Which Act Scheme Requires Workers to Have Health Insurance?
Published On Aug 02, 2022 10:00 AM By InsuranceDekho
Table of Contents
If you are a working professional, you might have tons of responsibilities on your shoulders. Apart from work duties, there are financial needs of your family to be taken care of as well. There are times when a single income doesn’t cover the budgetary requirements of the entire family. A great way to ensure the security of the family in your absence is by enrolling on the Employee State Insurance Scheme (ESIS). This Employee Health Scheme is a broad plan, which covers multiple things under it. Before applying for ESIS insurance, every employee must know about Employee State Insurance details.
- Employee State Insurance Scheme is an integrated social system specially designed for the safety of the employees under the Employee State Insurance Act 1948.
- ESIS insurance protects the employee in the case of sickness, disability, physical injury, and more. Moreover, it provides the working individual and their beneficiaries with medical facilities.
- In case an employee loses their steady flow of income, the ESIS card helps in availing cashless benefits.
Moreover, the government has been taking various initiatives to enhance the coverage of the ESI Scheme. These reforms have been a part of a series of “2nd Generation Reforms Agenda” known as ‘ESIC-2.0’. It was launched on July 20, 2015, and is going to be implemented within a stipulated time. Health Reforms Agenda of ESIC 2.0 include:
- Online health record of the ESI beneficiaries
- Special cleanliness drive as part of Swachh Bharat Mission
- Abhiyan Indradhanush
- New medical helpline for emergency and seeking guidance from casualty/emergency of
- Employee State Insurance hospital
- Special OPD for senior citizens and differently-abled persons in Employee State Insurance hospital
The PMJAY Scheme is formed by subsuming multiple schemes including the Employee State Insurance Scheme (ESIS).
Features of ESIS
ESIS provides employees with a varied range of features. You can go through the list of features of ESIS mentioned below in detail:
- It provides maternity cover for 26 weeks. Moreover, the cover can be extended up to one month if your wages are subjected to a contribution for 70 days.
- It offers payment in installments to beneficiaries during unfortunate events.
- It offers an unemployed member with coverage for 3 years. However, it is possible only if the member discloses essential details like the previous workplace and permanent invalidity.
- It supplies 90% of the employee’s wage when an individual becomes temporarily or permanently disabled.
- Complete medical care and attention is provided to an employee registered under the ESI Act, 1948 at the time of their incapacity and restoration of health.
The significant benefit of availing ESIS is the financial protection to the employee and their dependents. Besides, ESIS grants other health insurance benefits for the betterment of each employee.
Benefits of ESI Scheme
If you, as an employee, are fired from your previous job or choose to resign from your last position, the flow of your income reduces. ESIS acts as an income replacement when you are unemployed.
The financial security of your family is at stake after your death. However, ESIS ensures that your family receives a monthly payout in your absence.
Having a child marks the beginning of a new phase of life. With that, your responsibilities, as well as expenses increase. ESIS provides maternity benefits to every new parent.
When you enter insurable employment, ESIS serves medical coverage for you and your entire family. The Government of India recently launched the Ayushman Bharat Yojana to facilitate quality healthcare services to the below poverty line segment of society. For Ayushman Bharat Yojana registration and eligibility check, you can head to the official PMJAY website.
You get cash benefits of up to 70% of the wages during the medical leave. This is provided for up to 91 days.
Benefits for the dependents
If you happen to suffer any health issues or injuries when at work, you do not have to worry about the financial crisis arising due to loss of pay. With ESIS, you and your dependents will get monthly payments.
For temporary disablement, ESIS provides monthly payments at a 90% wage until recovery. For permanent disablement, ESIS provides monthly payments at a 90% wage for the entire life.
Who is Eligible for the ESI Scheme?
To avail the benefits offered under the Employee State Insurance Scheme, you should meet certain criteria set by the committee. Those eligible for ESI Scheme –
- Have to be employed in a non-seasonal factory that has more than 10 employees working for it. This eligibility criterion is applicable under Section 2(12) of the Act.
- Need to have a wage limit of ₹21,000 per month, effective from January 01, 2017.
To sum up, the responsibilities of an employee increase with a rise in workload. Moreover, our sedentary lifestyle demands special attention, which is possible only with ESIS. The guaranteed protection from ESIS makes multiple lives easier. Apart from ESIS, you can also buy a health insurance plan to give yourself financial backing.
How To Claim Royal Sundaram Health Insurance