Coverage Under the ESI Scheme and Eligibility Criteria for Employees
17 July, 2023
8 Shares
1326 Reads
Share
You're a hardworking employee, diligently putting in your hours day after day. But what if the unexpected happens? An illness, an injury, a medical emergency that requires costly treatment? Without the right coverage, these incidents could easily send you spiralling into debt, causing stress and anxiety that could impact your work and your life. That's where the ESI scheme comes in - a safety net for employees that offers coverage for medical expenses and more. But who's eligible for this program, and how does it work?
Read ahead to know and learn more about the scheme in detail.
Eligibility for ESI Scheme
ESI scheme eligibility criteria for employees seeking coverage are essential in determining who can benefit from this program. Any employee who earns less than ₹21,000 per month and works in a factory or establishment with 10 or more employees is eligible for coverage under the scheme.
In addition to meeting salary and employment requirements, employees must contribute a small percentage of their salary towards the scheme, which their employer matches. This contribution ensures that employees can access various benefits, including medical, sickness, maternity, and disability benefits.
Furthermore, by meeting these eligibility criteria, employees can rest assured that they have a safety net to fall back on in a situation of unexpected medical emergencies, allowing them to focus on their work and health with peace of mind.
Benefits of the Scheme
The benefits or advantages of the scheme are as follows:
- Medical Benefits: The scheme offers a comprehensive range of medical benefits to employees, including access to medical care, specialist consultations, diagnostic tests, and hospitalisation. This coverage extends to employees and their dependents, ensuring their families are protected in medical emergencies. Additionally, employees have access to a vast network of hospitals and clinics that are empanelled under the ESI scheme, allowing them to receive high-quality medical care at an affordable cost.
- Sickness Benefits: It also offers sickness benefits to employees who cannot work due to illness. This benefit provides a portion of the employee's salary during their absence, allowing them to focus on their health recovery without the added stress of managing finances. Sickness benefits can be claimed for up to 91 days, with the amount of help being calculated based on the employee's salary and duration of absence.
- Maternity Benefits: Pregnant employees are also eligible for maternity benefits under the scheme. This benefit includes a period of paid leave before and after delivery, as well as medical care and expenses related to childbirth. This coverage extends to normal and caesarean deliveries and applies for up to 26 weeks of leave. With these benefits, employees can ensure they have the support they need during this time without worrying about the financial implications of having a child.
How to Apply for the ESI Scheme
If you are a worker who meets the ESI scheme eligibility, you can apply for coverage through a simple and straightforward application process.
- The first step is to have or obtain a certificate of registration from the ESI Corporation, which can be done or completed by filling out application details and submitting it along with the major documents such as proof of employment, proof of identity, and bank account details.
- Once your form has been processed or taken forward and your certificate of registration has been issued, you can start contributing to the scheme through your employer. It is required to keep track of your contribution amounts and ensure that your employer matches them.
- In case of any changes to your employment status or personal details, such as a change of address, you will need to update the information with the ESI Corporation.
Final Thoughts
In conclusion, the ESI scheme provides a safety net for employees by offering a wide range of benefits for unexpected medical expenses. By meeting the eligibility criteria, employees can gain access to medical, sickness, maternity, and disability benefits, ensuring they have the support they seek during difficult times.
However, it is noteworthy that the scheme may not cover all medical expenses, and employees may still face financial burdens in case of serious illnesses or injuries. This is where Niva Bupa, as an insurance provider, can help. It offers a vast range of health insurance plans that can supplement the benefits offered, providing employees with additional coverage and peace of mind.
Secure your Health with comprehensive insurance plans from Niva Bupa
Health Insurance - Health Insurance | Medical Insurance | Best Health Insurance Plans | Health Insurance Plans | Health Insurance Policy | Best Health Insurance Plans | Best Family Health Insurance | Best Mediclaim Policy | Best Health Insurance In India | Best Medical Insurance In India | Best Health Insurance Plans In India | Best Health Insurance Policy In India | Mediclaim | Best Health Insurance For Senior Citizens In India | Best Health Insurance | Health Insurance With Opd Cover | Mediclaim Insurance | Medical Insurance Plans | Best Health Insurance Company in India | Critical Illness Insurance | Personal Accident Insurance | Mediclaim Policy | Individual Health Insurance | Pregnancy Insurance | Maternity Insurance | Best Family Health Insurance plans in India | Best Health Insurance company | Family Health Insurance | Best Health Insurance plans for Senior Citizens | Mediclaim Policy for Family
Health Insurance Schemes - Chief Ministers Comprehensive Health Insurance Scheme | Employee State Insurance Scheme | Swasthya Sathi Scheme | Pradhan Mantri Matru Vandana Yojna | Government Health Insurance Scheme | Dr. YSR Aarogyasri Scheme | Pradhan Mantri Suraksha Bima Yojna | Health Insurance Deductible | West Bengal Hcovealth Scheme | Third Party Administrator | Rashtriya Swasthya Bima Yojana | In Patient Vs Out Patient Hospitalization | Mukhyamantri Chiranjeevi Yojna | Arogya Sanjeevani Health Insurance | Copay Health Insurance | Cashless Health Insurance Scheme | Mukhyamantri Amrutum Yojna
Travel Insurance - Travel Insurance | International Travel Insurance | Student Travel Insurance | Travel Insurance USA | Travel Insurance Canada | Travel Insurance Thailand | Travel Insurance Germany | Travel Insurance Dubai | Travel Insurance Bali | Travel Insurance Australia | Travel Insurance Schengen | Travel Insurance Singapore | Travel Insurance UK | Travel Insurance Vietnam | Malaysia Tourist Places | Thailand Visa for Indians | Canada Visa for Indians | Bali Visa for Indians | ECR and Non ECR Passport | Qatar Visa Status | USA Visa | Vietnam Visa | USA H1B Work Visa
Become an agent - Insurance Agent | Insurance Advisor | Licensed Insurance Agent | Health Insurance Consultant | POSP Insurance Agent
Group Health Insurance - Startup Health Insurance | Commercial Health Insurance | Corporate insurance vs personal insurance | Group Personal Accident Insurance
Top Hospitals - Best Hospitals in Chennai | Top Hospitals in Delhi | Best Hospitals in Gurgaon | Best Hospitals in India | Top 10 Hospitals in India | Best Hospitals in Hyderabad | Best Hospitals in Kolkata | Best cancer hospitals in Bangalore | Best cancer hospitals in Hyderabad | Best cancer hospitals in Mumbai | Best cancer hospitals in India | Top 10 cancer hospitals in India | Top 10 cancer hospital in Delhi | Multi Speciality Hospitals in Mumbai | Multi Speciality Hospitals in Chennai | Multi Speciality Hospitals in Hyderabad | Super Speciality Hospitals in Delhi | Best Liver Hospitals in Delhi | Best Liver Hospitals in India | Best Kidney Hospitals in India | Best Heart hospitals in Bangalore | Best Heart hospitals in India | Best Heart hospitals in Kolkata | Best Heart hospitals in Delhi
Others - Top Up Health Insurance Policy | Corporate Health Insurance | Health Card | Section 80d of Income Tax Act | Ayushman Bharat | Health Insurance Portability | GoActive Family Floater Plan | Health Companion Family Floater Plan | Health Premia Family Floater Plan | Health Pulse Family Floater Plan | Health Recharge Family Floater Plan | Heartbeat Family Floater Plan | Money Saver Family Floater Plan | Saral Suraksha Bima Family Floater Plan | Senior Citizen Family Floater Plan | Super Saver Family Floater Plan | Corona Kavach Family Floater Plan | Hospital Cash Insurance | Cashless Health Insurance | Health Companion Price revision | Heartbeat Price revision | ReAssure Price revision
Health & Wellness - PCOD | PCOD Problems Symptoms | Stomach Infection | Stomach Infection symptoms | Home remedies for Stomach Infection | Hypertension definition | How to Control Sugar | Typhoid in Hindi | Blood sugar symptoms | Typhoid symptoms in hindi | Low sugar symptoms | ब्लड शुगर के लक्षण | pregnancy me kya kare | Open heart surgery cost | Blood infection symptoms in hindi | BP badhne ke karan | Khansi ka gharelu upay | Omicron | Coronavirus Health Insurance | Covid XE Variant | Norovirus
www.nivabupa.com
+91 11 41743397
1860-500-8888
3rd Floor, Capital Cyberscape, Sector 59, Gurgaon
- Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) (IRDAI Registration Number 145, Category:Health), 'Bupa' and 'HEARTBEAT' logo are registered trademarks of their respective owners and are being used by Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) under license. CIN: U66000DL2008PLC182918
- 1 Niva Bupa processes pre-authorisation requests within 30 minutes for all active policies, subject to receiving all documents and information(s) up to Niva Bupa’s satisfaction. The above commitment does not include pre-authorisation settlement at the time of discharge or system outage.
- 2 Since Inception refers to claim data from 2010 till December 2023.
- 3 ReAssure 2.0 Premium: The premium is including taxes and for Bronze Variant, for a 25-year-old individual living in Delhi.
- 4 Aspire Premium: The premium is including taxes and for Gold+ Variant, for a 25-year-old individual living in Delhi.
- 5 Senior First Premium: The premium is including taxes and for Gold Variant, for a 65-year-old individual living in Delhi.
- 6 Health Premia Premium: The premium is including taxes and for Silver Variant, for a 25-year-old individual living in Delhi.
- 7 SmartHealth + Disease Management Premium: The premium is including taxes and for Disease Management Gold Variant rider when bought with ReAssure 2.0 Bronze variant with Base Sum Insured of 5 lacs, for a 25-year-old individual living in Delhi.
- Beware of spurious / fraud phone calls! Do not share your confidential information like Debit / credit card number, Internet Banking User ID/Password, Pin, CVV, OTP, etc. with anyone. Avoid clicking on attachments / payment link received in mails / message from unknown sources. IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment or premium. Public receiving such phone calls are requested to lodge a police complaint. Do not respond to unsolicited and attractive offers received through unidentified calls, emails, SMSs, and other social media platforms. Beware of misleading telephone calls from people posing as Niva Bupa officials, agents, IRDAI Officials, Officials from ECI (Office of the Executive Council of Insurers) etc. and offering alluring benefits or sharing false information on your policy or on Niva Bupa. Niva Bupa shall not be responsible for any loss or damages whatsoever for any acts or omissions arising out of such spurious calls, and all customers are advised to contact our customer care at 1860-500-8888 and verify any representations or promises made by any such spurious callers before acting upon the same.