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ParismitaBarman1

The document provides an overview of the Employees' State Insurance Act (ESI Act) of 1948 in India. The ESI Act was enacted to provide social security to factory workers in the form of health insurance and cash benefits for sickness, maternity, disability, and death due to employment. Key aspects of the ESI scheme discussed include administration, financing through employee and employer contributions, medical benefits including inpatient and outpatient care, sickness and maternity benefits, disablement and dependent benefits, and funeral expenses. The ESI scheme aims to alleviate the economic and physical suffering of insured industrial workers.

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1 of 34
SEMINAR ON ESI ACT-1948
INTRODUCTION • An industrial worker is exposed to the risk of occupational diseases and accidents which creates a Physical, feeling of economic and social insecurity. It is the responsibility of the employers and the state to provide insurance for such situation .The Employees state Insurance Act which was enacted in 1948, proved to be very beneficial step towards the social security of factory workers, The act alleviates economic and physical suffering by providing benefits in cash and kind during sickness, materenity and occupational injury.
HISTORY OF ESI • The ESI Act was enacted in 1948. • The scheme was first started in february,1952 in the industrial areas of Delhi and Kanpur. • The Act has been amended in 1975,1984,1989 and 2010.
esi1948.pptx
ADMINISTRATION
FINANCE • The scheme is run contributions employees and employers and grants from Central and State Governments . • The employers contributes 3.25 per cent of total wage bill. • The employee contributes 0.75 per cent of wages. • Employees getting daily wages below Rs 176 are exempted from payment of contribution. • The state Government share of expenditure on medical care is 1/8 of total cost of medical care. • The ESI Corporation’s share of expenditure on medical care is 7/8 of total cost of medical care.
esi1948.pptx
esi1948.pptx
MEDICAL BENEFIT • Medical benefit consist of “full medical care” including hospitalization, free of cost to the insured person . • The services comprise- 1.Out patient care 2.Supply of drugs and dressing 3.specialist services. 4.pathological and radiological investigations. 5.domiciliary services. 6. antenatal ,natal and postnatal services. 7.immunization services. 8.family planning services. 9. emergency services. 10.ambulance services. 11.health education and 12.in-patient treatment.
Medical benefit Direct pattern Indirect pattern
Direct Pattern: In areas having a concentration of 1000 or more employees family units. Service dispensaries are established with full time medical and paramedical personnel On an average a doctor will attend to about 80 cases in out-patient department per day and makes one home visit a day.
2. In areas where the employees are less than 750,part-time dispansaries are established. 3.If the residential concentration of employees is scattered over a long distance, mobile dispenseries are established.
• Indirect pattern: This is also known as “panel system”. Registered medical practitioners designated as Insurance Medical Practitioners are appointed to provide medical care. Medical care is also extended to families of workers where requisite arrangements could be done.
Other medical facilities • (1) Dentures, spectacles and hearing aids are provided free. • (2) Artificial limbs are provided free to insured persons who lose their limbs in employment injury or otherwise . • (3) Special appliances such as hernia belts, walking callipers, surgical boots, spinal braces and jackets are provided as prescribed by specialists.
cost of medical benefit • The per capita cost of medical benefit under the ESI Scheme has been steadily increasing. It was Rs. 23.79 in 1961-62, Rs. 58.91 in 1969-70, Rs. 67.53 in 1973-74, Rs. 406.78 in 1992-93 and Rs. 905 in 2001-02, and has been rising further sinc then. Expenditure on medical benefit was Rs. 4058 crores i 2012-13 and was 9368 crores by 2020.
esi1948.pptx
SICKNESS BENEFIT • It consists of periodical cash payment to an insured person in case of sickness, if his sickness is duly certified by an Insurance Medical Officer or Insurance Medical Practitioner. The benefit is payable for a maximum period of 91 days, in any continuous period of 365 days, the daily rate being about 70% of the average daily wages. A person IX. P receiving the sickness benefit is required to remain under medical treatment provided under the Act.
• EXTENDED SICKNESS BENEFIT: • In addition to 91 days of sickness benefit, insured persons suffering from certain long-term diseases are entitled to Extended Sickness Benefits shown below, for a maximum period of two years. • 34 diseases for which Extended Sickness Benefit with effect from 1.1.2000 is payable, in case where the insured person has been in continuous employment for 2 years. I. Infectious Diseases • 1. Tuberculosis. • 2. Leprosy. • 3. Chronic empyema. • 4. AIDS. II. Neoplasms
• Endocrine,Nutritional and Metabolic disordders. • Disorder of nervous system • Disease of cardiovascular system • Chest disease. • Disease of digestive system. • Orthopaedic diseases. • Psychosis . • Others
esi1948.pptx
MATERNITY BENEFIT • The benefit is payable in cash to an insured woman for confinement/miscarriage or sickness arising out of pregnancy/confinement or premature birth of child or miscarriage. • For confinement, the duration of benefit is 26 weeks, for miscarriage 6 weeks and for sickness arising out of confinement etc. 30 days. • The benefit is allowed at about full wages. The rate of confinement expenses has been increased from Rs. 5,000 to Rs. 7,500 per confinement.
esi1948.pptx
DISABLEMENT BENEFIT • The Act provides for cash payment, besides free medical treatment in the event of temporary or permanent disablement as a result of employment injury as well as Occupational diseases. • The rate of temporary disablement benefit is about 90 per cent of the wages as long as the temporary disablement lasts. • In case of total permanent disablement, the insured person is given life pension worked out on the basis of loss of earning capacity determined by a medical board, while in cases of partial permanent disablement a portion of it is granted as life pension
esi1948.pptx
DEPENDENT’S BENEFIT • In case of death, as a result of employment injury, the dependants of an insured person are eligible for periodical payments. • Pension at the rate of 90 per cent of the wages is payable, shared by dependants in a fixed ratio, on monthly basis in accordance with the prescribed share. • An eligible son or daughter is entitled to dependant's benefit up to the age of 18: the benefit is withdrawn if the daughter marries earlier.
esi1948.pptx
FUNERAL EXPENSES • Funeral benefit is a cash payment payable on the death of an insured person towards the expenses on his funeral, the amount not exceeding Rs. 15,000/-
esi1948.pptx
REHABILITATION BENEFIT • On monthly payment of Rs 10, the insured person and his family members continue to get medical treatment after permanent disablement, or retirement. • The ESI Scheme has been implemented in 34 States/ Union territories. The Scheme, by 31.03.2020, covered 309 lakhs employees: including 62.6 l lakhs women, and the total number of be des were around 1324 lakhs (40)
esi1948.pptx
BENEFITS TO EMPLOYERS • (1) Exemption from the applicability of Workmen's Compensation Act 1923 • (2) Exemption from Maternity Benefit Act 1961 • (3) Exemption from payment of Medical allowance to employees and their dependants or arranging for their medical care • (4) Rebate under the Income Tax Act on contribution deposited in the ESI Account • 5) Healthy work-force.
SUMMARY
CONCLUSION • The ESI act is a social welfare legislation enacted with the objective of providing certain benefits to employees in case of sickness, maternity and employment injury The employee state Insurance scheme Act as a landmark in the history of social security in India. The ESI filled the gap of workers compensation Act. The scope of Coverage of the ESI Act is much more wider than the workmen's compensation Act.
BIBLIOGRAPHY 1. Gulani K.K; “Community Health Nursing [principles and practice “3rd edition ,2019; kumar publishing house ,Delhi ,page no:455-57 2. Prof Saxena R.P “Textbook of Community Health Nursing II for Bsc Nursing students, 3rd edition; 2020; Lotus publishers , Jalandhar ,page no:310-12 3. K .Park; “Park’s textbook of Preventive and Social Medicine 26th edition, Jabalpur, paGe no:910-12

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esi1948.pptx

  • 2. INTRODUCTION • An industrial worker is exposed to the risk of occupational diseases and accidents which creates a Physical, feeling of economic and social insecurity. It is the responsibility of the employers and the state to provide insurance for such situation .The Employees state Insurance Act which was enacted in 1948, proved to be very beneficial step towards the social security of factory workers, The act alleviates economic and physical suffering by providing benefits in cash and kind during sickness, materenity and occupational injury.
  • 3. HISTORY OF ESI • The ESI Act was enacted in 1948. • The scheme was first started in february,1952 in the industrial areas of Delhi and Kanpur. • The Act has been amended in 1975,1984,1989 and 2010.
  • 6. FINANCE • The scheme is run contributions employees and employers and grants from Central and State Governments . • The employers contributes 3.25 per cent of total wage bill. • The employee contributes 0.75 per cent of wages. • Employees getting daily wages below Rs 176 are exempted from payment of contribution. • The state Government share of expenditure on medical care is 1/8 of total cost of medical care. • The ESI Corporation’s share of expenditure on medical care is 7/8 of total cost of medical care.
  • 9. MEDICAL BENEFIT • Medical benefit consist of “full medical care” including hospitalization, free of cost to the insured person . • The services comprise- 1.Out patient care 2.Supply of drugs and dressing 3.specialist services. 4.pathological and radiological investigations. 5.domiciliary services. 6. antenatal ,natal and postnatal services. 7.immunization services. 8.family planning services. 9. emergency services. 10.ambulance services. 11.health education and 12.in-patient treatment.
  • 11. Direct Pattern: In areas having a concentration of 1000 or more employees family units. Service dispensaries are established with full time medical and paramedical personnel On an average a doctor will attend to about 80 cases in out-patient department per day and makes one home visit a day.
  • 12. 2. In areas where the employees are less than 750,part-time dispansaries are established. 3.If the residential concentration of employees is scattered over a long distance, mobile dispenseries are established.
  • 13. • Indirect pattern: This is also known as “panel system”. Registered medical practitioners designated as Insurance Medical Practitioners are appointed to provide medical care. Medical care is also extended to families of workers where requisite arrangements could be done.
  • 14. Other medical facilities • (1) Dentures, spectacles and hearing aids are provided free. • (2) Artificial limbs are provided free to insured persons who lose their limbs in employment injury or otherwise . • (3) Special appliances such as hernia belts, walking callipers, surgical boots, spinal braces and jackets are provided as prescribed by specialists.
  • 15. cost of medical benefit • The per capita cost of medical benefit under the ESI Scheme has been steadily increasing. It was Rs. 23.79 in 1961-62, Rs. 58.91 in 1969-70, Rs. 67.53 in 1973-74, Rs. 406.78 in 1992-93 and Rs. 905 in 2001-02, and has been rising further sinc then. Expenditure on medical benefit was Rs. 4058 crores i 2012-13 and was 9368 crores by 2020.
  • 17. SICKNESS BENEFIT • It consists of periodical cash payment to an insured person in case of sickness, if his sickness is duly certified by an Insurance Medical Officer or Insurance Medical Practitioner. The benefit is payable for a maximum period of 91 days, in any continuous period of 365 days, the daily rate being about 70% of the average daily wages. A person IX. P receiving the sickness benefit is required to remain under medical treatment provided under the Act.
  • 18. • EXTENDED SICKNESS BENEFIT: • In addition to 91 days of sickness benefit, insured persons suffering from certain long-term diseases are entitled to Extended Sickness Benefits shown below, for a maximum period of two years. • 34 diseases for which Extended Sickness Benefit with effect from 1.1.2000 is payable, in case where the insured person has been in continuous employment for 2 years. I. Infectious Diseases • 1. Tuberculosis. • 2. Leprosy. • 3. Chronic empyema. • 4. AIDS. II. Neoplasms
  • 19. • Endocrine,Nutritional and Metabolic disordders. • Disorder of nervous system • Disease of cardiovascular system • Chest disease. • Disease of digestive system. • Orthopaedic diseases. • Psychosis . • Others
  • 21. MATERNITY BENEFIT • The benefit is payable in cash to an insured woman for confinement/miscarriage or sickness arising out of pregnancy/confinement or premature birth of child or miscarriage. • For confinement, the duration of benefit is 26 weeks, for miscarriage 6 weeks and for sickness arising out of confinement etc. 30 days. • The benefit is allowed at about full wages. The rate of confinement expenses has been increased from Rs. 5,000 to Rs. 7,500 per confinement.
  • 23. DISABLEMENT BENEFIT • The Act provides for cash payment, besides free medical treatment in the event of temporary or permanent disablement as a result of employment injury as well as Occupational diseases. • The rate of temporary disablement benefit is about 90 per cent of the wages as long as the temporary disablement lasts. • In case of total permanent disablement, the insured person is given life pension worked out on the basis of loss of earning capacity determined by a medical board, while in cases of partial permanent disablement a portion of it is granted as life pension
  • 25. DEPENDENT’S BENEFIT • In case of death, as a result of employment injury, the dependants of an insured person are eligible for periodical payments. • Pension at the rate of 90 per cent of the wages is payable, shared by dependants in a fixed ratio, on monthly basis in accordance with the prescribed share. • An eligible son or daughter is entitled to dependant's benefit up to the age of 18: the benefit is withdrawn if the daughter marries earlier.
  • 27. FUNERAL EXPENSES • Funeral benefit is a cash payment payable on the death of an insured person towards the expenses on his funeral, the amount not exceeding Rs. 15,000/-
  • 29. REHABILITATION BENEFIT • On monthly payment of Rs 10, the insured person and his family members continue to get medical treatment after permanent disablement, or retirement. • The ESI Scheme has been implemented in 34 States/ Union territories. The Scheme, by 31.03.2020, covered 309 lakhs employees: including 62.6 l lakhs women, and the total number of be des were around 1324 lakhs (40)
  • 31. BENEFITS TO EMPLOYERS • (1) Exemption from the applicability of Workmen's Compensation Act 1923 • (2) Exemption from Maternity Benefit Act 1961 • (3) Exemption from payment of Medical allowance to employees and their dependants or arranging for their medical care • (4) Rebate under the Income Tax Act on contribution deposited in the ESI Account • 5) Healthy work-force.
  • 33. CONCLUSION • The ESI act is a social welfare legislation enacted with the objective of providing certain benefits to employees in case of sickness, maternity and employment injury The employee state Insurance scheme Act as a landmark in the history of social security in India. The ESI filled the gap of workers compensation Act. The scope of Coverage of the ESI Act is much more wider than the workmen's compensation Act.
  • 34. BIBLIOGRAPHY 1. Gulani K.K; “Community Health Nursing [principles and practice “3rd edition ,2019; kumar publishing house ,Delhi ,page no:455-57 2. Prof Saxena R.P “Textbook of Community Health Nursing II for Bsc Nursing students, 3rd edition; 2020; Lotus publishers , Jalandhar ,page no:310-12 3. K .Park; “Park’s textbook of Preventive and Social Medicine 26th edition, Jabalpur, paGe no:910-12