How does ESIC Health Coverage Work?

The Employees' State Insurance Scheme of India is a multi-dimensional health insurance policy that offers comprehensive medical care to insured candidates and their family members.

It covers medical supervision, treatment, medicines and injections, charges along with expert consultation and hospitalisation when the insured person is absent from work due to employment injury, sickness, and maternity.

What are the Key Features of the ESIC Health Insurance Scheme?

Here is the list of the key features and benefits of the ESIC scheme:

● Medical Benefit

The insured person and their family members can avail comprehensive medical care from the start of their eligible employment. There is no upper limit when considering treatment expenses.

● Sickness Benefit

Insured candidates can receive 70% of their average daily wages during their sickness period, for up to 91 days in a year. However, the insured worker needs to complete at least 78 days within a 6-month employment period in the pre-defined establishment, according to the Employees’ State Insurance Corporation.

● Maternity Benefit

It is available for 26 weeks and can be increased by an additional month according to the doctor's advice. The insured woman receives her full salary during this period. But she must have contributed for at least 70 days in the previous two contribution periods.

● Disablement Benefit

Suppose an employee witnesses an accident and is temporarily disabled. They can receive 90% of their wages until their health recovers fully. If the accident makes him permanently disabled, then 90% of his salary will be given to him for the rest of his life.

● Dependent Benefit

According to the ESIC health insurance scheme, the dependents of the insured person also receive financial support if the person experiences a serious injury or falls sick while working.

● Funeral Expenses

To cover the funeral expense of a deceased insured person, a fixed amount of up to ₹15,000 is provided. The eldest surviving family member receives this amount.

● Confinement Expenses

Suppose an insured woman or an insured worker's wife needs to go through childbirth where ESIC medical facilities are unavailable. Then, this scheme provides confinement expenses for pregnancy, miscarriage, or premature childbirth.

● Vocational Rehabilitation

The ESIC assists with Vocational Rehabilitation(VR) training at VRS for permanently disabled insured workers.

What are the Eligibility Criteria for the ESIC Scheme?

Here are the criteria mentioned in the following section:

● Employment Status

Must be a full-time, temporary, casual, or part-time employee in a covered establishment.

● Establishment Size

Applicable to employees of shops, hotels, cinemas, restaurants, newspapers, educational/medical institutions, provided they have 10 or more employees.

● Wage Limit

Employees must have a salary of ₹21,000 per month or less, and disabled candidates must earn ₹25,000 per month.

● Age limit

There is no age limit for this health coverage.

Final Words

The ESIC health coverage provides comprehensive medical protection to employees and their families. With benefits such as medical benefits, income support during sickness, maternity, and disability, it acts as a reliable safety net for eligible workers in India.