Page 87 - DMGT306_MERCANTILE_LAWS_II

Mercantile Laws – II

Notes  Examine the benefits conferred by the Act
 Explain provisions related to the adjudication of disputes
 Determine the penalties mentioned under the Act

Introduction

In ESI scheme, a worker in insurable employment is called insured person (IP). Insured persons
and their family are entitles to different types of benefits. The benefits are broadly classified into
two: (1) Medical benefit and (2) cash benefit.
The employees registered under the scheme are entitled to medical treatment for themselves
and their dependents, unemployment cash benefit in certain contingencies and maternity
benefit in case of women employees. In case of employment-related disablement or death there
is provision for a disablement benefit and a family pension, respectively. Funeral Benefit to

dependents of Insured Persons/Insured Women. Super Specialty Treatment through Private Tie
Up Network as well as through its own Super Specialty Hospitals situated throughout India.
Also ESI is constructing Medical and PG Medical, Dental Colleges in which it has set aside
certain percentage of seats for children of person having ESI coverage. Recently ESI took a
decision to make the dependent benefit to a ceiling of 1200 for all eligible dependents of a
deceased person. Through approximately 86000 dependents got benefit. From time to time ESI
is relaxing conditions for disbursement of Sickness Benefit and Super Specialty Treatment.
Outpatient medical facilities are available in 1398 ESI dispensaries, and through 1678 empanelled
private medical practitioners. Inpatient care is available in 145 ESI Hospitals and 42 Hospital
annexes; a total of 19387 beds. In addition, several state government hospitals also have beds for
exclusive use of ESI Beneficiaries. Cash benefits can be availed in any of 783 ESI centers throughout
India.

Recent years have seen increasing role of information technology in ESI, with the introduction

of Pehchan smart cards in ‘Project Panchdeep’, India’s largest e-governance project. In addition to
insured workers, poor families eligible under the Rashtriya Swasthya Bima Yojana can also
avail facilities in ESI hospitals and dispensaries. There are plans to open medical, nursing and
paramedical schools in ESI hospitals.

5.1 Benefits of this Act

All the benefits under the scheme are paid in cash except medical benefit, which is given in kind.
The benefits are:

5.1.1 Sickness and Extended Sickness Benefit

For sickness during any period, an insured person is entitled to receive sickness cash benefits at
the standard benefit rate for a period of 91 days in any two consecutive benefit periods. The
eligibility condition for sickness benefit is that the contribution of an insured person should
have been paid/or payable for not less than half the number of days of the corresponding
contribution period. An insured person suffering from, any special, long-term ailment, for
example, tuberculosis, leprosy, mental disease - is eligible for extended sickness benefit at a rate
which is 40 % higher than the standard, benefit rate, rounded to the next higher multiple of 5
paisa, for a period of 124/ 309 days.

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