What is Employee State Insurance Scheme (ESIS) - Benefits & Eligibility

The Employees’ State Insurance Scheme (ESIS) is a government-backed social security initiative that provides healthcare and financial support to employees working in eligible establishments. It covers medical expenses, maternity leave, disability benefits, and more, ensuring protection for workers and their families in times of need.

Keep reading to learn more about the scheme’s benefits and eligibility.

What is ESI?

Employee State Insurance (ESI) is a social security scheme that offers financial and medical support to employees and their families. It is governed by the Employees' State Insurance Act 1948 and managed by the Employees' State Insurance Corporation (ESIC) as part of the Ministry of Labour & Employment, Government of India.

What is the employees’ state insurance act of 1948?

The Employees' State Insurance Act 1948 was India’s first major law providing social security for workers. It was introduced to protect employees from financial difficulties caused by sickness, maternity, disability, or employment-related injuries.

When and how did ESIC start?

The Employee State Insurance Scheme was launched in Kanpur and Delhi on February 24, 1952. Prime Minister Jawaharlal Nehru inaugurated the scheme in Kanpur, addressing 70,000 workers.

The scheme initially covered 1.2 lakh employees and has since expanded to 668 districts across 36 states and union territories. As of March 31, 2023, it had 3.42 crore insured persons and 13.3 crore total beneficiaries.

Coverage Position	(As on 31st March 2023)
No. of Insured Persons	3.42 Crores
No. of Employees	3.05 Crores
Total No. of Beneficiaries	13.30 Crores
No. of Insured women	67.60 Lakhs
No. of Employers, etc	20.83 Lakhs

Features of employees’ state insurance scheme

ESIS provides financial and medical security to employees and their families, ensuring access to healthcare and income support during difficult times. Here are the main features of the scheme:

Coverage and Eligibility

The ESIS covers employees earning up to ₹21,000 per month (₹25,000 for employees with disabilities). It applies to workers in factories, establishments, and businesses with 10 or more employees (20 in some states). The scheme extends protection to full-time, contractual, and casual employees, ensuring a wider section of the workforce has access to essential health benefits.

Medical Benefits

Employees and their dependents can receive comprehensive medical care at ESI-empaneled hospitals and dispensaries. The coverage includes:

Outpatient and inpatient treatments
Maternity care and pre-existing condition coverage
Specialist consultations, surgeries, and diagnostic tests
Free medicines and emergency care

ESIS helps reduce the financial burden on employees by providing cashless medical treatment.

ESIS Cash Benefits

Beyond medical assistance, ESIS provides financial support during difficult situations. Employees can claim cash allowances in cases of:

Sickness: Up to 70% of wages for a maximum of 91 days per year
Disablement: Compensation for temporary or permanent disability
Maternity: 100% of wages for up to 26 weeks
Dependents' Benefit: Monthly pension for family members in case of work-related death
Unemployment: Up to 24 months’ worth of benefits under the Rajiv Gandhi Shramik Kalyan Yojana

This financial support ensures employees and their families can manage essential expenses even when they are unable to work.

Shared Responsibility

ESIS is funded jointly by employers, employees, and the government:

Employers contribute 3.25% of wages
Employees contribute 0.75% of wages (waived for those earning less than ₹137 per day)
State governments contribute one-eighth of medical expenses, up to ₹1,500 per insured person annually

This shared funding model ensures the scheme remains sustainable and beneficial for all stakeholders.

ESI Benefits

The Employees’ State Insurance (ESI) Scheme provides a range of medical and cash benefits to employees and their families, ensuring financial security during medical emergencies, maternity, disability, and unemployment. Here are the key benefits:

ESIC Medical Benefits

Employees and their families receive comprehensive medical care from the first day of employment, with no cap on treatment costs. Key benefits include:

Outpatient and inpatient care at ESI-empaneled hospitals
Specialist consultations, surgeries, and diagnostic tests
Maternity and emergency care
Medical benefits post-retirement for the insured person and spouse, available for a nominal ₹120 annual fee

Cash Benefits for Sickness

Employees facing illness-related absence can claim sickness benefits at 70% of their wages for up to 91 days per year, provided they have contributed for at least 78 days in the past six months. Additional provisions include:

Extended sickness benefit (80% of wages for up to two years) for 34 specified long-term illnesses
Full wage benefit for sterilisation procedures (7 days for vasectomy, 14 days for tubectomy)

ESI Benefits for maternity

Women employees are eligible for 26 weeks of fully paid maternity leave for up to two pregnancies, which can be extended by one month on medical advice. Eligibility requires a minimum contribution of 70 days in the last two contribution periods.

Support in Case of Disability

Employees who suffer work-related disabilities receive financial support as follows:

Temporary Disablement: 90% of wages paid until recovery, regardless of length of employment
Permanent Disablement: A lifelong monthly benefit based on the assessed loss of earning capacity, as determined by a medical board

Dependants’ Benefit

In case of an employee’s death due to an occupational hazard, dependents receive 90% of the insured wage as a monthly pension, ensuring financial stability for the family.

Other Benefits

ESIS also provides additional financial and social security benefits:

Funeral expenses: ₹15,000 paid to dependents
Confinement expenses: Assistance for childbirth outside ESI medical facilities
Vocational rehabilitation: Support for permanently disabled employees
Physical rehabilitation: Treatment for disabilities caused by workplace injuries

Unemployment allowance:

Rajiv Gandhi Shramik Kalyan Yojana (RGSKY): 50% of wages for up to one year in case of involuntary job loss
Atal Beemit Vyakti Kalyan Yojana: A one-time relief payment (50% of wages for up to 90 days) for eligible unemployed workers

When is ESIS registration required?

Under the Employee State Insurance Act 1948, employers must register with the Employees’ State Insurance Corporation (ESIC) once they meet specific criteria related to workforce size and employee wages.

Number of Employees

ESIS registration is mandatory for establishments that employ:

10 or more employees in most Indian states and union territories

This applies to factories, shops, hotels, cinemas, road transport services, and private medical and educational institutions.

Employee Wage Limit

ESIS coverage applies to employees earning up to ₹21,000 per month. However, for employees with disabilities, the wage limit is ₹25,000 per month.

Note: Employers must register within 15 days of meeting these criteria to ensure compliance and avoid penalties.

Procedure for ESIS registration

Employers can complete Employee State Insurance Scheme (ESIS) registration online through the ESIC portal. The process involves the following steps:

Visit the ESIC portal.
Click on ‘Employer Login’, then select ‘Sign Up’.
Enter your company details, including:
1. Company Name
2. State and Region
3. Email Address (used as the username)
4. Phone Number
Submit the form: Once you submit it, a confirmation email with login credentials will be sent to your registered email, allowing you to proceed with employee registration.

Employer registration in ESIC

Employers must register with the Employees' State Insurance Corporation (ESIC) to provide social security benefits to their employees. The registration process involves the following steps:

Logging into the ESIC Portal

Use the credentials received via email to log in.
Click ‘New Employer Registration’ and select the appropriate unit type.

Filling Employer Registration Form-1

Enter details about your establishment, including:

Name and Address
PAN
Jurisdiction of the Local Police Station
Ownership Type (Owned or Rented)
Nature of Business
Date of Establishment’s Commencement
List of Owners and Their Designations
Licence Details (if applicable)

Providing Employee Details

Enter the total number of employees.
Specify the number of employees earning below ₹21,000 and their hiring date.
Register employees by filling out the Employee Declaration Form. You can select existing registered employees or add new ones.

Selecting the ESIC Branch Office

Choose the relevant ESIC branch office and inspection division.
Carefully review all entered details before submitting the registration.

Documents required for ESIS registration

To complete the Employees' State Insurance Scheme (ESIS) registration, employers must submit the following documents:

Establishment Details

Registration Certificate under the Factories Act or Shops and Establishments Act
Certificate of Incorporation, Memorandum of Association (MOA), and Articles of Association (AOA) (for companies)
Partnership Deed (for partnership firms)
PAN Card of the Business
Cancelled Cheque with company bank details
Address Proof of the establishment

Employee Information

List of Employees with names, salaries, attendance records, and date of joining
List of Directors and Shareholders
PAN Card details of each employee
Aadhaar Card of employees (if available)

Required Forms

Employer Registration Form (Form No. 1) – This must be downloaded, filled out with the above details, and uploaded to the ESIC portal for registration completion.

Note: Document requirements may vary based on the type of business entity.

How do you apply for an ESI card (Pehchan Card)?

The ESI Card (Pehchan Card) is an identification document that enables insured employees to access medical benefits under the Employees' State Insurance (ESI) Scheme. It contains essential details like the employee’s name, ESI insurance number, photograph, address, and dependent details.

Follow these steps to apply for an ESI Pehchan Card online:

Log in to the ESIC Portal: Visit the ESIC portal and enter your username and password.
Navigate to the ‘e-Pehchan Card’ Section: On the dashboard, click the ‘Employee’ section and click ‘e-Pehchan Card’ to initiate the application.
Select Unit Details: Choose the relevant unit details and click ‘View’ to proceed.
Generate the ESI Card: Locate the employee’s name and click ‘View Counter Foil’ to generate the ESIC e-Pehchan Card.
Download and Print: Click ‘Print’ to download the Employee State Insurance E-Pehchan Card as a PDF.
Affix Signature and Photograph: Print the ESI card and add the employee’s signature, employer’s stamp, and required photographs (including dependents, if any).

Note:

The ESI Pehchan Card must be signed and stamped by the employer or an ESIC official to be validated.
To avail of benefits, employees can present this attested Pehchan Card and a valid photo ID at ESI hospitals and dispensaries.

Employees State Insurance Scheme hospital list

The Employees' State Insurance Corporation (ESIC) provides a network of hospitals, dispensaries, and medical colleges to offer healthcare services to insured employees and their dependents. These facilities include ESIC hospitals, ESIS hospitals, medical colleges, dispensaries, and Dispensary cum Branch Offices (DCBOs).

You can locate an ESIS hospital using the ESIC portal by following these steps:

Visit the ESIC Official Website: Go to the ESIC website to access the hospital search tool.
Navigate to ‘Quick Finder’: Locate the ‘Quick Finder’ section on the homepage.
Search by State and Facility Type: Use the dropdown menu to select your preferred facility type and search by state:

ESIC Hospitals
ESIS Hospitals
Medical Colleges
Dispensaries
Dispenser cum Branch Office (DCBO)

Emplyee State Insurance Scheme Hospital List

Recent Improvements in ESIC Hospitals

ESIC hospitals have introduced various enhancements to improve healthcare quality, including:

Electronic Health Records (EHR) for better patient data management.
VIBGYOR - Operation Indradhanush focuses on medical advancements.
24/7 Medical Helpline for insured employees.
Special OPD services for improved patient care.
Pathology and X-ray services through the Public-Private Partnership (PPP) model.
Quality control for medicines and drugs.
Regular inspections by ESIC members to ensure service quality.
Queue management systems and behavioural training for medical staff.
Specialised care units, including ICU, CT Scan, MRI, Dialysis, and Cath Labs.
Mother & Child Care hospitals with dedicated services.

Employees and their dependents can avail of medical benefits at any registered ESIC or ESIS hospital by presenting their ESI Pehchan Card and a valid ID.

ESI Claim Process

Here’s a step-by-step guide on how you can claim ESI:

Visit the ESIC Branch Office: Choose the office assigned to your establishment.
Submit the Required Documents

Completed claim form (varies by benefit type)
Medical certificates (for sickness/maternity benefits)
Hospital bills and prescriptions (for medical reimbursement)
Employment proof (for unemployment benefits)
Death certificate & dependent details (for dependents’ benefits)
Dispenser cum Branch Office (DCBO)

Claim Processing & Approval: The ESIC office will verify and process the claim. If approved, the benefit amount is credited to the registered bank account.

For smooth claim processing, ensure all required forms and medical records are accurate and up to date.

When to claim & How to check claim status?

ESI benefits can be claimed after a qualifying event such as:

Illness – After getting a certified medical report from an ESIC-authorized doctor
Injury/Disability – After an accident or workplace injury, based on medical certification
Maternity – Before or after childbirth, depending on the type of claim
Unemployment – After losing a job due to establishment closure or retrenchment
Death – Dependents can claim benefits upon the insured person's demise

Note: Keep your ESI Pehchan Card for quick reference and processing.

How to Check Claim Status?

You can track your ESI claim online through the UMANG App:

Download & Open the UMANG App
- Available on both Android & iOS stores.
Enter ESIC Insurance Details
- Provide your IP or ESIC Insurance Number and click ‘Get OTP’.
Authenticate & Access Claim Status
- Enter the OTP sent to your registered mobile number and click ‘Submit’.
- Select ‘Claim Status’ from the service menu.
View Your Claim Status
- Your pending and approved claims will be displayed.
- Use the advanced search option for specific details.

This digital tracking system ensures a hassle-free way to monitor your claim progress.

Frequently Asked Questions

You are eligible for ESI benefits if:

You are an employee working in an establishment with 10 or more employees (or as per your state’s threshold).
Your monthly salary is ₹21,000 or below (₹25,000 for employees with disabilities).
Your employer is registered under the Employees’ State Insurance (ESI) scheme and contributes to ESIC.

If your Employee State Insurance (ESI) e-Pehchan Card is lost or damaged, you must inform your employer immediately. Your employer will then initiate the process of applying for a replacement card through the ESIC office. In some cases, you may need to provide identification details and supporting documents to verify your ESI membership before the new card is issued.

ESI salary is calculated based on the employee’s gross monthly wages. The calculation includes:

Included in ESI salary: Basic pay, Dearness Allowance (DA), House Rent Allowance (HRA), overtime allowance, night shift allowance, medical and washing allowances, and attendance bonuses.
Excluded from ESI salary: Annual and incentive bonuses, gratuities paid at intervals exceeding two months, travel allowances, and employer contributions to PF/Gratuity.

The ESI contribution rates are:

Employee Contribution: 0.75% of gross wages
Employer Contribution: 3.25% of gross wages

ESI and EPF registrations both provide social security benefits, but they serve different purposes:

ESI (Employees’ State Insurance) covers medical and cash benefits, such as hospitalization, sickness, maternity, and disability.
Contribution: 0.75% (employee) + 3.25% (employer) of wages up to ₹21,000/month.
EPF (Employees’ Provident Fund): A retirement savings scheme where contributions accumulate with interest for post-retirement use.
Contribution: 12% (employee) + 12% (employer) of basic salary + DA.

No, you cannot apply for an ESIC card online yourself. Only employers are authorised to submit ESI registration and Pehchan Card applications for employees through the ESIC portal. Once the employer completes the registration, employees can collect their e-Pehchan Card from their employer or the designated ESIC office.

No, ESI benefits cannot be claimed for treatment at a private hospital unless it is an emergency and no ESIC facility is available. In such cases, prior approval from the ESIC Medical Officer is required for reimbursement. Otherwise, medical treatment is available only at ESI hospitals, dispensaries, and tie-up clinics.

Yes, employers must deposit ESI contributions for the previous month's wages for the previous month's w. If contributions are not deposited on time, the employer will be liable for penalties and interest charges.

If ESI contributions are not paid by the due date, a 12% annual interest is charged on the unpaid amount until it is cleared. Additionally, non-payment or delayed payment can result in legal consequences for the employer.

Yes, you can transfer your Employees' State Insurance (ESI) benefits when changing jobs. Since your ESI number remains the same throughout your career, you only need to provide your new employer with your ESI Insurance Number (IP Number) and other relevant details.