ESIC – Employee State Insurance Scheme Benefits, Eligibility, Coverage

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The Employees’ State Insurance Scheme of India (ESIC) aims to provide socio-economic security to employees in the organized sector. This comprehensive scheme is administered by the Employees’ State Insurance Corporation, a statutory corporate body. The ESIC safeguards employees against various risks, including illness, maternity, disability, and fatalities resulting from workplace accidents. Additionally, the scheme ensures medical care for insured employees and their families. Continue reading below for detailed information about the ESIC Scheme.

What is ESIC Scheme 2025 ?

The ESIC Scheme 2024, or the Employees’ State Insurance Scheme, is a comprehensive social insurance program aimed at providing financial and medical protection to workers and their families. This scheme safeguards employees against income loss due to circumstances such as illness, disability, maternity, or death resulting from workplace injuries. Additionally, it ensures access to quality medical care for insured employees and their dependents.

The Employees’ State Insurance Corporation (ESIC) was established under the Employees’ State Insurance Act and operates as an autonomous organization under the Ministry of Labour and Employment, Government of India. The Act empowers the ESIC to offer a wide range of benefits and protections for workers.

As a legal entity, the corporation is authorized to raise and repay loans, subject to approval by the regulatory authorities. It can acquire both movable and immovable property in its name and retains all income generated through its operations. This robust framework ensures the scheme's sustainability and effectiveness in delivering its objectives.

OROP Pension Table 2025

ESIC Scheme 2025 Objective

The primary objective of the Government of India in implementing the Employees’ State Insurance (ESI) scheme is to safeguard workers from specific health-related risks. These include illness, permanent or temporary disablement, or death resulting from occupational diseases or workplace injuries that can hinder a worker's ability to earn a livelihood or lead to income loss. The scheme aims to alleviate the financial burden caused by such adverse events. Additionally, it offers maternity benefits to eligible beneficiaries, further enhancing its support to employees.

Features & Benefits of ESIC Scheme 2025 

• Affordable Healthcare: The scheme ensures that insured individuals receive medical treatment through cost-effective and high-quality healthcare providers. From the day of employment, the worker or employee is comprehensively covered.
• Temporary Disability Benefits: Employees who are temporarily incapacitated are entitled to receive 90% of their monthly salary until they recover fully.
• Permanent Disability Benefits: In cases of permanent incapacity, beneficiaries are entitled to 90% of their monthly wages for the rest of their lives.
• Maternity and Family-Related Benefits: Insured women can claim 100% of their daily wages for up to 26 weeks during maternity leave. This can be extended for an additional month if recommended by a medical professional. Benefits are provided for six weeks in case of a miscarriage and 12 weeks in the case of adoption.
• Medical Leave Compensation: Employees can receive 70% of their daily wages for up to 91 days for medical leave over two consecutive periods.
• Coverage from Day One: Both the insured person and their dependents are covered as soon as employment begins.
• Dependent Support: In the unfortunate event of work-related illnesses or injuries, the dependents of the insured receive financial support. Monthly payments are divided equally among the surviving dependents.
• Post-Retirement Benefits: Upon retirement, voluntary or early retirement, or inability to work due to permanent disability, an annual payment of Rs. 120 is provided to the insured and their spouse.
• Funeral Expenses: A lump sum of Rs. 15,000 is provided to the insured’s dependents or the person conducting the last rites to cover funeral expenses.

These features make the ESIC Scheme 2025 a comprehensive safety net for employees and their families, ensuring financial security and access to essential healthcare services.

One Nation One Subscription Scheme

Required Documents for ESIC Scheme                                                            

Some of the important documents required for ESIC Scheme are as follows:

• Registration Certificate
• List of all employees working in the establishment
• Certificate of Registration in case of a partnership or a company
• PAN Card details of the Business Entity
• PAN Card details of all employees.
• Articles of Association and Memorandum of Association of the company
• Employees Compensation details
• Register which includes the attendance details of the employees
• Cancelled cheque of the bank account of the company
• List of shareholders and directors of the company

Eligibility Criteria for ESIC Scheme 2024 

The following entities are eligible to apply for the ESIC Scheme 2024:

• Non-seasonal factories employing 10 or more persons
• Hotels
• Restaurants
• Shops
• Road motor transport undertakings
• Cinemas including preview theatres
• Newspaper establishments
• Establishments engaged in Insurance Business
• Non-Banking Financial Companies,
• Airport Authorities
• Port Trust
• Warehousing establishments
• Private Institutes having 10 or more persons in employment
• Medical and Educational Institutes having 10 or more persons in employment, etc

Working of ESIC Scheme

The ESIC (Employees' State Insurance Corporation) scheme operates on a self-financing basis, relying on contributions from both employers and employees. These contributions are required to be deposited with the ESIC within 15 days following the end of the month in which the contribution is due. Employers are responsible for collecting the employee’s contribution and submitting the combined amount through approved banks, either online or offline.

The contribution rates are determined by the government and are currently set at 1% of the employee’s wages and 4% of the employer’s wages. For newly registered setups, during the first 24 months, the contribution rates are slightly reduced, with employees contributing 1% and employers contributing 3%. Additionally, employers may choose to contribute on behalf of workers whose daily wages are below ₹137. Employees who earn less than ₹137 per day are exempt from making any contributions to the scheme.

Procedure for ESIC Scheme Employer Registration 

Employers with more than ten workers on any given day are required to register with the Employees' State Insurance (ESI) scheme.

• Submission of Form-01: The first step in the registration process is for the employer to submit the ESIC registration Form-01.
• Issuance of Unique Identification Number: Upon submission of Form-01, the employer will receive a 17-digit unique identification number, also known as the code number, from the regional ESIC office. This number is typically issued within 15 days of the form submission.
• Use of Unique Code Number: The code number will be used in all correspondence related to the ESIC scheme.
• Form 3 Declaration: Along with Form-01, employers must submit a declaration in Form 3, which provides additional details about the establishment and its employees.

Once registered, the employer can proceed with the necessary steps for making contributions and ensuring that employees are enrolled under the scheme.

Procedure for ESIC Scheme Employee Registration 

When an employee joins a Private Limited Company, they must complete the following steps for registration under the Employees' State Insurance (ESI) scheme:

• Completion of Form 1 (Declaration Form): The employee is required to fill out Form 1, also known as the Declaration Form, which includes personal and family details.
• Submission of Family Photo: Along with the Declaration Form, the employee must provide a copy of their family photo. This is submitted by the company to the ESI branch office.
• Issuance of Photo ID and Insurance Number: Within three months of joining the ESI scheme, the employee will receive a permanent photo ID card and an insurance number, which will serve as their unique identification under the scheme.
• Transfer of Registration: If the employee switches companies, their ESIC registration can be transferred, ensuring continued coverage under the scheme.

This process ensures that employees are registered and receive all the benefits of the ESIC scheme.

Do’s and Don’ts under the ESI Plan 

Here are some important guidelines for ESI beneficiaries to keep in mind:

Do’s:

• Provide ESI Registration Number: If you change employers, make sure to provide your ESI Registration Number to the new employer to ensure continuity of coverage.
• Carry ESI Card for Treatment: To avail treatments at ESI hospitals and dispensaries, always carry your ESI Card, Pehchan Card, or e-Pehchan Card.
• Follow Doctor’s Advice: Always adhere to the treatment and advice provided by the doctor to ensure proper medical care and recovery.

Don’ts:

• Don’t Lose Your ESI Card: Ensure that your ESI smart card is not lost. If lost, obtaining a new e-Pehchan card might be challenging.
• Report Card Theft: If your card is stolen or lost, immediately notify the nearest ESIC dispensary or branch office to avoid misuse.

By following these simple guidelines, beneficiaries can ensure they receive the full benefits of the ESI scheme and maintain smooth coverage throughout their employment.

ESIC – Employee State Insurance Scheme Contact Details

For further details or in case of any query or complaint related to the ESIC Scheme, feel free to contact on the below-given details:

Address:

ESI Head Office

Employees’ State Insurance Corporation

Panchdeep Bhawan

Comrade Indrajeet Gupta (CIG) Marg,

New Delhi – 110 002

Phone Numbers:

011-23234092

23234093

23235496

23234098

23236051

23236998

23235187

Toll-Free/Help Desk Number: 1800-11-2526

Medical Helpline: 1800-11-3839

Official Website:- https://www.esic.gov.in/

E-Mail Id for Grievances/Suggestions: pg-hqrs@esic.nic.in

E-Mail Id for IT Related Issues: itcare@esic.nic.in

Summary of ESIC - Employee State Insurance Scheme

The Employees’ State Insurance Scheme (ESIC) provides social and medical security to workers in the organized sector. Administered by the Employees’ State Insurance Corporation (ESIC), it covers risks such as illness, maternity, disability, and workplace accidents. The scheme offers financial and medical benefits, including healthcare, temporary and permanent disability benefits, maternity leave compensation, and funeral expenses. Contributions from both employers and employees ensure the scheme’s sustainability.