Provident Fund Organization, ESI Schemes

The main responsibility for the operation of medical benefit under the employees’ state insurance act, 1948 lies with the state governments which are required to make available the services of the medical and Para-medical personnel. In most the states a special wing has been established for the purpose. As the medical benefit under the ESI scheme has been extended also to the family members of the insured persons and superannuated employees, the responsibility of the state governments in this regard has increases. A director, administrative medical officer or a chief medical officer under the labour department has been made in charge of the wing.

Social Security Directorate

A few states have established social security directorates for implementing certain social security schemes for the poor, unorganized workers, rehabilitation of bonded labourers and implementation of the interstate migrant workmen (regulation of employment and conditions of services) act, 1979. They also look after the implementation of national old age pension scheme, national family benefit scheme and national maternity benefit scheme.

Employees’ State Insurance Scheme of India is a multidimensional social security system tailored to provide socio-economic protection to worker population and their dependants covered under the scheme. Besides full medical care for self and dependants, that is admissible from day one of insurable employment, the insured persons are also entitled to a variety of cash benefits in times of physical distress due to sickness, temporary or permanent disablement etc. resulting in loss of earning capacity, the confinement in respect of insured women, dependants of insured persons who die in industrial accidents or because of employment injury or occupational hazard are entitled to a monthly pension called the dependants benefit.

The scale of Medical Benefit under section 57 of Act to be provided to the IPs and members of their families is to be prescribed by State Government in consultation with the Corporation under Section 58(1 & 3) of Act under State Medical Benefit Rules.

An IP and/or a member of his family do not have the right to claim Medical Services over and above those which have been so prescribed. The beneficiaries are entitled to reasonable medical, surgical and obstetric treatment.

To Insured Persons: IPs are entitled to avail treatment in ESI Dispensary/Hospital/Diagnostic Centre and recognised institutions, to which he is attached such as:-

• Outpatient treatment
• Domiciliary treatment by visits at their residences.
• Specialists Consultation.
• In-patient treatment(Hospitalisation)
• Free supply of drugs dressings and artificial limbs, aids and appliances.
• Imaging and laboratory services.
• Integrated family welfare, immunisation and MCH Programme and other national health programme etc.
• Ambulance service or re-imbursement of conveyance charges for going to hospitals, diagnostic centres etc.
• Medical Certification and
• Special provisions.

To Family Members of Insured Persons: While in all implemented areas, IPs are entitled to medical care as detailed above, members of a family of an IP are entitled to one or other of then the family member of the insured person is eligible to take one or other medical under the following standards:

• “FULL” Medical Care i.e., all facilities as for IPs including hospitalisation.
• “EXPANDED” Medical Care i.e., all facilities as for IPs except hospitalisation. A small number of IPs in the States of Gujarat and Bihar fall under this category.

The Corporation aims at providing Medical care according to uniform standards to the Family members in all implemented areas as the rates of the contribution paid by the employees and the employers are the same throughout the country.