Employees' State Insurance Scheme (ESIC) is a multidimensional social security system tailored to provide socio-economic protection to worker population and their dependents. Besides full medical care for self and dependents, the insured persons are also entitled to a variety of cash benefits. TK Bhattacharyya, Commissioner, ESIC, spoke to Hindustan Times on a range of issues. Excerpts:
Please elaborate on ESIC's Health Insurance Scheme — the only scheme to offer full medical care to workers and their dependents without any ceiling on individual expenditure.
A person and his family are entitled to receive medical benefit from the day the person joins insurable employment. Medical Benefit under ESI scheme is given either in the form of out-patient treatment and attendance in a hospital or dispensary, clinic or other institution or by visits to the home of the insured person or treatment in a hospital or other institution.
On completion of two years' service with 156 days contribution, insured person is entitled to receive medical benefit for a period of three years even after he ceases to be in insurable employment.
An insured person on completion of 3 months' service with 39 days' contribution is entitled for Super Speciality Treatment. In case of his family members, six months' insurable employment with 78 days' contribution is required.
What kind of medical and other benefits does the scheme cover?
Besides medical benefits, the corporation provides sickness benefit for 91 days, maternity benefit for 12 weeks, disablement benefit (for temporary disablement till disability lasts and for permanent disablement till life) and dependent benefits in case of death due to employment injury. Unemployment Allowance is also paid for 12 months to insured persons who rendered jobless due to closure of factory or retrenchment or permanent invalidity.
How far and deep is ESIC's reach?
The ESI Act applies to factories employing 10 and more persons. The provisions of the Act are being brought into force area wise in the states. The ESI Act contains an enabling provision under which the “appropriate government” is empowered to extend the provisions of the Act to other classes of establishments.
Thirteen state governments have reduced the threshold for coverage of shops and establishments to 10 or more persons, employees of factories and establishments drawing monthly wages up to Rs 15,000 per month are covered under the ESI scheme.
Can you elaborate on the commitments and achievements ESIC during the diamond jubilee year (2011-12)?
The ESI Corporation has completed 60 years of services to its stakeholders. A number of commitments have been made towards making ESI Scheme more friendly and result-oriented. The results of all these commitments have come out to be exceedingly well.