ESIC UTTAR PRADESH REGION |
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Chinta se mukti |
IMPORTANT DECISIONS
E.S.I. Corporation has introduced Identity Cards with family photographs of Insured Persons for smooth administration of Medical Benefits in the E.S.I. Dispensaries and Hospitals.
To compensate the erosion in monetary value of Permanent Disablement Benefit & Dependant's Benefit, periodical enhancement is granted in terms of percentage of original daily rate.
Cash Benefit is paid at the Branch Offices in Cash/Money Order/ Cheque at the option of the Insured Persons/beneficiaries. The Money Order commission is borne by the E.S.I. Corporation. However, cash Benefit exceeding Rs.3,000.00 is paid through account payee Cheque/demand draft or by money-order only.
The family members not residing with the Insured Person at the work place are entitled to receive medical benefit if they reside in implemented area in the State and separate family Identity Card is issued exclusively for family members.
Medical Benefit
Medical benefit under ESI scheme is provided mainly through state government except in Noida areas where medical benefit is provided to the I.Ps and their family members directly by ESIC. One modal hospital at Noida is also functioning under direct control of E.S.I. Corporation . Entire expenditure of this Model Hospital is borne by the E.S.I. Corporation . In other areas, medical treatment and attendance to insured persons and their family members is provided through a network of dispensaries and hospitals run by Director, ESI Scheme, Govt. of U.P. Sarvodaya Nagar, Kanpur under the overall control and superintendence of the labour department, Govt. of U.P. The total expenditure in administering the medical benefit is shared by the Corporation and the State government in the ratio of 7:1. Out door treatment is provided in ESI dispensaries and in-patient treatment through hospitals. In case any, super specialty treatment is required which is not available in ESI hospitals , the insured person, family members are referred to super specialty hospitals havings tie-up arrangement with the State government.
A ceiling of Rs.1200 per Insured Person per annum has been fixed with effect from 01.04.2009 towards medical care. E.S.I. Corporation and the State Govt. share the expenditure on medical care at a agreed ratio of 7:1 and excess expenditure beyond the ceiling is borne by the State Govt.
Public Grievance Redressal Cell
Cabinet Secretariat , Govt. of India vide Gazette notification no. A-11013/1/88 dated 02.08.98 has extended the jurisdiction of Directorate of Public Grievances to E.S.I. Corporation Ministry of Labour.
Accordingly ESI Corporation U.P. region has established “ Public Grievance Redressal Cell” at Regional Office , Kanpur. Shri
S.Prasad Rao, Joint Director has been nominated as complaint officer . He , with the help of one Dy. Director and other clerical staff is looking after the complaint cell . This cell is monitoring the complaint related to Branch Offices and other ESI institutions
BENEFITS : Quantum, Scale and Contributory Conditions
|
S.l. |
Benefit |
Contributory condition |
Duration |
Rate |
|
1(a). |
SICKNESS
BENEFIT |
Payment for any two least 78 days in the relevant contribution
period |
91days in any two consecutive benefit periods. |
Standard
Benefit Rate
(About 70% of the arange daily wages. |
|
(b). |
EXTENDED
SICKNESS BENEFIT
(for 34 specified long term diseases) |
Continues employment for a period of two year
and contribution for 156 days in four consecutive contribution
periods |
Two years |
80% of the Standard Benefit rate |
|
(c). |
ENHANCED
SICKNESS BENEFIT |
Same
as for Sickness Benefit at (a) above. |
7
days for vasectomy and 14 days for tub ecotomy; extendable
in cases of post operative complication etc. |
Equal to Standard Benefit rate (full wages)
|
|
(ii). |
DISABLEMENT BENEFIT (EMPLOYMENT INJURY) |
|
(a). |
Temporary
Disablement Benefit |
He
should be an employee on the date of employment injury |
Till
the incapacity lasts |
90%
of the Standard Benefit rate (about 90%)of
the wages. |
| (b). |
Permanent
Disablement Benefit |
-Do- |
for
life |
Depends
upon the loss of earning capacity of the workers which is
determined by a Medical Board. |
|
(iii) |
DEPENDANTS
BENEFIT
|
The
deceased should be an employees on the date of fatal employment |
1.
To widow/ widows for life or until remarriage.
2. To widowed mother during life.
3. To legitimate or adopted son and to legitimate or adopted
unmarried daughter till the age of 25 years.
4. To legitimate infirm son and to legitimate adopted
son or adopted unmarried infirm daughter till infirmity lasts.
5. To legitimate or adopted unmarried infirm daughter
till infirmity lasts.
6. To other dependants for life or till marriage, cessation
of infirmity or due to age of 25 years as the case may be. |
90%
of the Standard Benefit rate (about 75%) of the wages)
to be divided amongst the dependants in the prescribed
ratio. |
| (iv) |
MATERNITY
BENEFIT |
Payment
of contribution for 70 days in immediately preceding two consecutive
contribution periods |
12 weeks of which not more than six can precede
the expected date of confinement; 6 weeks for miscarriage
and additional one month for sickness arising out of pregnancy
confinement, premature birth of child or miscarriage. |
Equal to
the standard benefit |
| (v) |
FUNERAL
EXPENSES |
He
should be an insured person on the date of death |
|
Actual
expenditure on funeral not exceeding Rs.10,000=00-w.ef
01-04-2009 |
| (vi) |
REHABILITATION
ALLOWANCE |
Entitlement
to medical benefit or if disabled due to employment injury |
For
each day on which insured person remains admitted in Artificial
Limb-Centre for fixation/ repair or replacement of artificial
limb |
At double the Standard benefit rate. |
| (vii) |
MEDICAL
BENEFIT |
No
condition (insured person and his family the date of entry of
I. P. into insurable employment ) |
Till
the disability/ disease lasts |
Full
medical care (all facilities including hospitalization) for
I. P and members of their family. |
| (viii) |
THE I.P. WHO HAS PREMATURE RETIRED
OR TAKEN V.R.S. AND
MEDICAL BENEFIT TO RETIRED/ DISABLED INSURED
PERSONS
AND HIS / HER SPOUSE |
On
payment of Rs.10/- p.m. in lump-sum for one year in advance.
(i) by insured persons who leave insurable employment on
attaining the age of superannuation after being insured for
not less than five years.
(ii) by insured persons who cease to be in insurable
employment on account of permanent disablement due to an employment
injury. |
Period for which contribution
is paid.
Period for which contribution is paid, till attaining the
age of superannuation.
|
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| (ix) |
Confinement
Expenses |
To
an insured Woman or an I. P. in respect of his wife in case
facilities for confinement are not available in E. S. I. Institutions |
UP
to two confinements |
Rs.2500=00-
per case
01-12-2008 |
| (x) |
Vocational
Rehabilitation Allowance |
Not
more than 45 years of age and disability not less than
40% due to employment injury. |
All
the days of training in Vocational Rehabilitation Centre |
Rs.
123/- per day on the amount charged by Vocational Rehabilitation
Centre, Whichever is higher |
| (xi) |
Unemployment
Allowance |
An
I. P. who has lost employment due to closure of factory, retrenchment
or permanent invalidity and the contribution in respect of him
have been paid / payable for a minimum of Three years prior to
the loss of employment |
Maximum 12 months during life time
w.ef 01-02-2009 |
50% of Standard Benefit Rate . |
Revolving Fund :
A Revolving Corpus Fund was set up with the Regional Office with the consent of the State Government for making payments to the entitled Insured Person and family members in respect of the following categories of claims.
a) Advance for getting Speciality/Super-Speciality Treatment and/or reimbursement of the expenditure, If Insured Person had initaily borne the expenditure from his own source.
b) Reimbursement of charges in respect of expensive diagnostic service (exceeding Rs. 1000/- each test). The payment from the Fund will be made by the State Medical Commissioner, Regional office Kanpur againest the vaild sanction order, issued by the director, E.S.I. Scheme, Govt. of U.P., Kanpur/Principal Secretary, Labour Deptt., Govt of U.P. as the case may be.
All payments will be made by Account payee Cheque/DDrafts and all cheques/Drafts are sent to Director, ESI Scheme who arrange to hand over the cheques to the concered Insured Person. The Institutional cheques D.Drafts are directly sent by SMC branch to cancessds institutions. its is in opertation since 2001-2002.
Latest instruction on Revolving Fund
In the 143rd meeting held on 08.07.08 the Corporation has decided as under :-
1. The expenditure of super specialty treatment ( including diagnostic) will be totally borne by ESI Corporation outside the existing ceiling w.e.f. 01.08.2008.
2. Reference for super specialty treatment ( including diagnostic) can be either by-ESIS hospitals under the state Govts. Or Hospitals run directly by ESIC so that IPs do not face any problem.
3. For providing super specialty treatment ( including diagnostic) the tie up arrangements already made by state Govts will continue on same terms and conditions. In addition to this, SSMCs/SMCs/D(M)D will make tie up arrangements with reputed Govt./semi Govt./Private hospitals/Institutions all over the State’s that all areas where IPs are concentrated are covered and Ips are not required to unnecessarily travel long distance and facility is available at the nearest possible location.
As indicated above, the patients will be referred for super specialty treatment either by the Medical Supdt. Of the State ESI Hospital or the Medical Supdt. Of ESIC Hospital wherever the IPs goes. M.S. of the Hospitals shall ensure the eligibility of the IPs before referring him to super specialty treatment. The treatment shall be verified by the concerned Medical Supdt. Before payment or forwarding the estimate/bill to SSMCs/SMC for payment to the Institution.
In case of ESI Hospital run by State Govts. The bills shall be submitted to the SSMC/SMC once a month a month for making payment to the approved hospital/Institution. All bills/vouchers etc. shall be kept at SSMC/SMC office and the responsibility of audit of expenditure shall rest with SSMC/SMC.
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Further in continuation of the guidelines issued on 23.07.08, it is further clarified vide Hqrs’ letter No. V-24/111/10/2004- Med.I dated December 1, 2008 that:
1. Tie up arrangements as per the instructions in the letter dt. 23.07.08 can also be made by Medical Supdts. of all ESIC run hospitals directly.
2. Tie up arrangement made by SSMCs/SMCs may can also be used by Medical Supdts. of all ESI Hospitals. For this either the SSMCs/SMCs may include this provision in the MOU ( Memorandum of Understanding) entered by them with the tie up institutions or Medical Superintendents of ESIC form hospitals can themselves enter into MOU with the tie up institutions on similar lines as SSMCs/SMCs.