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Intro

In response to the grim pandemic situation in the nation, the Employees State Insurance Corporation (ESIC) has come up with crucial medical services such as free treatment programs that lend a helping hand to its beneficiaries. In accordance with statutory compliance, ESIC allows the subscribers to claim the sickness benefits. 

Medical Care for ESIC Beneficiaries

All insured persons and their family members—who are infected with COVID-19—may avail free medical care. Each ESIC hospital now functions with at least 20% of its bed capacity reserved exclusively for the beneficiaries affected by COVID-19, as directed by the government. ESIC has reached out to the beneficiaries during the pandemic. Organizations that stick to payroll compliance can significantly help their employees with these exclusive provisions from ESIC. 

Under the directive, ESI subscribers are assured of emergency and non-emergency medical care in being infected with COVID-19. Persons who abstain from work due to the infection are entitled to claim sickness benefits for the period of abstention. The sickness benefit at the rate of 70% of the daily wages is payable for 91 days. 

Employers—who diligently meet the statutory compliance needs and honor their payroll compliance needs as well—would be extending their support to the cause indirectly. 

Medical Benefits under the Exclusive Directive

• The insured persons or their family members, if suffering from COVID-19, are eligible to avail medical care in any COVID-19 dedicated hospital. 
• ESI beneficiaries can seek emergency or non-emergency treatment without a referral letter—from tie-up hospitals—in line with their entitlement. 
• Insured persons who avail of non-COVID-19 medical services at private hospitals, according to statutory compliance, can claim reimbursement of expenditure.
• ESI subscribers can be referred to tie-up health care centers for prescribed consultation, investigation, and admission during the period for which a specific ESIC hospital is functioning as a dedicated COVID-19 hospital.
• Insured persons have been allowed to purchase medications from private pharmacies and chemists during the lockdown period. This significantly eases the hardship of beneficiaries in these challenging times. Subsequent reimbursement by ESIC is possible.

Monetary Benefits for Insured Persons and Their Family Members

• Insured persons abstaining from work due to infection are eligible to claim sickness benefits for the period of abstention; they are entitled to sickness benefits at 70% of their average daily wage for 91 days.
• Unemployment caused during the pandemic entitles subscribers to avail relief under Atal Beemit Vyakti Kalyan Yojana (ABVKY). Up to 50% of the average daily wage can be claimed for a maximum of 90 days under this scheme. Statutory compliance requirements entitle subscribers to submit their claims online. 
• ESIC members faced with unemployment caused by closure or retrenchment are allowed to seek unemployment allowance for two years under Rajiv Gandhi Shramik Kalyan Yojana.
• In the unfortunate eventuality of the death of a member, ESIC covers the funeral expense up to Rs. 15,000/- that would be payable to the eldest surviving family member. 
• ESIC members whose medical card validity expires during the pandemic period can continue availing of the regular medical benefits until 30 June 2021. Rule 60 and Rule 61 of ESIC (Central Rules) enable such subscribers to deposit the lump-sum contribution amount after the lockdown is being lifted off. 

Wrap-Up

ESIC has offered several relief measures and extended numerous helpful provisions under the ESI Act to the employees during this pandemic period. The enhanced benefits and calm conditions would support the employees during such difficult times as the COVID-19 related lockdowns.

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