The ESI full form is Employee’s State Insurance and it was formulated in the year 1952. The aim of the scheme was to provide the proper financial assistance to the employees during sickness and many other causes. Some of the criteria of this benefit scheme are as follows:
- Permanent or temporary disability
- Disease formed through the occupation
- Death due the employment injury
One of the major area of this scheme which it is highly used for is the benefits related to sickness. This article will cover the details about the ESI full form for the sickness benefits.
The Sickness Benefits
The sickness benefits provided to the employee is through financial aid under the scheme of the ESI. But some conditions are to be met to avail this advantage. The employee must be covered by the ESI full form over a period of sickness that has been certified and requires medical treatment which forbids the employee from attending work. For 2 back to back periods of benefits, up to 70 percent of the total wage of the employee can be accumulated for the sickness benefits for 91 days.
In order to be eligible for this option, the employee has to fulfill the conditions given below.
- Employee who is covered by the ESI and has entered into the insurable employment for the first time are required to wait for around 9 months before he or she can become eligible to the sickness benefit, because his or her adjacent period of benefit starts only after that interval has been completed.
- The Sickness Benefit is not eligible to be paid for the first 2 days of the sickness except in the case of the spell occurring within 15 days of the closure of the earlier spell for which the sickness benefit has been last paid. This period of two days is called the “waiting period”.
- The employee who is covered by the ESI has to have paid the contribution which is not less than 78 days at the time of the corresponding period of contribution.
Extension of the Sickness Benefit
Under the scheme of the ESI full form, the eligible employee can extend the period of benefit for an additional 2 years after the 91 days are completed in case of long term diseases which leads to tremendous difficulty for the employee. This means that this extended period is only applicable after the first allotted 91 days are fully used.
It should be mentioned though that if the employee want to be eligible for this extended period of sickness benefit, he or she has fulfill certain conditions. For example, the employee must have a continuous working period for at least 2 years or more than that prior to availing this benefit at the initiation level of the spell of the sickness. Also, the disease which is diagnosed has to satisfy some other contributing conditions as well.
The list of the diseases which are eligible for the extended period of the sickness benefit of the ESI full form for an additional 2 years are as follows.
- Disease of Eye
- Immature Cataract with vision 6/60 or less
- Detachment of Retina
- Diseases of Cardiovascular System
- Coronary Artery Disease like unstable angina or myocardial infraction with ejection less than 45%
- Congestive Heart Failure
- Cardiac Valvular Diseases with failure/complications
- Heart disease with surgical intervention alongwith complications
- Disorders of Nervous System
- Intracranial Space Occupying Lesion
- Spinal Cord Compression
- Parkinson’s disease
- Myasthenia Gravis/Neuromuscular Dystrophies
- Orthopaedic Diseases
- Dislocation of vertebra/prolapse of intervertebral disc
- Non union or delayed union of fracture
- Post Traumatic Surgical amputation of lower extremity
- Compound fracture with chronic osteomyelitis
- Infectious Diseases
- Chronic Empyema
- Chest Diseases
- Interstitial Lung Disease
- Chronic Obstructive Lung Diseases (COPD) with congestive heart failure (Cor Pulmonale)
- Endogenous depression
- Manic Depressive Psychosis (MDP)
- Malignant Diseases
- Diseases of the Digestive System
- Cirrhosis of liver with ascities/chronic active hepatitis
- Endocrine, Nutritional and Metabolic Disorder
- Diabetes Mellitus-with proliferative retinopathy/diabetic foot/nephropathy.
- More than 20% burns with infection/complication
- Chronic Renal Failure
- Reynaud’s disease/Burger’s disease.
The Enhanced Sickness Benefit
The incentive of the Enhanced Sickness Benefit has been introduced in the year 1976. It is specifically aimed towards the employees who are already registered under the ESI full form who are going to have a tubectomy or vasectomy done. Keeping the family welfare in mind, if any employee decides to undergo any of the two operations of sterilization as mentioned, they will be eligible to get the full 100 percent of their average daily salary.
The duration selected for vasectomy is 7 days and for tubectomy is 14 days and the days can counted from the date of the operation or from the date when the employee is admitted into the hospital. If any complications arise after the operation, then the employees will be eligible to extend their enhanced sickness benefit under the ESI full form.
For further information refer Company Vakil experts.