• Non-seasonal factories using power and employing ten(10) or more persons
• Non-seasonal and non power using factories and establishments employing twenty (20) or more persons.

As provided under the ESI Act, the scheme is administered by a duly constituted corporate body called the Employees’ State Insurance Corporation (ESIC).  It comprises members representing Central and State Governments, Employers, Employees, Parliament and the medical profession.  Union Minister of Labour functions as Chairman of the Corporation whereas the Director General, as chief executive, discharges the duty of running the day-to-day administration.

A Standing Committee representing all stake   holders is elected from the body corporate for managing the affairs of the scheme and monitoring the progress of implementation of various decisions and policies etc. from time to time.

The Medical Benefit Council , a statutory body advises the Corporation on matters related to administration of medical benefit under the ESI scheme.

The central headquarters of the Corporation is located at New Delhi.  For purpose of coverage, revenue collection, extension of the scheme to new classes of establishments, implementation of the scheme in new areas, co-ordination with the State Governments and general administration the Corporation has established Regional and sub-Regional Offices across the country mostly located in State capitals.

Given the huge number of beneficiaries – about 329 lakhs now – the Corporation has set up a wide spread network of service outlets for prompt delivery of benefits in cash and kind that includes full medical care.

Medical facilities are provided through a network of 1427 ESI Dispensaries, over 2100 Panel Clinics, 307 diagnostic centres besides 143 ESI hospitals and 43 hospital annexes with over 27000 beds.  For providing super-speciality medical care the Corporation has tie up arrangements with advanced medical institutions in the country, both in public and private sector.  The medical benefit is administered with the active co-operation of State Governments.

The payment of cash benefits is made at the gross roots level through as many as 800 Branch Offices and Cash Offices that function under the direct control of the Corporation. 

The ESI Scheme is mainly financed by contributions raised from employees covered under the scheme and their employers, as a fixed percentage of wages.  As of now, the rates of contribution are:- 

1. Employees’ earning upto Rs.50/- a day as wages are exempted from payment of their part of contribution.                                                                    
2. The State Govts bear one-eighth share of expenditure on Medical Benefit within the per capita ceiling of Rs.900/- per annum and any additional expenditure beyond the ceiling.

Employees of covered units and establishments drawing wages upto Rs.10,000/- per month come under the purview of the ESI Act, 1948 for multi-dimensional social security benefits.

Employees covered under the scheme are entitled to medical facilities for self and dependants.  They are also entitled to cash benefits in the event of specified contingencies resulting in loss of wages or earning capacity.  The insured women are entitled to maternity benefit for confinement.  Where death of an insured employee occurs due to employment injury or occupational disease the dependants are entitled to family pension – the dependants benefit.

Various benefits that the insured employees and their dependants are entitled to, the duration of benefits and contributory conditions therefore, are as under ; - 

Full medical facilities for self and dependants are admissible from day-one of entering insurable employment.  Whereas, the primary, out patient, inpatient and specialist services are provided through a network of Panel clinics, ESI dispensaries and hospitals, super speciality services are provided through a large number of advanced empanelled medical institutions on referral basis.

Sickness Benefit is payable to an insured person in cash, in the event of sickness resulting in absence from work and duly certified by an authorised insurance medical officer/practitioner.

Extended Sickness Benefit is payable to insured persons for the period of certified sickness in case of specified 34 long term diseases that need prolonged treatment and absence from work on medical advice.

• ESB is payable for a maximum period of two years on the basis of proper medical certification and authentication by the designated authority.
• Amount payable in cash as extended sickness benefit is equal to about 70 per cent of the daily wages.
• The benefit is payable within 7 days following the submission of complete claim papers at the Branch Office concerned.

This cash benefit is payable to insured persons in the productive age group for undergoing sterilisation operation, viz. vasectomy/ tubectomy .

Maternity Benefit is payable to insured women in case of confinement or miscarriage or sickness related thereto.

Disablement Benefit is payable to insured employees suffering from physical disablement due to employment injury or occupational disease.

Dependants benefit (family pension) is payable to dependants of a deceased insured person where death occurs due to employment injury or an occupational disease.

Some other benefits offered by the Scheme are:-

• Funeral expenses on death of an I.P. subject to a maximum of Rs.2500/- payable at the Branch Office.

• Vocational Rehabilitation in case of disabled insured persons under 45 years of age with 40 percent or more disablement.

• Free supply of physical aids and appliances such as crutches, wheelchairs, dentures, spectacles and other such physical aids.

• Preventive health care services such as immunisation, family welfare services, HIV/AIDS detection, treatment etc.

• Confinement Allowance @ Rs.1000/- is paid to an insured woman or in respect of the wife of an insured person in case she does not avail medical facilities of the scheme for child delivery.

a) Duties of Employers

(b)     Rights of Employers

• Right to receive payment of any benefit under the Act shall not be transferable or assignable.

• Cash Benefits payable under the Act are not liable to attachment or sale in execution of any decree or order of any court.

• Employer shall not dismiss, discharge or reduce the wages or otherwise punish a covered employee during the period he/she is in receipt of Sickness Benefit or Maternity Benefit etc.

• By reason of his liability to pay his share of contribution under the ESI Act, no employer shall directly or indirectly reduce the wages of a covered employee.

• Right to register their grievances/complaints at any level for immediate redressal.

• Right to approach ESI Court against any action/decision of the Medical Board etc.

The ESIC is to ensure that:

• The quality and quantity of benefits is as per norms and standards laid down by the Corporation for the purpose.
• The benefits are made available within the given time frame to insured persons and beneficiaries.
• No harassment is caused to the beneficiaries across the counter at the grass root level by way of word or deed.
• All requisite information, procedural guidance etc. is made available to the beneficiaries for claiming benefits.
• All types of forms etc. are made available to the beneficiaries free of cost as may be required by them for filing claims etc.
• No beneficiary is exploited at any level in any way in the process of delivery of benefits.
• Office hours as notified for ESIC/ESIS establishments are strictly adhered to by the staff and displayed prominently so as to avoid any inconvenience being caused to the beneficiaries in smooth flow of benefits.
• Drugs, dressings, injections etc. as prescribed by the authorised doctors are made available timely.
• A complaint box is fixed within the office premises for posting written complaints.

• To develop a responsive, purposive and productive relationship with employers.
• Seek their active involvement in the improvement of the scheme as a confidence building measure.
• Provide them necessary guidance in fulfilling their lawful obligations under the ESI Act.
• Make available to them requisite Forms and proformae as may be required by them from time to time.
• To ensure that any lax medical certification on part of ESIC does not bring down the productivity of a factory or establishment.
• To ensure that in case of any difficulty, doubt or misunderstanding employer is given a chance to be heard at an appropriate level.
• To ensure that all correspondence emanating from the employer is responded to, timely and objectively.
• To ensure that an employer is not being harassed by any official of the Corporation authorised to inspect the premises or the records.
• To ensure that any grievances received from employers are looked into promptly and pointedly for speedy redressal.

ESI Scheme, being a multi-discipline service intensive social security programme for workers, an estimated 3.5 lakh beneficiaries visit the service outlets at the grassroots level daily, either for treatment or for availing cash benefits.  In such a highly interactive and dynamic system there is sufficient scope for any inadvertent or wilful harassment being caused to the beneficiaries. The Corporation has, therefore, set up an elaborate system for speedy redressal of public grievances and complaints at various levels.  Grievances can be reported in writing, on telephone, by post or in person to any of the following officers:-