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Transcript of Esi Insurance
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Employee State Insurance:
Introduction
The Employee State Insurance Act, [ESIC] 1948, is a piece of social welfare leislation enacte!
primarily with the o"#ect of pro$i!in certain "enefits to employees in case of sic%ness,maternity an! employment in#ury an! also to ma%e pro$ision for certain others matters inci!ental
thereto& The Act in fact tries to attain the oal of socio'economic #ustice enshrine! in the
(irecti$e principles of state policy un!er part 4 of our constitution, in particular articles 41, 4)
an! 4* which en#oin the state to ma%e effecti$e pro$ision for securin, the riht to wor%, to
e!ucation an! pu"lic assistance in cases of unemployment, ol! ae, sic%ness an! !isa"lement&
The act stri$es to materialise these a$owe! o"#ects throuh only to a limite! e+tent& This act
"ecomes a wi!er spectrum then factory act& In the sense that while the factory act concerns with
the health, safety, welfare, lea$e etc of the wor%ers employe! in the factory premises only& ut
the "enefits of this act e+ten! to employees whether wor%in insi!e the factory or esta"lishment
or else where or they are !irectly employe! "y the principal employee or throuh an interme!iate
aency, if the employment is inci!ental or in connection with the factory or esta"lishment&
Objective
The e$er e+pan!in in!ustrial hori-on an! reciprocal uprisin of la"our consciousness
necessitate the employee an! employer to "e con$ersant with the current la"or leislation that
o$ern their relationship, rihts an! o"liation&
The einnin The Employee State Insurance act was promulate! "y the .arliament of In!ia in
the year 1948&To "ein with the ESIC scheme was initially launche! on ) /e"ruary 190) at #ust
two in!ustrial centers in the country namely %anpur an! (elhi with a total co$erae of a"out 1&)
lac wor%ers&
There after the scheme was implemente! in a phase! manner across the country with the acti$e
in$ol$ement of the state o$ernment&
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Applicability
The ESIC Act applies to non'seasonal, power usin factories or manufacturin units employin
ten or
more persons an! non'power usin esta"lishments employin twenty or more persons& 2n!er the
ena"lin pro$isions of the act, a factory or esta"lishment, locate! in a eoraphical area, notifie!
for
implementation of the scheme, falls in the pur$iew of the act& Employees of the aforesai!
cateories of
factories or esta"lishments, "ut !rawin waes only up to 3s ,0 a month are entitle! to health
insurance co$er un!er the ESI act& The wae ceilin for purpose of co$erae is re$ise! from time
to
time5 to %eep pace with risin cost of li$in an! su"se6uent wae hi%es& The present ceilin of
3s
,0 has "een effecti$e from 1 7anuary 199 the appropriate o$ernment state or central is
empowere! to e+ten! the pro$ision of the ESI Act to $arious classes of esta"lishment, in!ustrial,
commercial, aricultural or otherwise in nature& 2n!er these ena"lin pro$isions most of the
state
o$ernments ha$e e+ten!e! the ESI act to certain specific classes of esta"lishments& i%e shops,
1ESI Act&1948& Sec&1
AC(s of :o$ernment
Centre for Ci$il Society 0
hotels, restaurants, cinemas, employin ) or more persons&) ut no in!ustry has the riht to opt
out
of the scheme&
;ae ceilin for co$erae
The monthly wae limit for co$erae un!er the ESI act woul! "e such as prescri"e! "y the
central
o$ernment in the ESI [central] rules, 190& The e+istin wae ceilin for co$erae [e+clu!in
remuneration for o$er'time wor%] is 3s&0 per month [rule 0 of ESI central rules, 190]& An
employee who is co$ere! at the "einnin of a contri"ution perio! shall continue to remain
co$ere!
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till the en! of that contri"ution perio! notwithstan!in the fact that his waes may e+cee! the
prescri"e! wae ceilin at any time after the commencement of that contri"ution perio!& Wage
ceiling for purpose of coverage is revised from time to time by the central government on
the
specific recommendation of the corporation, at present the corporation has recommended
for the
increase of the wage limit to s !",""" and its implementation is awaited#
ar aainst reco$ery of compensation or !amaes un!er any other law
An insure! person or his !epen!ants shall not "e entitle! to recei$e or reco$er, whether from the
employer or any other person, any compensation or !amaes un!er the ;or%men
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A!ministration
The comprehensi$e an! well'!esine! social security proramme is a!ministere! "y an ape+
corporate "o!y calle! the Employee State Insurance Corporation& It comprises mem"ers
representin
$ital interest roups that inclu!e, employee, employers, the central an! state o$ernment,
"esi!es,
representati$es of parliament an! me!ical profession& The corporation is hea!e! "y the union
minister of la"our, as its chairman, where as, the !irector eneral, appointe! "y the central
o$ernment functions as its chief e+ecuti$e officer& A stan!in committee constitute! from
amonst
the mem"ers of the corporation, acts as an e+ecuti$e "o!y& The me!ical "enefit council,
constitute! "y
the central o$ernment, is yet another statuary "o!y that a!$ises the corporation on matters
relate!
to effecti$e !eli$ery ser$ices to the "eneficiary population& The corporation with its central hea!
6uarters at >ew (elhi, operates throuh a networ% of ) reional an! su"' reional offices
locate! in
$arious state& The respecti$e state o$ernments ta%e care of the a!ministration of me!ical
"enefit&
E+cept in case of (elhi an! >oi!a, reater >oi!a areas of 2ttar pra!esh, where, the corporation
a!ministers me!ical facilities !irectly&0
) ESI Act&1948&Sec&1
* ESI Act&1948& Sec&0*?1
4 )1'))& ESI Annual 3eport
0 ESI Act 1948& Sec 8,9,1&
AC(s of :o$ernment
Centre for Ci$il Society
/inance
i%e most of the social security schemes, the worl! o$er, ESI scheme is a self'financin health
insurance scheme& Contri"utions are raise! from co$ere! employees an! their employers as a
fi+e!
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percentae of waes& As of now, co$ere! employees contri"ute 1&0@ of the waes, whereas as
the
employers contri"ute 4&0@ of the waes, paya"le to the insure! persons& Employers earning
less
than s $" a !ay as !aily wae are e+empte! from payment of their share of contri"ution& The
state
o$ernment as per the pro$ision of the act contri"utes 18 of the e+pen!iture on me!ical "enefit
within a per capita ceilin of 3s& per insure! person per annum& Any a!!itional e+pen!iture
incurre! "y the state o$ernment, o$er an! a"o$e the ceilin, an! not fallin within the sharea"le
pool, is "orne "y the state o$ernments concerne!& The contri"ution is !eposite! "y the
employer in
cash or "y chea6ue at the !esinate! "ranches of some nationalise! "an%s& The responsi"ility for
payment of all contri"utions is that if the employer with a riht to !e!uct the employees share of
contri"ution from employees waes relatin to the perio! in respect of which the contri"ution is
paya"le&
Contri"ution perio!s an! "enefit perio!
;or%ers, co$ere! un!er the ESI Act, are re6uire! to pay contri"ution towar!s the scheme on a
monthly "asis contri"ution perio! means a si+'month time span from 1 April to * Bcto"er an! 1
>o$em"er to *1 arch& Thus, in a financial year there are two contri"ution perio!s of si+
months
!uration& Cash "enefits un!er the scheme are enerally lin%e! with contri"ution pai!& The "enefit
perio! starts their months after the closure of a contri"ution perio!,
%ontribution period corresponding benefit period
! April to &" September ! 'anuary to &" 'une of the following year
! October to &! march !( 'uly to &! )ecember
3eistration
Simultaneously with his or her entry into employment in a co$ere! factory or esta"lishment, an
employee is re6uire! to fill in a !eclaration form& The employee is then allotte! a reistration
num"er,
which !istinuishes an! i!entifies the person for the purposes of the scheme& A person is
reistere!
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once an! only upon his entry in insura"le employment&8 ut recent S%*s judgement in
+alarishna v
ESI% has hel! that a wor%er co$ere! un!er the act woul! "e entitle! to "enefit from the !ate of
his
employment an! not from the !ate of reistration after contri"ution "y the employer&
I!entity car!
Bn reistration e$ery insure! person is pro$i!e! with a Dtemporary i!entification certificatea!a for early !etection an! treatment of occupational !iseases pre$alent
amon
wor%ers employe! in ha-ar!ous in!ustries& /or payment of cash "enefits, the corporation
operates
throuh a networ% of o$er 84 local offices an! cash offices, whose functionin is super$ise! "y
the
reional su"'reional offices& At the rass root le$el, ser$ices !eli$ery units, comprisin
!ispensaries,
clinics, hospitals an! local offices etc are the mainstay of the hue ser$ice intensi$e set'up&1
Social security "enefits
-uantum, scale and contributory conditions
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Employees co$ere! un!er the scheme are entitle! to me!ical facilities for self an! !epen!ants&
They
are also entitle! to cash "enefits in the e$ent of specifie! continencies resultin in loss of waes
or
earnin capacity& The insure! women are entitle! to maternity "enefit for confinement& ;here
!eath
of an insure! employee occurs !ue to employment in#ury or occupational !isease, the !epen!ants
are entitle! to family pension&
Farious "enefits that the insure! employees an! their !epen!ants are entitle! to, the !uration of
"enefits an! contri"utory con!itions therefor are as un!er
!# .edical benefit
/ull me!ical facilities for self an! !epen!ants are a!missi"le from !ay one of enterin insura"le
employment& ;hereas, the primary, out patient, in patient an! specialist ser$ices are pro$i!e!
throuh a networ% of panel clinics, ESI !ispensaries an! hospitals, super specialty ser$ices are
pro$i!e! throuh a lare num"er of a!$ance! empanelle! me!ical institutions on referral "asis&
Eligibility to medical benefit
G /rom !ay one of enterin insura"le employment for self an! !epen!ants such as spouse,
parents an! chil!ren own or a!opte!&
G /or self an! spouse on superannauation su"#ect to ha$in complete! fi$e years in insura"le
employment on superannuation or in case of ha$in suffere! permanent physical
!isa"lement !urin the course of insura"le employment&
G The rate of contri"ution for superannuate! !isa"le! is 3s 1,)) per annum paya"le in lump
sum at the local office for a$ailin full me!ical care for self an! spouse&11
1 An Intro!uction' ESIC Scheme of In!ia&
11 ESI Act 1948& Sec 0&
AC(s of :o$ernment
Centre for Ci$il Society 8
/# Sicness benefit 0cash1
Sic%ness "enefit is paya"le to an insure! person in cash, in the e$ent of sic%ness resultin in
a"sence
from wor% an! !uly certifie! "y an authorise! insura"le me!ical officer practitioner&
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G The "enefit "ecomes a!missi"le only after an insure! has pai! contri"ution for at least 8
!ays in a contri"ution perio! of months&
G Sic%ness "enefit is paya"le for a ma+imum of 91 !ays in two consecuti$e contri"ution perio!&[
one year]
G .ayment is to "e ma!e "y the local office within !ays of certificate of sic%ness at a stan!ar!
rate, which is not less than 0@ of the waes&1)
[The loic "ehin! fi+in of 8 ? 91 !ays of contri"ution is "ase! on certain statistics wor%e! "y
the
corporation to i$e cash "enefits& ut the officials in the corporation !on
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3# .aternity benefit 0cash1
aternity "enefit is paya"le to insure! women in case of confinement or miscarriae or sic%ness
relate! thereto&
G /or claimin this an insure! woman shoul! ha$e pai! for at least !ays in ) consecuti$e
contri"ution perio!s i&e& 1 year&
G The "enefit is normally paya"le for 1) wee%s, which can "e further e+ten!e! up to 1 wee%s
on me!ical roun!s&
G The rate of payment of the "enefit is e6ual to wae or !ou"le the stan!ar! sic%ness "enefit
rate&
G The "enefit is paya"le within 14 !ays of !uly authenticate! claim papers&14
4# )isablement benefit 0cash1
(isa"lement "enefit is paya"le to insure! employees sufferin from physical !isa"lement !ue to
employment in#ury or occupation !isease&
G An insure! person shoul! "e an employee on the !ate of the acci!ent&
1) ESI Act 1948& Sec 49&
1* ESIC Scheme of In!ia Citi-ens Charter
14 ESI Act 1948& Sec 0&
AC(s of :o$ernment
Centre for Ci$il Society 9
G Temporary !isa"lement "enefit at @ of the waes is paya"le till temporary !isa"lement
lasts an! is !uly certifie! "y authorise! insurance me!ical officer&
G In case of permanent !isa"lement, the cash "enefit is paya"le is paya"le for life& Amount
paya"le is wor%e! out on the "asis of earnin capacity !etermine! "y a me!ical "oar!&
G (isa"lement "enefit is paya"le within one month of su"mission of the complete claim
papers&10
5# )ependands benefits 0cash1
(epen!ants "enefit [family pension] is paya"le to !epen!ants of a !ecease! insure! person
where
!eath occurs !ue to employment or occupational !isease&
G A wi!ow can recei$e this "enefit on a monthly "asis for life or till remarriae&
G A son or !auhter can recei$e this "enefit till 18 years of ae&
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G Bther !epen!ants li%e parents inclu!in a wi!owe! mother can also recei$e the "enefit un
un!er certain con!ition&
G The rate of payment is a"out @ of the waes sharea"le amon !epen!ants in a fi+e! ratio&
G The first installment is paya"le within a ma+imum of * months followin the !eath of an
insure! person an! thereafter, on a reular monthly "asis&1
(# Other benefits
a# a# 6uneral e2penses
Bn the !eath of an insure! person su"#ect to a ma+imum of a 3s& ),0 paya"le at the local
office&
b# 7ocational rehabilitation
In case of !isa"le! insure! persons un!er 40 years of ae with 4@ or more !isa"lement&
c# 6ree supply of physical ai!s an! appliances such as crutches, wheelchairs, spectacles an!
other
such physical ai!s&
d# 8reventive health cares ser$ices such as immuni-ation, family welfare ser$ices, HIFAI(S
!etection, treatment etc&
e# .edical bonus 3s)0 is pai! to an insure! woman or in respect of the wife of an insure!
person in
case she !oes not a$ail hospital facilities of the scheme for chil! !eli$ery&1
Employee State Insurance Corporation, (elhi reion
The scheme was implemente! in (elhi on )4 /e"ruary 190)& As on *1 arch )) 4&94 lac
employees
an! 0&0 lac insure! persons are co$ere!& The num"ers of "eneficiaries inclu!in insure! in
(elhi are
)1&90 lac& The scheme is a!ministere! throuh the reional office locate! at (elhi (e$elopment
Authorityew (elhi&
The cash
"enefits are !is"urse! throuh a networ% of 1) local offices& The me!ical care is a!ministere! "y
the
corporation itself in the national capital territory of (elhi&
10 ESI Act 1948& Sec 01&
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1 ESI Act 1948& Sec 0)
1 ESIC Scheme of In!ia, Citi-ens Charter
AC(s of :o$ernment
Centre for Ci$il Society
Co$erae
The co$erae position of (elhi reion as on *1'*')) is as un!er
[/iures in lacs]
9EA
! /""" /""! /""/
>o of employees 0&4* 0&*) 0&) 4&94
>o of insure!
persons
0&8 0&8 0&) 0&0
>o of "eneficiaries ))&44 ))&4 )1&8) )1&90
>o of employers &)0 &)) &)) &)8
;e can clearly fin! in the a"o$e column, that year "y year, >um"er of Employees an! num"er of
eneficiaries co$ere! are !ecreasin, the reason i$en the Assistant !irector of ESIC, (elhi 8 ;
haul
is that, there has "een a chane in the pay scale yearly an! as an! when the pay scale increases
a"o$e
3s ,0 the >um"er of Employees who come un!er the act are re!uce!, "ut he has also faile! to
note
an important point that num"er of new employees comin un!er the act are also increasin
yearly&
Income an! e+pen!iture
It shoul! "e note! that the ESI Corporation controls the whole fun! of the ESIC !irectly an! the
reional office in particular state has no say with rear! to financial a!ministration& The
corporation
has one "u!et yearly an! it allocates the fun! to particular state on the "asis of total num"er of
"eneficiaries, e+pen!iture of the prece!in year an! re6uirement of the ne+t year&
The position of contri"ution income realise! an! e+pen!iture incurre! "y the (elhi corporation
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!urin the last * years is shown "elow[ fiures in lacs]
9EA %ontribution
income
EE
Cash ? other
"enefit
e+clu!in
me!ical "enefit
A!ministrat
i$e
e+pen!iture
Total e+pen!iture on
re$enue account
e+clu!in me!ical
"enefit
ESI
E(ICA
(EHI
1999') 9)9&89 09&84 99)&1) 101&9 8*80&19
)')1 91&1 9*&4* 9&)0 18*&9 918&9)
)1')1 94&0 9**&18 90)&90 188&1* 944&9)
Note: the above figures do not contain the capitalised value expenditure in medical care during
the years.
E+pen!iture inclu!es e+pen!iture on me!ical "enefit, cash an! other "enefits, a!ministrati$e
e+penses an! total e+pen!iture of !rus an! !ressin with pay an! allowances "ut e+clu!in rent
of
"uil!in&
AC(s of :o$ernment
Centre for Ci$il Society 1
a%e payment of arrears to assistant ca!re as per CAT or!er&
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It should be noted that the findings from the above table are very clear, that the
e2penditure is
more than the revenue of the corporation# =he reason given for this by .rs =homas,
director, ESI%
)elhi is that, it is only in )elhi, which has $ major hospitals, including a super specialty
hospital
in ohini, which caters the needs of employees through out north India#
3eser$e fun!s an! in$estment of ESIC fun!s
The in$estments ma!e "y the corporation pertainin to !ifferent reser$e fun!s an! ESIC eneral
reser$e fun!s as on *1'*')) were as un!er
S?#;O ;A.E O6 =@E 6>;)S A.O>;= AS
O; &!&/""/0s
lacs1
1 ESIC .3BFI(E>T /2>( )*909&99
) ESIC :3B2. I>S23A>CE /2>( *1&84
* .E>SIB> 3ESE3FE /2>( 1,94&
4 (E.3ECIATIB> 3ESE3FE /2>( B/
B//ICE 2I(I>:S A>( STA//
J2A3TE3S
0*)&00
0 (E.3ECIATIB> 3ESE3FE /2>( B/
HBS.ITA 2I(I>:S
1)*&4)
STA// CA3S 3E.ACEE>T3ESE3FE
/2>(
)0&91
3E.AI3 A>( AI>TE>A>CE 3ESE3FE
/2>( /B3 B//ICE 2I(I>: A>( STA//
J2A3TE3S
449&8
8 3E.AI3 A>( AI>TE>A>CE 3ESE3FE
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/2>( /B3 HBS.ITA 2I(I>:S
40&8
9 .E3A>E>T (ISAEE>T E>E/IT
3ESE3FE /2>(
19*81&*1
1 (E.E>(A>T E>E/IT 3ESE3FE /2>( 0*11&88
11 CA.ITA CB>ST32CTIB> 3ESE3FE
/2>(
404&81
1) CB>TI>:E>C 3ESE3FE /2>( 0&
1* I>FESTE>T B/ ESI :E>E3A 3ESE3FE
/2>(
48*&9)
TBTA *18&
It shoul! "e note! from the a"o$e ta"le that ESIC has a hue amount of reser$e fun!& The reason
for
such e+cess amount in the corporation is that, it is less than 0@ of the employees potentially use
the
"enefit offere! to them& ost of the employees prefer to o to pri$ate hospitals rather than wait
for
the corporation to appro$e their "enefit& I ha$e foun! that ettin a sanction for the me!ical or
cash
"enefit is such a cum"ersome proce!ure that it ta%es months to et the appro$al& oreo$er most
of
the employees are illiterate who are not in the position to file an application in the office&
Infrastructure for !eli$ery of me!ical care
The me!ical scheme in (elhi is "ein a!ministere! "y the Corporation throuh a separate
!irectorate
hea!e! "y !irector [me!ical] (elhi& In national capital territory of (elhi full me!ical care
comprisin
of< Dout patient ser$ices< specialists ser$ices an! hospital ser$ices is pro$i!e! un!er ESI scheme
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AC(s of :o$ernment
Centre for Ci$il Society )
throuh ser$ices !ispensaries !ianostic centres an! ESI hospitals& The e+pen!iture on me!ical
care
is share! "etween the ESI Corporation an! o$ernment of >CT of (elhi in ratio of 1& The
me!ical
infrastructure in the national capital territory of (elhi as un!er
!# ;o# of ESI hospitals with bed strength as on &!&/""/
S#;O ;A.E O6 =@E @OS8I=A? +E) S=E;B=@
1& ESI HBS.ITA, ASI(A3A.23, >E;
(EHI
00K0 E(S /B3 BCC2.ATIB>A
(ISEASE CE>TE3&
)& I>(I3A :A>(HI ESI HBS.ITA,
7HII, (EHI
)4K1 E(S /B3 I>(I:E>B2S
SSTE B/ E(ICI>ES
*& ESI HBS.ITA B=HA, >E; (EHI )) E(S [1 E(S
CBISSIB>E(]
4& ESI HBS.ITA, 3BHI>I, >E; (EHI ) E(S [1 E(S
CBISSIB>E(]
/# eserved beds in other hospitals as on &!&/"/
S#;O#
;A.E O6 =@E @OS8I=A?
;O#O6#+E)S
1& 3&&T&& HBS.ITA, =I>:S;A CA., >E;
(EHI
4[T E(S]
)& &3&S&T&& HB.ITA, EH3A2I, (EHI 0[T E(S]
>.+E O6 ESI )IS8E;SAIES
a& /ull time !ispensaries **
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"& o"ile !ispensaries 1
c& Ayur$e!ic wins 9
e& (ianostic centres 4
$#8osition of type of medical care as on &!&/""/
;ame of the
state
estricted medical care E2panded medical care 6ull medical care
>nitC
(elhi L L 0,0,90
3# ;o# of I.O*sD specialistsD para medical and other categories staff in ESI hospitalD
dispensaries,
diagnostic centres, Ayurvedic wings, family welfare projects, central
AC(s of :o$ernment
Centre for Ci$il Society *
;O ;ame of the
posts
ESI hospital
+asaidarapur
ESI hospital,
'ilmil
ESI hospital,
ohla
ESI hospital,
ohini
SA>C
TIB>E
(
.BSIT
IB'>
SA>C
TIB>E
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(
.BSIT
IB>
SA>C
TIB''
>E(
.BSITI
B>
SA>CTI
B>E'I(
.BSITI
B>
1 :E>E3A
(2T
B//ICE3S
1) 01 84 44 *0 *) 84 )
) S.ECIAIST
S
4 *K)
.T
)* 10 1 18 )* 1)
* (E>TA
S23:EB>
* ) 1 1 1 L ' '
4 SE>IB3
3ESI(E>TS
09 48 )* 10 1 ) 1
0 72>IB3
3ESI(E>TS
0 14 14 ' 1 ' '
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.A3A
E(ICA?
>23SI>:
STA//
89 40 ** )1 )) 10 * 114
BTHE3
CATE:B3
STA//
*9 * 190 11 * 9 110 0*
4# O%%>8A;%9 O6 @O8I=A? +E)S A;) SE7I%ES >=I?ISA=IO; A==E;)A;%E
I;
@ospitals, specialists centre, investigations, ;umber of Admissions from ! A8I? /""! to
&!
.A%@ /""/#
a& Hospitals
S; ESI
hospital
+eds Occupancy Attendance Admissions Investigatio
n
1 asai!arap
ur
8@ 084 *044 9))
) 7hilmil )0 8*@ ))89 1)*)9 )109
* B%hla ))[1]
commissio
ne!
149@ ))44 980 1441
4 3ohini ))[1]
commissio
ne!
9@ 1*8*1 04 99
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b# Attendance in dispensaries up to &!&/""/:
Atten!ance of I.o& Bf& Employees !eeme! e+pose! to ris% for sic%ness e+ten!e! sic%ness "enefit '0,),9
G =otal no of %ash benefit payments !,"/,&/
G A$erae no of Cash "enefits payments per employee per annum '&19
G A$erae !aily "enefit rate 3s& &)1
G aternity "enefit, a$erae amount pai! per confinement 3s11,4)9
;umber of worers who became permanently disabled and die at wor in /""/
.ermanent !isa"lement ' 094
>o of !eath cases M*8
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8osition of on going construction projects
8lots acFuired for construction projects
1& ;a-ir .ur, )'0'99 M plans appro$e! "y C( on *''))&
)& Ar#un naar, 1'*'8' oun!ary wall constructe!& .lans with C(, >BC rante! "y ((A up
to )*'')*&
*& ayur $ihar, 1*''9) M plans with HJ3SC( for appro$al&
8osition of pending reimbursement cases, number and amount as on &!&/""/
*9 '3s&)4,4,)18
Bn papers, the ESI Corporation in (elhi appears iantic with 0,9,90 insure! persons
)1,90,9
"eneficiaries, four ma#or hospitals with 1,110 "e!s, ** !ispensaries, 0 !octors with annual
re$enue
of 94& crores& In reality, the Coporation is ri!!le! with pro"lems& ac% of proper ser$ice,
unfrien!ly
!octors, an! cum"ersome proce!ures restrict employees from usin their "enefits to full
potential&
18 ESIC Annual 3eport )1')
AC(s of :o$ernment
Centre for Ci$il Society 0
(octors !o not i$e proper treatment an! prefer to atten! to the payin patients& As a result,
employees are often force! to pay more than their monthly contri"utions& The !ispensaries !o not
ha$e enouh me!icines in stoc% an! persua!in a !octor to authorise the purchase of me!icines
elsewhere is a cum"ersome an! time'consumin process& (octors are $ery often a"sent an!
hospital
e6uipments are "ro%en for e+ten!e! perio!& .atients sufferin from occupational !isease ha$e
!ifficulty fin!in proper treatment& ;or%ers complain of "ein treate! as "ears at the ESIC
office&
/or instance, when I $isite! =A=A7I !ispensary I foun! a patient [7ual opee] who was
sufferin from some luns pro"lem "ein !enie! a!mission in the hospital, the reason i$en "y
the !octor was that he ha! no serious pro"lem to "e a!mitte! in the hospital& The !octors were
"usy ha$in snac%s for half an hour e$en thouh the patients were in a lon 6ueues& In
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ayapur !ispensary out of 1 !octors on !uty only * !octors were present, con!ition of the
toilets were pathetic& The story of Sham al is precarious, he ha! a "asic pro"lem suffere! "y a
human "ein li%e fe$er an! hea!ache, the !octor ha! written for a .aracetamol an!
>eimusuli!e& ut to my surprise I foun! that Sham al !i! not et >eimusuli!e ta"lets "ecause
the ta"lets were out of stoc%& Bne shoul! imaine that if a !ispensary !oesn
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clear itself of all leal o"liations& They stri%e off the name of e$ery wor%er from the roll list
once he
has wor%e! for a perio! of up to 89 !ays& E$en thouh, in many cases, the same employee is
ta%en
"ac% within a wee%, the roll'list now shows his name as a fresh employee& Therefore at any point
in
time, thouh hun!re!s of wor%ers are actually wor%in in the factory, the roll'list woul! not
contain
the names of the ma#ority of them since they are all !e #ure employe! for less than * months&
=his
what happened to .ahesh a machine operator, who gets no benefit from the ESI, even
though he
is contributing for the corporationC I had met a person by name ;arayana, whose fingers
was cut
off while operating a machine some !! years bac# =ill now he has neither got medical nor
the cash
benefit# @is case is pending from the past !! years# =he story of S#G#Bupta, am abir,
Burvindar
are allsimilar whose cases are pending from past many years# Bod nows the plight of all
these
employeesH
.oor cash manaement
(urin the course of au!it of (elhi reion of ESIC, au!it notice! that )90 employers !eposite! a
sum
3s **&)9 lacs into the State "an% of In!ia, Shah!ara, (elhi !urin 1988 to 199& ut the "an%
faile! to
cre!it this amount in the account of ESIC& To resol$e this, three meetins "etween officers of
SI an!
ESIC were hel! !urin may 1998 an! march )1, till now this amount has not "een cre!ite! in
the
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account of ESIC& Thus failure to protect its financial interests resulte! not only in losin s
&/ lacs
"ut also loss of interest of s $3#! lacs& Apart from this ESIC in (elhi has faile! to reco$er s#
(5
AC(s of :o$ernment
Centre for Ci$il Society
crore from (elhi o$ernment on account of e+pen!iture incurre! on me!ical care "y ESIC
(elhi& In
(elhi, where the scheme is !irectly run "y the ESI Corporation, the entire e+pen!iture on
me!ical
care is incurre! initially "y the corporation an! is su"se6uently share! with o$ernment of (elhi&
E+pen!iture incurre! "eyon! the amount "eara"le "y ESIC is reco$era"le from the o$ernment
of
(elhi in !ue course& The o$ernment& of >CT of (elhi ha! "een sharin an! payin 18 share of
e+pen!iture on me!ical care plus e+penses incurre! o$er an! a"o$e the ceilin up to the year
1989'9&
Su"se6uently the o$ernment of >CT of (elhi !i! not pay their share from the year 199'91 on
the
plea that they are not lia"le to pay the e+pen!iture "eyon! the ceilin in the a"sence of
areement&
The issue has "een ta%en up with o$ernment of >CT of (elhi at the hihest le$el& The
o$ernment
of (elhi has not committe! to pay its so far&
E$en thouh there has "een chane in the metho!oloy of selectin units for inspection the
>um"er of Inspection, which was to "e hel! as on )), was 1*,*)1 "ut till now only )*
inspections
were con!ucte!& This is one of the main reasons for ESIC (elhi "ein in arrears of 3s )&*)
crore as on
*1'*'))& Apart from this the ESIC annual reports are spea%in the mantra of computerisation
of ESI
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!ispensaries an! local offices, "ut to the "est of my %nowle!e I coul! not fin! a sinle computer
in
local office or the !ispensaries& >ow where !oes all this money oN =he e2penditure of the
corporation is more than its revenue from the past four years, if this state continues, what
is the
future of ESI% in )elhiC The ESIC in (elhi has set a HIFAI(S cell with the assistance of
>ATIB>A AI(S CB>T3B B3:A>ISATIB> in the year 1999, In or!er to pre$ent control
sprea!
of HIFAI(S amonst ESI "eneficiaries& ut e$en after three years it has not come up with any
official
!ata& Is the cell really functioningC )r aju in chare of the cell has no answer for this
6uestion& The
ESIC (elhi has set up a pu"lic rie$ances commission to loo% into the rie$ances an! !ifficulties
face! "y the employees, "ut has the commission "een successful in sol$in the pro"lems of the
employees is the 6uestion to "e answere! "y the commission& Thus the employees< state
insurance
corporation in (elhi has "ecome a legalised way of duping the employers and the employees
at
large* clearly, it nee!s a fun!amental chanes so it is more fruitful to the employees& E$en as
there
has "een a sea of chane in the in!ustrial sector, the ESI scheme is continue! with the same
pro$isions& The system cannot "e ma!e more $ia"le an! useful without the participation of the
employees& Bne of the reasons for the failure of the corporation is lac% of acti$e participation "y
the
employees& /or instance there is no sta"le employees union or oranisation to loo% into the
functionin of the corporation& Bne of the "est ways to impro$e the functionin of the
corporation is
to pri$atise the manaement of the newly constructe! hospitals, which the state o$ernment has
faile! to commission on time& If pro$e! successful, the scope of pri$atisation woul! "e e+ten!e!
to
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other ESI hospitals whose performance is "elow stan!ar!& In fact the Sathyam committee which
was
forme! to loo% into the !iscrepancies in the functionin of ESI hospitals ha! recommen!e! that
surplus capacities coul! "e lease! or rente! to the pri$ate sector& Three T.A
e!icare .$t& T( has ma!e a "i! for the scheme& ut there has har!ly "een any hea!way on
this
front& Some of the recommen!ations i$en "y 7E.A %O..I==EE to ta%e steps to ma%e
the
system more $ia"le an! useful are li%e enhancement of wae ceilin for purpose of co$erae
from the
present 3s ,0 to a minimum of 3s 9,& /or up ra!ation of me!ical ser$ices un!er the
scheme,
the committee has recommen!e! enhancement on e+pen!iture of me!ical "enefit from the
present 3s
to 3s& 80, the new ESI hospitals shoul! not "e constructe! as lon as any a!!itional
ser$ices
re6uirements coul! "e out'source! throuh tie'up arranement with o$ernment of pri$ate
me!ical
institutions issuin of national i!entity car!, which coul! ena"le a "eneficiary to utilise the
treatment
facilities from the ESI hospitals or institution across the country, the employees shoul! "e
allowe! to
utilise pri$ate me!ical facilities, instea! of only oin to ESI hospitals an! !ispensaries, the
present
system which is tar!y nee!s to "e controlle! "y ESI employers an! employees& The role of
finance,
la"our an! health !epartments shoul! "e cut !own&19
19 Tri"une >ews Ser$ice, )) Bct&
AC(s of :o$ernment
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Centre for Ci$il Society
The stratey
Thus the only way to achie$e this oal is "y participation of citi-ens roups an! other non'profit
aencies that a!$ocate for wor%ers< health care rihts& These roups can pressurise ESIC at the
local
le$el to impro$e me!ical ser$ices, the supply of me!icines, an! "enefits relate! to acci!ents an!
occupational !isease& any of the aencies are a!!ressin this aspect, "ut o$erall coor!ination
has
"een lac%in& These lo""yin roups shoul! #oin force with the wor%ers< watch!o committee
an!
start a "ier mo$ement to enerate pressure on the roun! for lealise! rihts of wor%ers in
helpin
them to form an! monitor the ESIC& Chane can only come a"out on the "asis of "uil!in up
consistent rassroots'"ase! pressure roups reionally an! nationally& The me!ia, which has
shown
fa$or towar!s the contri"utin employees rear!in the issue of the ESIC in the past, will also "e
le$erae! effecti$ely& Toether they can wor% to "roa!en the scope of the ESIC co$erae to the
informal sector throuh the * amen!ment of the constitution, which calls for local self'
o$ernance
from the $illae to the !istrict le$els&
Ac%nowle!ement
.&>& =aul, pu"lic relation officer, ESIC hea! office'>ew (elhi&
>alini Than!an, me!ical officer, ESIC hea! office' >ew (elhi&
anala, accounts !epartment, ESIC hea! office'>ew (elhi&
Thomas, !irector, ESIC 3eional office'>ew (elhi&
r& 7oon, !eputy !irector, ESIC reional office'>ew (elhi&
(r 3a#u, hea! of HIF cell !epartment, ESIC reional office'>ew (elhi&
(r artin athew, me!ical superinten!ent, ESIC hospital, asai!arapur'>ew (elhi&
(r 3e%ha Ararwal, ESIC !ispensary, %al%a#i&
.rala! ala$a!%ar, researcher an! trainer of wor%ers on ESIC'um"ai&
r >arayan, secretary, employee union'>ew (elhi&
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eshwanth Shenoy, A!$ocate'um"ai&
3eference
ESIC Annual 3eport')1'))
/inancial Statement an! .erformance u!et'))')*
ESIC are Act 1948
Stan!ar! >ote on ESI Scheme of In!ia'))
Employers :ui!e arch')*
ESIC Citi-ens Charter
Employees :ui!e')*
rief proce!ure for claimin cash "enefits
>ewspaper article on Ferma Committee 3eport
>ewspaper articles on ESIC
Annual 3eport of ESIC Hospital asai!arapur