redressal. complaints of any nature and help for their redressal.

Improved services through infrastructure development in Improved services through infrastructure development in Branch Offices/dispensaries have been made. Proper Branch Offices/dispensaries have been made. Proper arrangements for sitting, drinking water and sanitation arrangements for sitting, drinking water and sanitation facilities are provided.facilities are provided.

Tie-up arrangements for providing super-speciality treatment.Tie-up arrangements for providing super-speciality treatment.

Model Hospital, Joka is being run by ESI Corporation.Model Hospital, Joka is being run by ESI Corporation.

Submission of DF’s has been decentralised for submission in Submission of DF’s has been decentralised for submission in Branch Offices by Employers.Branch Offices by Employers.

Right to Information Act has been adopted in all offices of Right to Information Act has been adopted in all offices of ESIC.ESIC.

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“A customer is the most important visitor on our premises. He is not dependent on us. We are dependent on him. he is not an interruption on our work. He is the purpose of it. He is not an outsider on our business. He is a part of it. We are not doing him a favour by serving him. he is doing us a favour by giving us an opportunity to do so” --

Mahatma Gandhi

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WE MARCH TOGETHER TO HAVE A SATISFIED MAN POWER BY PROVIDING:

Efficient

Services to

Insured Persons

- THANK YOU -

SHRI B.K. SAHUAdditional Commissioner and Regional Director

ESI CORPORATION: WEST BENGAL REGION

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