EMPLOYEES’ STATE

INSURANCE CORPORATION
HOSPITALS

(ESIC ACT)

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 ACKNOWLEDGEMENT

I would like to take this opportunity to thank

University Of Mumbai for having projects as a part of the
B.M.S.
Many people have influenced the shape and content
of project and many supported me through it. My
successful completion of this project involved more than
just my desire to learn the value of completing the
project.
I would personally like to thank and express my
sincere gratitude to Mr. Anand Deshpane for assigning
me a project on ESIC ACT which is interesting and
exhaustive subject. Without their help the project
seemed difficult to complete.

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 Certificate
I Mr. Anand Deshpande hereby certify that students studying
in Class: F.Y.B.M.S. Div: B
Roll no. Name Signature
128 Nabeel Juwle
127 Ahmed Patel
126 Salmam Sheikh
125 Aditya Pawaskar
124 Khan Yethesham
123 Naseer Choudhry
122 Idrisi Mohd Aquib
121 Arbaz Sheikh
Academic year 2010-2011 at Rizvi College of Arts, Science &
Commerce has completed project entitled EMPLOYEES’ STATE
INSURANCE CORPORATION HOSPITALS under our guidance.

Signature: Signature:
(Project co-coordinator) (BMS co-coordinator)

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 Declaration
We are the students of class: F.Y.B.M.S. Div: B
Roll no. Name Signature
128 Nabeel Juwle
127 Ahmed Patel
126 Salmam Sheikh
125 Aditya Pawaskar
124 Yethesham Khan
123 Naseer Choudhry
122 Idrisi Mohd Aquib
121 Arbaz Sheikh
Academic year 2010-2011 studying at Rizvi College of Arts,
Science & Commerce

Hereby declare that the work done on the project entitled

EMPLOYEES’ STATE INSURANCE CORPORATION is true and original
and any reference used in the project is duly acknowledged.

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 Index
Sr.no Contents

1. Introduction.

2. ESIC Act.

3. Medical Benefit.

4. Treatment to family members of insured

person.
5. Treatment at outstations.

6. Treatment to retired and disabled

persons.

7. Sickness Benefit.

8. Disablement Benefit.

9. Maternity Benefit.

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10. Dependants Benefit:

11. Funeral Expenses:

12. Rehabilitation Allowance:

13. ESI Branch Offices In Mumbai Region

(Maharashtra)

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Introduction:
The ESI Corporation was founded on 24th February, 1952.

The ESI scheme is administered by an autonomous body constitute by the central

government, called as ESI Corporation. The ESI scheme is administered by the
ESI Corporation, which consists of representatives of:

a) Employers
b) Employees
c) Parliament
d) Central Government
e) State Government
f) Medical Profession

With effect from such date as a central government may, by notification in the
official gazette, notify in this behalf, there shall be established for the
administration of the scheme of Employees’ State Insurance in accordance with the
provision of the Act a corporation to be known as Employees’ State Insurance
Corporation.

The Corporation shall be a body corporate by the name of Employees’ State

Insurance Corporation having perpetual succession and a common seal and shall
by the said name sue or sued.[S.3]

ESIC Act:
The promulgation of Employees’ State Insurance Act, 1948 envisaged an
integrated need based social insurance scheme that would protect the interest of
workers in contingencies such as sickness, maternity, temporary or permanent
physical disablement, and death due to employment injury resulting in loss of
wages or earning capacity. The Act also guarantees reasonably good medical care
to workers and their immediate dependants.

Following the promulgation of the ESI Act the Central Govt. set up the ESI
Corporation to administer the Scheme. The Scheme thereafter was first
implemented at Kanpur and Delhi on 24th February 1952. The Act further

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absolved the employers of their obligations under the Maternity Benefit Act, 1961
and Workmen’s Compensation Act 1923. The benefit provided to the employees
under the Act is also in conformity with ILO conventions.

Medical Benefit:
The Scheme provides full range of medical care to Insured person and family,
through a network of ESI Dispensaries & Panel clinics, diagnostic centers and ESI
Hospitals etc. Super speciality facilities are provided to the beneficiaries through
recognized advanced medical institutions empanelled for the purpose on referral
basis. The Corporation has set up a revolving fund in most of the States to ensure
smooth flow of funds for super-specialty treatment of ESI beneficiaries.
All Insured Persons and members of their family are entitled to free, full and
comprehensive medical care under the Scheme. The package covers all aspects of
health care from primary to super specialty facilities.

Treatment to family members of insured person:

Members of IPs family are entitled to free, full and comprehensive medical care
under the Scheme. The package covers all aspects of health care from primary to
super specialist facilities. The family members of an Insured Person who reside at
the place of work or at a place other than the place of work of the Insured Person
or who move along with the Insured Person on leave or temporary transfer will be
provided medical care as under:-

The family members can get treatment along with Insured Person at the station
where the insured Person is posted permanently/ temporarily; The facilities of
medical benefit under the ESI Scheme will also be provided to the family members
of IP where the IP works and resides at one station and his family resides at
another station but both the places are implemented centers and located in the same
State or in different states.

Treatment at outstations:
An Insured Person (IP), who moves from his normal station, to another station in
the same State or another State where also the medical benefit provisions of E.S.I.
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Scheme are in force, either on authorized leave or on temporary duty, (for a period
not exceeding three months), will be provided medical treatment at the new place
also (temporary resident).

A temporary resident, before proceeding to a temporary residence, shall obtain on

request a certificate of entitlement on Form ESIC-105 from his employer. The
employers shall also indicate on Form ESIC-105 whether the members of family of
IP are also moving along with the Insured Person. This certificate of entitlement
will be valid for a maximum period of 3 months only from the date mentioned
therein. An IP who does not possess ESIC-105 cannot avail Medical Benefit at his
temporary residence.

A memorandum from employer sanctioning leave or tour indicating Name,

Address, Insurance Number, Employer's Code Number and period of leave or tour
can be accepted in lieu of ESIC-105. This will be treated by IMO/IMP in the same
way as ESIC-105.
A temporary resident can claim treatment at any State Insurance Dispensary/Clinic
of a panel Doctor at his temporary residence on the production of Form ESIC-105
and Identity Card and he should be accepted by the IMO/IMP on his list only if IP
actually needs medical treatment at that time. IMO/IMP will get the signature of
the IP on ESIC-Med 10 (on the reverse of ESIC-105), complete it and put his
signature in token of his acceptance of the temporary resident.

A temporary resident will be provided Medical Benefit in the same way and on the
same scale as other IPs in the area. As all benefits will be admissible to a
temporary resident, certificates, if justified, should also be issued to enable him to
claim cash benefits from the Branch Office to which IP is allotted at his permanent
place of residence.
If an IP wants to return to his original place of residence before issue of Final
Certificate, he should be issued a statement by IMO/IMP of temporary residence
giving details of certificate issued to enable follow-up action by IMO/IMP of
original place of residence. The IP shall get specimen signature of IMO/IMP on
Medical Certificate verified by the nearest Branch Office Manager and send it to
his Branch Office.

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A temporary resident whose stay at a place is less than 24 hours should also be
given medical treatment by the IMO/IMP, but the procedure detailed in the above
paragraphs need not be followed. As the treatment is of the nature of emergency
treatment, no capitation fee will be payable to the IMP/Employees facility
utilization dispensary.
If an IP's stay at a temporary residence is for a period of more than 3 months, he
will not be treated as temporary resident, but will be entitled to Medical Care at the
new place only as provided for change of dispensary/doctor/IMP/region.

Treatment to retired and disabled persons:

(Rules 60 & 61 of ESI Central Rules, 1950)
Insured Persons who cease to be in insurable employment on account of permanent
physical disablement due to employment injury or those who leave the insurable
employment on attaining the age of superannuation are eligible to receive medical
benefit for themselves and their spouses. The benefit is provided on payment of
contribution in lump sum for one year at the rate of Rs. 10 per month in advance.

Scale of medical benefit:

Superannuated or disabled insured worker will be entitled to the same scale of
Medical Benefit and to the same package of medical facilities that is admissible to
an Insured Person and spouse.

Sickness Benefit:
Section 2(20)
Sickness Benefit represents periodical cash payments made to an IP during the
period of certified sickness occurring in a benefit period when IP requires medical
treatment and attendance with abstention from work on medical grounds.

The maximum duration of Sickness Benefit is 91 days in two consecutive benefit

periods. There is a waiting period of 2 days which is waived if the insured person
is certified sick within 15 days of the spell for which sickness benefit was last
paid. The sickness benefit rate is roughly equivalent to 50% of the average daily

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wages of the insured person.

Extended Sickness Benefit

After exhausting the Sickness Benefit payable upto 91 days, an insured person if
suffering from Tuberculosis/Leprosy, mental and malignant diseases or any other
specified long-term disease, he is entitled to Extended Sickness Benefit at a higher
cash benefit rate of about 70% of average daily wage for a period of two years.

Enhanced Sickness Benefit

For undergoing sterilization operations for family planning, Insured Persons are
eligible to Enhanced Sickness Benefit at double the rate of sickness benefit.

Disablement Benefit:
Disablement benefit is admissible for disablement caused by employment
Occupational Diseases injury/OD. At the first instance, temporary disablement
benefit is payable as long as the temporary disability lasts. If the employment
injury results in partial or total/permanent disability, permanent disablement
benefit is payable till the death of the insured person.

No contributory conditions are prescribed for this benefit. While the rate of
temporary disablement benefit is 70% or a little more of the wages and that of
permanent disablement benefit is proportionate to the loss of earning capacity
caused by the injury.

Maternity Benefit:
Maternity benefit consists of periodical cash payments in case of confinement or
miscarriage or sickness arising out of pregnancy, confinement, premature birth of
child or miscarriage, to an insured woman as certified by a duly appointed medical
officer or mid wife.

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Dependants Benefit:
Dependants' benefit consists of periodical payments to dependants of an insured
person who dies as a result of an employment injury sustained as an employee
under the ESI Act.

There are no contributory conditions for qualifying to this benefit. Thus, if a person
dies of employment injury even on the first day of his employment, his dependants
are entitled to the benefit.

Funeral Expenses:
Funeral expenses are in the nature of a lump sum payment up to a maximum of
Rs. 5000/- payable at branch office made to defray the expenditure on the funeral
of deceased insured person. The amount is paid either to the eldest surviving
member of the family or, in his absence, to the person who actually incurs the
expenditure on the funeral.

Rehabilitation Allowance:
This Scheme has been designed to provide financial assistance to the insured
persons who are referred to vocational rehabilitation centre for training. The
vocational rehabilitation scheme framed under the provisions of section 19 of the
ESI Act, 1948 has been made applicable for the present to those insured persons in
whose case loss of earning capacity resulting from an employment injury has been
assessed as not less than 40% as per percentages given in Schedule II to the Act for
scheduled as well as non-scheduled injuries resulting from an employment injury
i.e. accident arising out of and during the course of employment or from an
occupational disease as defined in ESI Act.

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 ESI BRANCH OFFICES IN MUMBAI REGION

S.I. No Place/Address Tel No:

1. ANDHERI 26842416
Branch Manager, Branch Office,
ESI Corporation,
Dr.Mankodi's Building,
Telli Galli,
Mavasanji Road, Andheri,
MUMBAI-400&059.

2. COLABA 22842532/70/78
Branch Manager, Branch Office,
ESI Corporation,
Panchdeep Bhavan,
Shahid Bhagat Singh Marg,
Colaba,
MUMBAI-400 005.

3. DADAR 4223818
Branch Manager, Branch Office,
ESI Corporation,
Shardashram,
Bhavani Shankar Road,
Dadar, MUMBAI-400 028.

4. GOREGAON 28722290
Branch Manager, Branch Office,
ESI Corporation,
10,Jawahar Nagar,
S.V.Road,Goregaon(West),
MUMBAI-400 062.

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5. KANDIVILI 2863906
Branch Manager, Branch Office,
ESI Corporation,
Charkop Industrial Estate
MUMBAI-400 067.

6. KURLA 25152717
Branch Manager, Branch Office,
ESI Corporation,
18/TPS No. 11,
Nr. Ghatkopar Railway Station
MUMBAI-400 08.

7. MAHIM 4623818
Branch Manager, Branch Office,
ESI Corporation,
Dheeraj Sneh Building,
1st Floor, 30th Road,
Pali Naka, bandra (W)
MUMBAI-400 050.

9. THANE 25811768
Branch Manager, Branch Office,
ESI Corporation,
ESIC Hospital Complex,
Nurses Hostel Bldg, Road No. 33,
Wagle Estate,
THANE.

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