EMPLOYEES STATE INSURANCE SCHEME

PRESENTED BY :--GROUP 5 21 22 23 24 25 BHUPENDRA BHALAVI DEEPAK YADAV DEEPIKA BANSAL DHARMESH LAD GEETA MANDHANI

GUIDED BY:-DR. A.K. KHATRI DR. GEETA SHIVRAM

WHAT IS
EMBODIED IN ESI ACT

ESIS ?

AN INTEGRATED MEASURE OF SOCIAL INSURANCE

TASK OF PROTECTING EMPLOYEES AGAINST HAZARD OF

SICKNESSS

MATERNITY

DISABLEMENT

DEATH

& MEDICAL CARE TO

& THEIR

HOW DOES ESIS ASSIST WORKER ???

1.DEPENDENCE 2.INTERRUPTION ON CASH INCOME - MODERN ECONOMY OF MONEY INCOME

SMALL PERIOD
HARDSHIP

PROLONG LOSS
CATAS TROPHE

3.AS PROVIDER ----IT AMERIOTE-----ECONOMIC

ANXIETY

ACT AS A FRIEND IN NEED & STRESS

WHY ESI, A HEALTH SCHEME ???

DUAL ROLE
MEDICAL CARE RESTORE HEALTH THUS BETTER WORKING CAPACITY HEALTHIER WORKER SECURE WORKER CASH ASSISTANCE

SUSTAIN INCOME

&

HAPPIER EMPLOYEE

NEED OF ESI IN INDIA

ECONOMIC PROGRESS

industrial growth relation b\w employer & employee

WITH GLOBALISATION
1.SHIFTING OF LABOUR FORCE

2.INDIA IS EMERGING - MAJOR LABOUR MARKET

CONCERNING INDIA - ROOT IN GLOBAL MARKET BASIC PROTECTION FOR ALL WORKMEN & A DIALOUGE B/W STAKE HOLDERS G W E

WHERE ESIS STANDS IN PSM ?

PREVENTION OF OCCUPATIONAL DISEASES

MEDICAL MEASURES

ENGINEERING MEASURES

LEGISLATION

1.THE FACTORY ACT , 1948 2.THE ESI ACT , 1948

OCCUPATIONAL HEALTH
ESSENTIALLY A PREVENTIVE MEDICINE AIMS OF :1.PROMOTION & MAINTENANCE 2.PREVENTION 3.PROTECTION 4.PLACING & MAINTENANCE WITH

TO SUMMARIZE
ADOPTION OF WORK TO MAN & EACH MAN TO HIS JOB

OCCUPATONAL HAZARDS
PHYSICAL 1.HEAT & LIGHT 2.COLD 3.NOISE 4.VIBRATON 5.RADIATION CHEMICAL BIOLOGICAL MECHANICAL
10 % ACCIDENTS

PSYHOSOCIAL
*INSECURITY *JOB DISSATISFACTION *POOR HUMAN RELATION *FRUSTRATION

INFECTIVE 1.LOCA L AGENTS ACTION 2.INHALATON GASES

ANTHRAX BRUCELLOSIS LEPTOSIROSIS

WHY LEGISLATION IMPORTANT?

1.WORKER IS MORE IMPORTANT THAN MACHINE 2.ONE CANNOT PERMIT WORKE R TO ENDANGER HIS LIFE

LAWS HAVE TO BE FRAMED TO.

1. GOVERN THE CONDITION 2.SAFEGUARD THE HEALTH & WELFARE OF WORKER

SOCIAL SECURITY FOR INDUSTRIAL WORKER

LEGISLATION ARE->
1.WORKMAN COMPENSATION ACT ,1923 2.CENTRAL MATERNITY BENEFIT ACT ,1961 3.FAMILY PENSION SCHEME ,1971 4.ESI ACT ,1948

SOCIAL SECURITY

??????

SECURITY THAT SOCIETY FURNISHES THROUGH APPROPRIATE ORGANIZATION AGAIN ST CERTAIN RISKS TO WHICH ITS MEMBRES ARE EXPOSE

SOCIAL SEURITY REFERS

SOCIAL INSURANCE
INSURANCE SCHEME

TO

INCOME MAINTENANCE
CASH

SERVICES

->MEDICAL CARE ->SOCIAL WORK

INTERUPTION OF EMPLOYMENT ->PENSION ->DISABILITY INSURANCE ->SURVIVAL BENEFIT ->RETIREMENT ->UNEMPLOYMENT ->UNEMPLOYED

COVERAGE
ESI Act also applied to (coverage of Factories)

Factories using power in manufacturing process and employing 10 or more persons. Non power using factories or establishment employing 20 or more persons.

Provisions of act to other classes of establishments

INDUSTRIAL COMMERCIAL AGRICULTURAL OR OTHERWISE

THESE PROVISIONS UNDER STATE GOVT. HAVE EXTENDED TO FOLLOWING CLASSES

Shops
Hotels and Restaurants Cinemas including preview theaters

Road Motors transport undertakings

Newspaper Establishments

ESI applicable to over 2 lakh Industrial units across the country.

AREAS COVERED
ESI scheme is being implemented area wise

STATES
All the states except Nagaland, Manipur, Tripura, Arunachal Pradesh & Mizoram

UNION TERRITORIES
Dehli, Chandigarh and Pandichery
(As on 31-03-06)

No. of the Insured persons family units No. of the employees Total no. of beneficiaries No. of the Insured women No. of the employees

= 91,48,605 = 84,00,526 = 3,54,96,589 = 15,43,250 = 3,00,718

INDORE
REGIONAL OFFICE
PANCHDEEP BHAWAN, NANDA NAGAR INDORE

BRANCH OFFICES
INDUSTRIAL ESTATE, MARIMATA CHOURAHA INDORE 15 YASHWANT NIWAS ROAD INDORE 4 NEHRU NAGAR INDORE CITY BRANCH OFFICE 14 Y. N. ROAD INDORE

HOSPITALS
GENERAL HOSPITAL NANDA NAGAR T. B. HOSPITAL NANDA NAGAR

DISPENSARIES
ESI BUILDING NEHRU NAGAR NANDA NAGAR

COVERAGE IN INDORE
TOTAL NO. OF THE EMPLOYERS COVERED = 2,364
= 8,337

NO. OF THE EMPLOYEES (APPROVED) MILL AREA

NO. OF THE EMPLOYEES (APPROVED) NEHRU NAGAR = 1,786 NO. OF THE EMPLOYEES (APPROVED) CITY = 4,164

NO. OF THE EMPLOYEES (APPROVED) IND. ESTATE

= 19,198
=9,835

NO. OF THE INSURED PERSONS(APPROVED) MILL AREA

NO. OF THE INSURED PERSONS(APPROVED) NEHRU NAGAR =2,120 NO. OF THE INSURED PERSONS(APPROVED) CITY NO. OF THE INSURED PERSONS(APPROVED) IND.ESTATE =4,912 =22,663

COVERAGE OF EMPLOYEES
1)

A monthly wage limit is prescribed by central govt. for the purpose of coverage of employees/workers of aforesaid factories.

2) The wage ceiling is enhanced from time to time. The existing ceiling is Rs. 10,000/month.

ADMINISTRATION
ESI CORPORATION
MEMBERS
1) Chairman Union minister of Labour, Govt. of India 2) Vice chairman secretary to Govt. of India, Ministry of Labour 3) < 5 persons appointed by central Govt.

4) One person from each state

5) One person representing the Union Territories 6) 10 persons representing employers 7) 10 persons representing employees 8) 2 persons representing the medical profession 9) 3 members of parliament

10) Director general of the corporation

The committee meets twice a year to formulate policies etc.

STANDING COMMITTEE
This committee formed from the members which executes the decisions.

DIRECTOR GENERAL CHIEF ADVISOR

ASSISTED BY
1) MEDICAL COMMISSIONER 2) INSURANCE COMMISSIONER 3) FINANCIAL COMMISSIONER 4) ACTUARY Trained in maths, accounts, statics

ACTUARY

MEDICAL BENEFIT COUNCIL

Headed by DGHS India and assisted by medical commissioner in all aspects related to medical relief.

Minister of State (Independent Charge) for Labour and Employment, Shri Oscar Fernandes

EMPLOYEE INSURANCE COURT

The state Govt. shall constitute this for the local areas. The court shall
Decide any question or dispute arises in rates or payment of contribution, rates of wages. Violations of right to any benefit and as to amount and duration. In contravention person shall be liable for punishment.

FINANCE
CONTRIBUTION
Employers contribute Employees contribute 4.75% of total wage bill 1.75 of total wage bill

ADMINISTRATIVE EXPENSES

2/3 by central Govt.

& 1/3 by state Govt.

MEDICAL ASPECTS

7/8 by central Govt. & 1/8 by state Govt.

EXEMPTION
If employee receives < 50 Rs./day

COLLECTION OF COTRIBUTION
Employee shall pay at above specific rates within 21 days of last day of the calendar month.

CONTRIBUTION PERIOD & BENEFIT PERIOD

Two contribution periods each of 6 months duration Two corresponding benefit periods also of 6 months duration

INCOME / EXPENDITURE ACCOUNT

1) INCOME Actuals for 2000-2001 Actuals for 2001-2002 Actuals for 2003-04 Amount (Rs. in lakhs 1,56,428.23 1,73,019.26 1,97,564.00

Actuals for 2004-05

Actuals for 2005-06

2,24,606.05
2,41,061.77

Amount (Rs. in lakhs Actual expenditure for 2000-01 1,08,258.14 Actual expenditure for 2001-02 1,10,412.04 Actual expenditure for 2002-03 1,11,832.00 Actual expenditure for 2003-04 1,17,048.00 Actual expenditure for 2004-05 1,25,819.53 Actual expenditure 2005-06 1,27,896.16

TOTAL EXPENDITURE

BENEFITS OF ESI
The section 46 of ESI ACT provides the following social security Benefits---

(a) MEDICAL BENEFIT

(b) SICKNESS BENEFIT 1- Extended sickness benefit 2- Enhanced sickness benefit (c) MATERNITY BENEFIT (d) DISABLEMENT BENEFIT

BENEFITS OF ESI
conti.

(e) DEPENDENTS BENEFITS 1-Temporary disablement benefit 2-Permanent disablement benefit (f) FUNERAL EXPANSES

(g) NEED BASED BENEFITS 1-Rehabilitation benefits 2-Vocational rehabilitation 3-Unemployment allowance (under Rajiv Gandhi Shramik Kalyan Yojna)

MEDICAL BENEFITS
Insured medical persons and their dependents are entitled to medical care from day 1 of taking up employment in any factory or establishment covered under ESI ACT 1948. The forms of medical care are

FULL MEDICAL CARE

EXPANDED MEDICAL CARE

RESTRICTED MEDICAL CARE

OVERALL PACKAGE
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Out patient treatment Domiciliary treatment Super speciality treatment Specialist consultation & diagnostic facilities In patient treatment Free supply of drugs & dressings X-ray & lab investigations Immunization Antenatal care, confinement, & postnatal care Ambulance services Free diet during stay in hospital Free supply of artificial limbs, aids, & appliances for physical rehabilitation 13. Family welfare services 14. Medical certification

PATTERN OF DELIVERY

DIRECT PATTERN

INDIRECT PATTERN

FULL TIME DISPENSARIES PART TIME DISPENSARIES MOBILE DISPENSARIES

PANEL SYSTEM

INSURANCE MEDICAL PRACTITIONE

PATTERN OF DELIVERY

ESI DISPENSARIES

PANEL CLINICS

DIAGNOSTIC CENTRES

ESI HOSPITALS

MEDICAL BENEFITS TO FAMILY MEMBERS

Members of IP are entitled to free, full & comprehensive medical care Under the scheme. The package includes all aspects of health care. The family members can get benefit at the same station where IP is posted. If the family members reside at some other station but under implemented area then also they will be provided medical benefits.

MEDICAL BENEFITS TO RETIRED & DISABLED PERSONS

As per rules 60 &61 of ESI central rules. For IP who loses job due to employment injury. For IP who leave employment on attaining the age of superannuation. Benefits to the IP & their spouses. Provided on payment of contribution in lump sum for one year @ Rs10 in advance.

SICKNESS BENEFITS
Periodical cash payments to an IP during the period of a certified sickness, occuring in a benefit period. 50% of daily wages. Payable for 91 days during 2 consecutive benefit periods. QUALIFYING CONDITIONS Contribution for not less than 78 days during corresponding contribution period. At least 9 months of employment.

Waiting period of 2 days are not payable.

EXTENDED SICKNESS BENEFITS

Additional to 91 days of sickness benefit. 50% daily wages Payable for an extended period of 2 years, in a ESB period of 3 years. Applicable if the IP has been in continuous job for at least 2 years. w.e.f. from 1-1-2000, 34 diseases are considered for extended sickness benefit.

DISEASES CONSIDERED IN
(I) INFECTIOUS DISEASES 1. TB 2. Leprosy 3. Chronic empyema 4. AIDS NEOPLASMS 5. Malignant diseases ENDOCRINAL, NUTRITIONAL & METABOLLIC DISORDERS 6.DM with Proliferative retinopathy, diabetic foot, nephropathy.

ESB

(II)

(III)

DISEASES CONSIDERED IN ESB

(IV) DISORDERS OF NERVOUS SYSTEM 7.Monoplegia 8.Hemiplegia 9.Paraplegia 10.Intracranial space occupying lesions 11.Hemiparasis 12.Spinal cord compression 13.Parkinsons disease 14.Myasthemia gravis (V) DISEASES OF EYE 15.Immature cataract with vision 6/60 or less 16.Detachment of retina 17.Glaucoma

conti

DISEASES CONSIDERED IN ESB

(VI)DISEASES OF CVS 18.Coronary artery diseases 19.Congestive heart failure 20. .Cardiac valvular diseases 21.Cardiomyopathies 22.Heart diseases with surgical intervention / complications

conti

(VII)CHEST DISEASES 23.Bronchiectasis 24.Interstitial lung diseases 25.COPD with cor pulmonale

DISEASES CONSIDERED IN ESB

(VIII) DISEASES OF DIGESTIVE SYSTEM 26.Cirrhosis of liver with ascites or chronic active hepatitis

conti

(IX) ORTHOPAEDIC DISEASES 27.Dislocation of vertebra / prolapse of intervertebral disc. 28.Nonunion or delayed union of fracture. 29.Post traumatic surgical amputation of lower extremities. 30.Compound fracture with chronic osteomyelities. (X) PSYCHOSIS 31.Subgroups a.Schizophrenia b.Endogenous depression c.Manic depressive illness d.Dementia

DISEASES CONSIDERED IN ESB

(XI) OTHERS 32.>20% burns with infection / complications 33.Chronic renal fialure. 34.Reynauds disease / Burgers disease. Additional 730 cases may be considered by Director General or Medical Commissioner.

conti

ENHANCED SICKNESS BENEFITS

w.e.f. 1-8-1976. Incentive to IP undergoing tubectomy / vasectomy. 100% of daily wages. Tubectomy 14 days Vasectomy 7 days Starts from date of operation or date of admission in hospital. Period is extendable in case of complications.

To insured woman as cash in case of 1. Confinement 2. Miscarriage 3. Sickness

CONTRIBUTARY CONDITIONS
Same of sickness benefit

BENEFIT 100% of wages

DURATION OF BENEFIT 1.For confinement 12 weeks 2. For Miscarriage 6 weeks 3. For Sickness 4 weeks MEDICAL BONUS Lump sum payment Rs. 1000/If she doesnt avail free medical care at time of delivery

EMPLOYMENT INJURY Personal injury Due to accident or occupational disease During employment in factory under ESI Act TYPES OF DISABLEMENT
Temporary Permanent Partial Permanent Total

BENEFIT Cash payment Free medical services BENEFIT RATE Temporary roughly equal to 70% of wages

Permanent
Total - roughly equal to 70% of wages Partial- proportionate to % of loss of earning

capacity determined by medical board

LIST OF % LOSS OF EARNING CAPACITY

PART 1
INJURIES CAUSING PERMANENT TOAL DISABILITY

INJURIES
LOSS OF BOTH HANDS LOSS OF HANDS & a FOOT

% OF LOSS OF EARNING
100% 100%

PART- 2
CAUSING PERMANENT DISABLEMENT

INJURIES PARTIAL

AMPUTATION 90% THROUGH SHOULDER JOINT

LOSS OF THUMB LOSS OF ONE EYE 30% 40%

MIDDLE FINGER

12%

DURATION TDB Till the disability lasts waiting period of 3 days Permanent paid for life in form of pension

CONTRIBUTARY CONDITIONS None IP is eligible from very first day of joining

 periodical payments dependants of an insured person dies as a result of an employment injury/occupational

disease. BENEFICIERIES
1. Widow

2. Son or daughter
3. Other dependants-

BENEFIT At rate of 70 % of wages Shared by dependants in fixed ratio.

3/5 (widow) 2/5(son&daughter)

CONTRIBUTARY CONDITIONS None IP is eligible from very first day of joining

Lump sum payment up to Rs. 2,500/- made for expenditure on the funeral of deceased insured person.

Funeral expense is payable to Eldest surviving member Or person who actually spends on funeral

 On monthly payment of Rs. 10, Insured person & family members get medical

treatment, After permanent disablement or retirement TYPE VOCATIONAL PHYSICAL

PHYSICAL REHABILITATION Physical aids - wheel chairs, crutches, dentures, specs etc. VOCATIONAL REHABILITATION Financial assistance 100% of wages who are reffered to rehabilitation centre for training Conditions Disability should be =/> than 40% Upto 45 yrs of age

 Preventive health care

Preventive health care services such as immunization, family welfare services, HIV/AIDS detection, treatment etc.
Old Age Medical Care Old age Medical care for self and spouse at a nominal contribution of Rs. 120/- per annum.
Rajiv Gandhi Shramik Kalyan Yojana

a. Exemption from Workmens compensation Act b. c. d.

e.

1923 Exemption from Maternity benefit Act 1961 Exemption from payment of Medical allowance or arranging medical care. Rebate under the Income tax Act on contribution in ESI account Healthy work force which leads to WEALTH

RAJIV GANDHI SHRAMIK KALYAN YOJANA

DEFINITION
ESI SCHEME HAS INTRODUCE A SCHEME OF UNEMPLOYMENT ALLOWANCE TO THE IPS & THEIR FAMILY WHO HAVE BEEN RENDERED UNEMPLOYED INVOLUNTARILY DUE TO .. 1. CLOSURE OF THE FACTORY 2. ESTABLISHMENT 3. RETRENCHMENT OR PERMANENT INVALIDITY ARISING OUT OF NON EMPLOYMENT INJURY

INTRODUCE- FIRST APRIL 2005

KINDS OF EMPLOYMENT COVERED UNDER THE SCHEME

1. RETRENCHMENT AS DEFINED IN THE INDUSTRIAL DISPUTES ACT , 1947
2. CLOSURE OF THE FACTORY / ESTABLISMENT ACT AS DEFINED IN THE INDUSTRIAL 1947 3. PERMANENT INVALIDITY NOT LESS THAN 50% ARISING OUT OF NON EMPLOYMENT INJURY.

UNEMPLOYMENT ALLOWANCE
1. ELIGIBILITY CONDITION
2. DISQUALIFICATION / TERMINATION 3. HOW TO CLAIM

4. DURATION & RATE

5. MEDICAL CARE

ELIGIBILITY CONDITION
1. THE PERSON SHOULD HAVE BEEN, AN INSURED PERSON , UNDER ESI ACT
2. IP SHOULD HAVE CONTRIBUTED UNDER THE ESI SCHEME ,FOR A MINIMUM PERIOD OF FIVE YEARS PRIOR TO LOSS OF EMPLOYMENT

3. THE IP SHOULD QUALIFY FOR SICKNESS BENEFIT

4. UA SHALL CEASE TO BE PAYABLE FROM THE DATE THE IP GETS REMPLOYED ELSE WHERE
5. THE UA CAN BE AVAILED OF IN ONE SPELL OR IN DIFFERENT SPELLS OF UNEMPLOYMENT PROVIDED WHICH NOT BE LESS THAN ONE MONTH 6. ONLY THE IP WHO COVER TERM & CONDITION OR AFTER FIRST APRIL 2005 SHALL BE TO RECEIVE UA 7. THE PAYMENT OF UA SHALL BE SUB TO THE PROVISION OF SECTION 61 OF THE ESI ACT 1948

DISQUALIFICATION / TERMINATION OF UA
CONDITION FOR DISQUALIFICATION
1.DURING LOCKOUT 2.LAY OF/TEMPORARY CLOSUER OF FACTORY 3.STRIKE RESORTED TO BY THE EMPLOYEES 4.VOLUNTARY ABANDONMENT OF EMPLOYMENT/ PREMATURE RETIREMENT 5. LESS THAN FIVE YEAR CONTRIBUTORY SERVICE

6.ON OBTAINING THE AGE OF SUPERANNUATION OR SIXTY YEARS WHICHEVER IS EARLIER 7.CONVICTED (i.e.PUNISHED FOR FALSE STATEMENT) UNDER THE SECTION 84 OF ESI ACT WITH RULE 62 8.ON BEING RE-EMPLOYED ELSE WHERE DURING THE PERIOD HE/SHE IS IN RECEIPT OF UA 9.DISMISSIAL/TERMINATION UNDER DISCIPLINARY ACTION 10.ON DEATH OF IP

HOW TO CLAIM
TIME ANY TIME BUT NOT LATER THAN 3 MONTHS
FROM THE DATE OF RETRENCHMENT / UE

TO WHOM APPROPRIATE BRANCH OFFICE CERTIFICATE ISSUED BY INSPECTOR OF FACTORIES ,ASST/DEPUTY COMMISSIONER , LABOUR ,WORKMAN COMPENSATION COMMISSIONERE

 MODE OF PAYMENT OF ALLOWANCE

THE ALLOWANCE IS PAYABLE BY ACCOUNT PAYEE CHEQUE ONLY

PAYMENT IN THE EVENT OF DEATH OF INSURED PERSON

THE AMOUNT OF UA UPTO & INCLUDING DATE OF DEATH OF IP , IS PAYABLE TO HIS/HER NOMINEE /LEGAL HEIR.

DURATION
THE MAX. DURATION FOR WHICH AN IP SHALL BE ELIGIBLE TO DRAW THE UA DURING HIS/HER

ENTIRE LIFE TIME WOULD BE SIX

MONTHS .

RATE OF UNEMPLOYMENT ALLOWANCE

1. PERSON WHO BECOME UE SHALL BE CALCULATED

ON THE BASIS OF AVG. DAILY WAGE DURING THE LAST 4 COMPLETED CONTRIBUTION PERIODS . 2. THE DAILY RATE OF UA SHALL BE THE STANDARD BENEFIT RATE AS SPECIFIED IN THE TABLE OF STANNDARD BENEFIT UNDER RULE 54 OF ESI (CENTRAL) RULES 1950 CORRESPONDING TO THE AVG. DAILY WAGE SO ARRIVED

MEDICAL CARE
FOR WHOM HIMSELF/HERSELF & HIS/HER
FAMILY

FROM WHERE ESI DISPENSARIES/ESI HOSP./

IMPS CLINIC

TIME PERIOD CORESPONDING TO CONTRIBU

TION PERIOD BEFORE UE

ON THE EVENT OF DEATH OF IP FAMILY GETS

MED. CARE FOR 8 MONTHS

THANK YOU