Hkkjr ljdkj] Government of India iapnhi Hkou] lh-vkbZ-th ekxZ] ubZ fnYyh&110 002

xq.koÙkk LOkkLF; ns[kHkky dk oknk ,oa

lkekftd lqj{kk dk vk'oklu
PROMISE OF QUALITY HEALTHCARE &
ASSURANCE OF SOCIAL SECURITY
Hkkjrh; dh deZPkkjh jkT; chek ;kstuk & ifjp; %
laln esa deZpkjh jkT; chek vf/kfu;e] 1948 dk iz[;kiu Lora= Hkkjr esa dkexkjksa ds fy, O;kid
lkekftd lqj{kk ij izFke izeq[k fo/kku FkkA bl vf/kfu;e esa vkdfLedrkvksa ;Fkk chekjh] ekr`Ro] jkstxkj
pksV ds dkj.k e`R;q ;k viaxrk ,oa O;olkf;d jksx dh fLFkfr esa laxfBr {ks= ds dkexkjksa dks lkekftd
lqj{kk iznku djus dh ifjdYiuk dh xbZ gSA *tksf[keksa vkSj lalk/kuksa dk ,d=hdj.k* ds fl)kUr ij
vk/kkfjr ;g vuks[kh] cgqeq[kh LOkkLF; chek ;kstuk] O;kIr lnL;ksa dks vFkkZr~ ykHkkfFkZ;ksa dks lEiw.kZ fpfdRlk
lqfo/kk;sa iznku dj mfpr O;ogkj dh xkjaVh nsrh gSA blds vfrfjDr] chekÑr O;fDr;ksa dks chekjh ;k
jkstxkj pksV ;k csjkstxkjh ls mRiUu 'kkjhfjd d"V ds le; etnwjh ;k vtZu {kerk esa gqbZ gkfu gksus ij
i;kZIr udn {kfriwfrZ iznku dh tkrh gSA
bZ,lvkbZ ;kstuk ds rgr fgrykHk %
bZ,lvkbZ ;kstuk ds rgr iznku fd, tkus okys eq[;
fgrykHk gSa %
• chekjh fgrykHk
• fu%'kDrrk fgrykHk
• vkfJrtu fgrykHk
• ekr`Ro fgrykHk
• fpfdRlk fgrykHk
mijksDr ds vykok ykHkkfFkZ;ksa dks fn, tkus okys vU; fgrykHk gSa izlwfr O;;] vaR;sf"V O;;]
O;kolkf;d iquokZl] 'kkjhfjd iquokZl] csjkstxkjh HkÙkk ¼jk-xk-J-d-;ks½ vkSj jk-xk-J-d-;ks ds
rgr dkS'ky mUu;u izf'k{k.kA
fpfdRlk fgrykHk & ,d ut+j esa %
bZ,lvkbZLkh esa O;kid fpfdRlk ns[kHkky vksihMh] fpfdRlk ifjp;kZ] bykt] nokvksa] fo'ks"k ijke'kZ] chfer
O;fDr;ksa ¼vkbZIkh½ dks vkSj muds ifjokj ds lnL;ksa dks vLirky esa HkrhZ djuk rFkk lqij Lisf'k;fyVh ds
mipkj] ;kstuk ds rgr fn, tkrs gSaA fpfdRlk fgrykHk chfer O;fDr;ksa ¼vkbZIkh½ vkSj muds ifjokj ds
lnL;ksa dks mlh fnu ls miyC/k gksrs gSa tc os chek ;ksX; jkstxkj esa izos'k djrs gSaA bl ;kstuk dh vuks[kh
fo'ks"krk ;g gS fd blesa bZ,lvkbZ ykHkkfFkZ;ksa dks t:jr ds vuqlkj fpfdRlk ns[kHkky iznku dh tkrh gSA
blesa oS;fDrd fpfdRlk ns[kHkky ij O;; dh dksbZ lhek ugha gSA blds vykok bZ,lvkbZ
fMLisalfj;ksa@vLirkyksa esa lsokfuo`Ùk vkSj LFkk;h :Ik ls fu%'kDr chfer O;fDr;ksa vkSj muds thou lkfFk;ksa
dk `120 ds ukeek= okf"kZd izhfe;e ij ns[kHkky iznku dh tkrh gSA
bZ,lvkbZ vf/kfu;e]1948 dh /kkjk 56 ¼1½ ds vuqlkj ^^dksbZ chfer O;fDr ;k ¼tgka mDr fpfdRlk
fgrykHk mlds ifjokj dks fn;k tk jgk gS½ mlds ifjokj dk lnL;] ftldh fLFkfr ds fy, fpfdRlk
mipkj ,oa ifjp;kZ dh vko';drk gS mls fpfdRlk fgrykHk ikus dh gdnkjh gksxh**
Employees’ State Insurance Scheme of India – An introduction :
The promulgation of Employees’ State Insurance Act by the Parliament in 1948
was the first major legislation on comprehensive Social Security for Workers in
Independent India. The Act envisages social protection of workers in the organized
sector in contingencies, such as sickness, maternity, death or disablement due
to employment injury and occupational disease. Based on the principle of “pooling
of risks and resources”, the unique, multidimensional health insurance Scheme
guarantees a fair deal to the covered members by providing full medical facilities to
the beneficiaries, besides, adequate cash compensation to insured persons for loss of
wages or earning capacity in times of physical distress arising out of sickness or
employment injury or unemployment.
Benefits under ESI Scheme :
The main benefits provided under ESI Scheme are:
• Sickness Benefit
• Disablement Benefit
• Dependants’ Benefit
• Maternity Benefit
• Medical Benefit
Besides the above, other benefits being provided to the beneficiaries are
Confinement Expenses, Funeral Expenses, Vocational Rehabilitation, Physical
Rehabiliation, Unemployment Allowance (RGSKY) and Skill Upgradation Training
under RGSKY.
Medical Benefits – An Overview :
In ESIC, comprehensive medical care ranging from OPD, medical attendance,
treatment, drugs, specialist consultation, hospitalization of insured persons (IPs) and
their family members to super-speciality treatment, are provided under the Scheme.
Medical Benefit is available to the Insured Person (IP) and his family members from the
day one enters the insurable employment. What makes this Scheme unique, is that,
medical care is provided to ESI Beneficiaries as per need. There is no ceiling on
expenditure on individual medical care. Besides this, Medical Care as available in ESI
Dispensaries/Hospitals is also provided to retired and permanently disabled insured
persons and their spouses on payment of a token annual premium of `120/-.
Section 56 (1) of ESI Act, 1948 provides, “an Insured Person or (where such
medical benefit is extended to his family) a member of his family whose
condition requires medical treatment and attendance shall be entitled to
receive medical benefit”.
fpfdRlk fgrykHk ds fy, ik=rk %
dksbZ chfer O;fDr ¼vkbZih½ vkSj mlds ifjokj ds lnL; bZ,lvkbZ ;kstuk ds rgr izkFkfed vkSj f}Rkh;d
fpfdRlk fgrykHk ds ik= mlh fnu cu tkrs gSa tc os chek ;ksX; jkstxkj esa izos'k djrs gSaA bZ,lvkbZ
vf/kfu;e]1948 dh /kkjk 56 ¼3½ ds vuqlkj ^^,d O;fDr dks ml vof/k ds nkSjku fpfdRlk fgrykHk ikus dh
gdnkjh gksxh] ftlds nkSjku mlds lca/k esa va'knku ns; gSa ;k og chekjh fgrykHk ;k ekr`Ro fgrykHk ikus
ds nkos gsrq vgZd gS ¼;k og mDr fu%'kDrrk fgrykHk ikrk gS] tSls fd mls fofu;eksa ds rgr fpfdRlk
fgrykHk ikus dh vi;kZirk ugha gS**½A
fpfdRlk fgrykHk dh vof/k vkSj Lrj %
,d chfer O;fDr@,d chfer O;fDr ds ifjokj ds lnL; bl ;kstuk ds rgr fpfdRlk mipkj dk rc
rd fgrykHk mBk ldrk gS tc rd chfer O;fDr chek ;ksX; jkstxkj esa dk;Zjr gSA chfer O;fDr vkSj
mlds ifjokj ds lnL;ksa ds fy, iwjh fpfdRlk ns[kHkky ¼vLirky esa HkrhZ djus lfgr lHkh lqfo/kk,a½ nh
tkrh gSaA
fpfdRlk fgrykHk dk forj.k %
bZ,lvkbZ vf/kfu;e]1948 ds micU/kksa ds vuqlkj jkT; ljdkjsa bZ,lvkbZ fMLisalfj;ksa ¼izkFkfed fpfdRlk
lsokvksa ds fy,½ vkSj bZ,lvkbZ vLirkyksa ¼f}rh;d fpfdRlk lsokvksa ds fy,½ ds usVodZ ds ek/;e ls
fpfdRlk fgrykHk iznku djus ds fy, ftEesnkj gSaA tcfd d-jk-ch- fuxe fnYyh vkSj uks,Mk {ks= esa izR;{k
fpfdRlk ns[kHkky iznku djrk gSA bu nks {ks=ksa ds vykok fuxe }kjk 34 bZ,lvkbZLkh vLirky izR;{k :Ik ls
pyk, tkrs gSa ftlesa izR;sd jkT; esa de ls de ,d bZ,lvkbZlh ekWMy vLirky 'kkfey gSaA ykHkkfFkZ;ksa dks
lHkh bZ,lvkbZ fpfdRlk iznk;xh laLFkkuksa esa vksihMh lsok,a] vkarfjd jksxh lsok,a] uSnkfud lqfo/kk,a] eq¶r
nok,a vkSj Mªsflax vkfn nh tkrh gSA
Eligibility for Medical Benefit :
An insured person (IP) and his/her family member become eligible for primary &
secondary medical benefit under the ESI Scheme from day one of entering insurable
employment. Section 56 (3) of ESI Act, 1948 provides, “A person shall be entitled to
medical benefit during any period for which contributions are payable in respect of
him or in which he is qualified to claim sickness benefit or maternity benefit (or is in
receipt of such disablement benefit as does not disentitle him to medical benefit under
the regulations)”.
Duration and Scale of Medical Benefit :
The insured person/family member of an insured person can avail the medical
treatment under this Scheme till the insured person is in insurable employment. Full
medical care (all facilities including hospitalization) for insured person and their
family members is provided.
Delivery of Medical Benefit :
As per the provisions of ESI Act, 1948, the State Governments are responsible for
providing the medical benefits through the network of ESI Dispensaries (for primary
medical services) and ESI Hospitals (for secondary medical services). However, the ESI
Corporation provides medical care directly, in Delhi and Noida area. Besides these
two area, the Corporation is also running 34 ESIC Hospitals directly which includes
ESIC Model Hospitals, at least one in each State. The beneficiaries are provided OPD
services, in-patient services, diagnostic facilities, free drugs and dressings etc. in all
ESI medical delivery institutions.
bZ,lvkbZLkh us nokvksa ds fy, viuh QkekZdksfi;k dk fodkl fd;k gSA lHkh nok,a vkSj Mªsflax ¼Vhdk vkSj
fljk lfgr½ ftUgsa QkekZdksfi;k ds vuqlkj vke rkSj ij vfuok;Z ekuk tkrk gS] budh vkiwfrZ lHkh jksfx;ksa
dks eq¶r nh tkrh gSA xaHkhj jksfx;ksa ds ekeys esa ifjogu ds vuq"kaxh O;;] Bgjus ds izHkkj] ifjpkjdksa ds fy,
;k=k O;; ¼;fn vko';d gks½ dk Hkqxrku bZ,lvkbZLkh }kjk fd;k tk jgk gSA
d-jk-ch- ;kstuk dh fpfdRlk volajpuk %
d-jk-ch- ;kstuk ds ikl Hkkjr esa ,d N= ds rys lcls cM+h fpfdRlk volajpuk gSA 150 bZ,lvkbZ
vLirkyksa] 1372@91 bZ,lvkbZ fMLisaljh@vkbZ,l,e bdkb;ksa] 1380 iSuy fDyfudksa vkSj 7340 vkbZ,evks
ds fo'kky usVodZ ds ek/;e ls fpfdRlk ns[kHkky iznku dh tkrh gSA bZ,lvkbZ ;kstuk ns'k esa fpfdRlk vkSj
iSjk esfMdy dkfeZdksa dh Hkh lcls cM+h fu;ksDrk gSA
ESIC has developed its own pharmacopeia for drugs. All drugs and dressing
(including vaccine & sera), which is considered necessary and generally in accordance
with pharmacopeia, are supplied to all patients free of charge. In the case of critical
patients, incidental expenditure on transport, stoppage charges at the centre,
traveling expenses for attendants (if required) are also being paid by ESIC.
Medical Infrastructure of ESI Scheme :
The ESI Scheme has the largest medical infrastructure under one umbrella, in India.
Medical Care is provided through its huge network of 150 ESI Hospitals, 1372/91 ESI
Dispensaries/ISM Units, 1380 Panel Clinics and 7340 IMOs. The ESI Scheme is also
the largest employer of Medical and Para-Medical personnel of the country.
vfr&fo'ks"kKrk mipkj %
chek ;ksX; fu;kstu esa jgus ij chekÑe O;fDr dks ¼Lo;a ds fy,½
vfr fo'ks"kKrk mipkj dh ik=rk 3 ekg ¼de ls de 39 fnu ds
fy, va'knku dk Hkqxrku fd;k x;k gks½ gS rFkk muds ifjokj ds
lnL;ksa ds fy, bl mipkj dh ik=rk 6 ekg ¼de ls de 78 fnu ds
fy, va'knku dk Hkqxrku fd;k x;k gks½ gSA ,slh r`rh;d ns[k&js[k
¼vfr&fo'ks"kKrk mipkj½ dqN d-jk-ch- vLirky ;k d-jk-ch-
LukrdksÙkj vk;qfoZKku ,oa vuqla/kku laLFkkuksa esa miyC/k laLFkkfud
vfr&fo'ks"kKrk lqfo/kkvksa ;k Vkb&vi izca/k ds ek/;e ls jSQjy
vk/kkj ij cM+h la[;k esa mUur ukfedkf;r (empanelled)
fpfdRlk laLFkkuksa ds tfj;s iznku dh tk jgh gSA vHkh iwjs Hkkjr esa
yxHkx 750 futh vLirky d-jk-ch- fuxe ds fy, Vkb&vi
vLirky ds :i esa ukfedkf;r gSaA
fpfdRlk ns[kHkky ij O;; %
d-jk-ch- fuxe }kjk fiNys o"kZ fpfdRlk ns[kHkky dh iznk;xh ij
` 268962-11 yk[k dh jkf'k O;; dh xbZ gSA bl O;; dks bZ,lvkbZ
fuxe vkSj jkT; ljdkj ds chp 7%1 ds vuqikr esa ckaVk x;k gSA
fpfdRlk ns[kHkky O;; dh izfriwfrZ jkT; ljdkj dks ,d lhek ds
vk/kkj ij dh tkrh gS] tks orZeku esa ` 1500 izfr vkbZih ;wfuV@izfr
o"kZ gSA
o`) vkSj LFkk;h fu%'kDr ykHkkfFkZ;ksa ds fy, fpfdRlk
fgrykHk %
fpfdRlk fgrykHk iqu% mu chfer O;fDr;ksa dks foLrkfjr fd, x, gSa
tks vk;q c<+us ds dkj.k lsokfuo`fÙk ls ;k LFkk;h fu%'kDrrk ¼jkstxkj
laca/kh pksV ls mRiUUk½ ls jkstxkj ls ckgj gks x, gSaA bUgsa dsoy
bZ,lvkbZ laLFkkuksa }kjk mDr chfer O;fDr;ksa vkSj muds thoulkFkh
dks ` 10 izfr ekg dh nj ij ,d o"kZ dh ,d eq'r jkf'k ds Hkqxrku
ij fpfdRlk ns[kHkky nh tkrh gSaA
Ñf=e vaxksa vkSj midj.kksa dh O;oLFkk %
Ñf=e vax] d`f=e narkoyh] p'ek] Jo.k lgk;d ;a=] dkfMZ;d
islesdj] pyus ds dSfyilZ] lftZdy cwV] jh<+ dh gM~Mh dk lgkjk]
lsjsczy dkWyj] baVjkvksdqyj ysal vkfn mu jksxh ykHkkfFkZ;ksa dks eq¶r
iznku fd, tkrs gSa ftUgsa bu midj.kksa dh vko';drk gksrh gSaA
Super-Speciality Treatment :
The eligibility for super-specialty treatment is 3 months
(with contribution paid for at least 39 days) of insurable
employment for insured person (for self) and 6 months
(with contribution paid for at least 78 days) of insurable
employment by Insured Person for their family
members. Such tertiary care (super-speciality treatment)
is provided through in-house super speciality facilities
available in some of ESI Hospitals or ESI-PGIMSRs or
through large no. of advanced empanelled medical
institutions on referral basis through tie-up
arrangements. About 750 private hospitals in all India
are now empanelled as tie-up Hospitals for ESIC.
Expenditure on Medical Care :
The ESI Corporation incurred about ` 268962.11
lakhs on the delivery of medical care in the last year.
The expenditure is shared between the ESI
Corporation and State Govt. in the ratio of 7:1.
Medical Care expenditure is reimbursed to State Govt.
based on ceiling which at present is ` 1500/- per IP
unit/per annum.
Medical Benefit for Old Age and for
Permanent Disabled Beneficiaries :
The Medical Benefit has further been extended to the
insured persons who go out of employment on
account of attaining the age of superannuation (Old
Age) or on account of permanent disability (arising out
of employment injury). The Medical care is provided
in ESI institutions only, to such insured persons and
their spouse on payment of a lump sum amount for
one year at the rate of ` 10/- per month.
Provision of Artificial Limbs and Appliances :
Artificial limbs, artificial dentures, spectacles, hearing
aids, cardiac pacemaker, walking caliper, surgical
boots, spinal support, cerebral collar, intraoccular
lens etc. are provided free of cost to those patient
beneficiaries, who requires such appliances.
O;kolkf;d jksx dsUnz %
ubZ fnYyh] psUubZ] dksydkrk] eqEcbZ vkSj bankSj esa d-jk-ch- fuxe }kjk ikap tksuy O;kolkf;d jksx dsUnz
cuk, x, gSa tks O;kolkf;d jksxksa dk tYnh irk yxkus vkSj funku dh lqfo/kk,a nsrs gSa rFkk laacaf/kr {ks=ksa ds
vkl ikl ds jkT;ksa ds bZ,lvkbZ ykHkkfFkZ;ksa dh t:jrsa iwjh djrs gSaA bZ,lvkbZ vf/kfu;e] 1948 dh rhljh
vuqlwph esa O;kolkf;d jksxksa dks ifjHkkf"kr fd;k x;k gS vkSj bUgsa fu%'kDrrk fgrykHk] vkfJrtu fgrykHk
vkfn tSLks udn fgrykHk iznku djus ds fy, jkstxkj laca/kh pksV ds led{k ekuk tkrk gSA
ifjokj dY;k.k lsok,a vkSj ,M~l fu;a=.k %
lHkh bZ,lvkbZ vLirky@fMLisalfj;ka ifjokj dY;k.k ls lacaf/kr lsok,a iznku djrs gSaA fuxe }kjk ns'k ds
dkedkth oxZ ds chp ,M~l ds fu;a=.k ds mik; Hkh fd, x, gSaA ,d iw.kZ lfTtr funs'kky;] [kkl rkSj ij
ifjokj dY;k.k lsokvksa vkSj ,M~l fu;a=.k ds fy, ubZ fnYyh esa dk;Zjr gSA ;g funs'kky; ukdks (NACO)
vkSj LOkkLF; ,oa ifjokj dY;k.k ea=ky;] Hkkjr ljdkj ds leUo; ls dk;Z djrk gSA
Hkkjrh; fpfdRlk i)fr ¼vkbZ,l,e½ %
fpfdRlk dh ,yksiSfFkd i)fr ds lkFk d-jk-ch- fuxe }kjk Hkkjrh; fpfdRlk i)fr ¼vkbZ,l,e½ ds
vUrxZr vk;qosZn] ;ksx] ;wukuh] fl) vkSj gksfe;ksiSFkh ¼vk;q"k½ dh fpfdRlk ns[kHkky Hkh iznku dh tkrh gSA
bZ,lvkbZ vLirkyksa@fMLisalfj;ksa esa iwjs ns'k esa yxHkx 95 vkbZ,l,e bdkb;ka dk;Zjr gSaA
v{kerk lanHkZu %
fu%'kDrrk fgrykHk ¼udn esa½ iznku djus ds iz;kstu ls v{kerk ekiu dss lanHkZ fn, tkrs gSaA mDr v{kerk
ekiu lanHkksZa dks vafre :Ik nsus ds fy, iwjs ns'k esa yxHkx 70 fpfdRlk funsZf'k;ksa dk usVodZ gSA
deZpkjh jkT; chek fuxe esa fpfdRlk f'k{kk %
fuxe us i;kZIr fpfdRlk@iSjkesfMdy dkfeZdksa dh miyC/krk lqfuf'pr djus] bZ,lvkbZ ykHkkfFkZ;ksa dks
LokLF; ns[kHkky iznku djus ds fy, vkSj fpfdRlk lqfo/kkvksa@Kku esa lq/kkj ykus ds fy, fpfdRLkk
f'k{kk esa dne j[kk gSA orZeku esa 06 LukrdksÙkj vk;qfoZKku vkSj vuqla/kku laLFkku ¼cSaxyksj] psUubZ]
dksydkrk] eqEcbZ vkSj fnYyh½ ,oa ,d nar egkfo|ky; ¼fnYyh½ vkSj ,d fpfdRlk egkfo|ky; ¼cSaxyksj½
vkjaHk gks pqds gSaA
Occupational Diseases Centre :
The ESI Corporation has set up five zonal occupational Diseases Centre at New Delhi,
Chennai, Kolkata, Mumbai and Indore for providing facilities for early detection and
diagnosis of Occupational Diseases, and to cater to the needs of ESI Beneficiaries of
the neighbouring State in the respective zones. The occupational diseases as defined
in the third schedule of ESI Act, 1948 are considered to be arising out of/in the course
of employment and are taken as equivalent to employment injury for providing Cash
Benefits like Disablement Benefit, Dependants Benefit etc.
Family Welfare Services and AIDS Control :
All ESI Hospitals/Dispensaries provide services related to family welfare. The
Corporation has also taken measures for control of AIDS among the working
class of the country. A full fledged Directorate is working specially for family welfare
services and AIDS Control at New Delhi. This Directorate works in co-ordination with
NACO and also with Ministry of Health & Family Welfare, Govt. of India.
Indian System of Medicine (ISM) :
Alongwith the Allopathic system of medicine, the ESI Corporation is also providing
medical care through Indian System of Medicine (ISM) including Ayurveda, Yoga,
Unani, Siddha and Homeopathy (AYUSH). About 95 ISM units are working in ESI
Hospitals/Dispensaries throughout the country.
In - Capacity References :
For the purpose of providing of Disablement Benefit (in cash), references are made for
measuring incapacity. There is a network of about 70 Medical Refrees throughout the
country for finalizing such incapacity references.
Medical Education in ESIC :
ESIC has ventured into medical education to ensure availability of sufficient
Medical/Para-medical personnel and to improve the medical facilities/knowledge for
providing health care to the ESI Beneficiaries. Presently, 06 Post-graduate Institutes of
Medical Sciences and Research (Bangalore, Chennai, Kolkata, Mumbai and Delhi),
One Dental College (Delhi) and one Medical College (Bangalore) are already running.