ESIC Policy: You can avail 70% wage in medical leave; check eligibility and other details

The Employees' State Insurance Scheme is an integrated measure of Social Insurance embodied in the Employees' State Insurance Act and it is designed to accomplish the task of protecting 'employees' as defined in the Employees' State Insurance Act, 1948 against the impact of incidences of sickness, maternity, disablement and death due to employment injury and to provide medical care to insured persons and their families. The ESI Scheme applies to factories and other establishment's viz. Road Transport, Hotels, Restaurants, Cinemas, Newspaper, Shops, and Educational/Medical Institutions wherein 10 or more persons are employed.

The ESIC Policy ensures that you get paid at least 70 per cent of your total wage even when you are sick and unable to work. But, how to avail of the benefit? Who is eligible? And what kind of sickness is covered under this policy? Read more to get the answer to all your queries.

Sickness Benefit 

Any insured person suffering from a sickness certified by I.M.O.s/I.M.P.s. can avail a periodical payment of Cash Benefit under this act.

Sickness Benefit is calculated at a rate of 70% of the average daily wage at the maximum, and it can be availed of by an employee for up to 91 days in two consecutive benefit periods (normally, a benefit period comprises 6 months). An insured person must work for at least 78 days during a contribution period (normally, a contribution period consists of 6 months) to qualify for this benefit.

Extended Sickness Benefit :

A person is eligible for this benefit if one of 34 specific long-term diseases is diagnosed, such as TB, Cancer, or other malignant diseases that require prolonged treatment. 

Initially, Extended Sickness Benefit is calculated at 80% of average wages at the maximum and is payable for a period of 124 days, as well as 91 days of Sickness Benefit, which can be extended to 309 days. 

The Special Medical Board may also recommend an additional period of 330 days of Extended Sickness Benefit, depending on the situation. In addition to the 34 diseases listed, the competent Medical Authority of E.S.I. Corporation, New Delhi, can also approve some uncommon diseases for the same benefits.

Enhanced Sickness Benefit: 

During a sterilisation procedure, insured persons receive a benefit equal to their full wages for 7days/14days, respectively, for male and female workers.

Qualifying Conditions
(i) To receive Sickness Benefit, an insured person must have made contributions for a minimum of 78 days during the corresponding contribution period.

(ii) The first time someone enters into insurable employment, he has to wait for nearly 9 months before becoming eligible for sickness benefit because the corresponding benefit period begins only after that period.

(iii) In most cases, sickness benefit is not payable for the first two days of a period of sickness unless the illness begins within 15 days of the end of an earlier period for which sickness benefit has been paid. "Waiting period" refers to this period of 2 days.