Employee State Insurance Scheme: Check medical benefits, eligibility, and more

ESIC hospitals are facilities operated by the Employees' State Insurance Corporation (ESIC), a government-run organisation under the Ministry of Labour and Employment, providing medical care to individuals covered under the ESI scheme.

What is the ESI scheme?

The Employee State Insurance Scheme (ESIS) is a social security scheme offering medical care, financial benefits, and unemployment allowance, among other things, to insured employees and their family members.

It covers employees in establishments with 10 or more employees, except for Maharashtra and Chandigarh, where at least 20 workers are needed in an establishment. Both employers and employees contribute to this fund. The contribution rates are subject to revision from time to time, but for Financial Year 2024-25, the rate for employees is 0.75% of their wages, and for employers, it is 3.25% of the employee’s wages.

Eligible employees

Employees who earn up to ₹21,000 are covered under this scheme. This cap is at ₹25,000 for disabled employees. Further, there is no age limit for this. Initially, the scheme, launched under the Employees’ State Insurance Act, 1948, covered every non-season factory with a workforce of 10 or more employees. Later, the government extended the coverage to shops, hotels, restaurants, transport establishments, etc.

ESIC hospitals

Under the ESIS, comprehensive free medical care is offered to insured individuals and their families. There is no upper limit to the treatment cost. Medical care is also provided to retired and permanently disabled insured individuals, and their spouses, with an annual payment of just ₹120.

There are over 150 ESI hospitals and nearly 42 hospital annexes that provide in-patient services to insured individuals. For out-patient medical care, there are nearly 1,450 ESI dispensaries, 188 AYUSH units and 954 panel clinics. There is one occupational disease centre each in Mumbai, Delhi, Kolkata, Chennai and Indore.

The ESIC is working on enhancing its services and may soon offer free treatment at hospitals aligned under the Ayushman Bharat scheme to its beneficiaries. This will ensure expanded coverage to include private and charitable hospitals as well.

Other ESIS benefits

Under section 46 of the Employees’ State Insurance Act, 1948, the scheme offers many benefits. Some of the benefits other than medical care are: