Maternity Benefit Process and ESIC Procedure: Employee Health Benefits Guide

Dear Fellow Members,

I have one query related to the Maternity Benefit under ESIC. One of our female employees is covered under ESIC. She is pregnant now. However, in her two years of employment with us, she has not taken any ESIC benefits or even applied for TIC. She went on leave by simply submitting a leave application for prolonged leave. In the meantime, we arranged for TIC to provide her Maternity Benefit, which has not reached her yet. To my knowledge, she needs to visit the ESIC office once before the Expected Due Date (EDD) to claim the benefit. However, before she could do so, we received information about a miscarriage.

Kindly advise if she is still eligible for the said benefit under ESIC?

Thank you in advance.

Maulik Dave

Sir,

In order to be eligible for maternity benefit under the ESI Act, 1948, an insured woman should have contributed/contribution payable for not less than 70 days in the last two consecutive contribution periods, i.e., one year (Section 56(1)). Therefore, in my opinion, as stated by you, the said female employee is eligible for maternity benefit. In the case of a miscarriage, she is eligible for maternity benefit for a period of six weeks immediately following the date of her miscarriage (Section 56(3)).

The main requirement is that the insured woman was required to visit her ESI dispensary, obtain certification from the IMO concerned, and should have submitted the same to her ESIC Branch Office.

Since, as mentioned by you, the appropriate procedure was not completed, I suggest that the said female employee may contact the appropriate branch office of ESIC or ESI dispensary and discuss the issue. They can help by issuing a certificate at this stage, considering the medical certificates/papers from the medical institute/doctor where she is presently receiving treatment.

Dear member,

Thank you. TIC is valid only for a very short period. However, I presume that you are working as an HR official in your establishment, and I would suggest that you ensure that each and every employee of your unit, covered under the ESI Act, 1948, must have an ESIC Pehchan Card duly issued by the appropriate Branch Office. You can also check the status of other covered employees to verify if they possess an ESIC Pehchan Card or not.

The availability of Pehchan Cards for all employees will ensure timely access to benefits in the event of any contingencies.

The ESI card shall be arranged by the employer immediately on joining, not at the time when a person needs to get benefits from ESIC. Here, the employer is at fault.

You can go to the Branch Office of ESIC or Insurance Medical Officer (IMO) and convince them that she should receive benefits. If she does not receive benefits due to the employer's fault, she may claim the same directly from you under the Employees' Compensation Act.

Email: varghese21283@gmail.com
Phone: 9961266966

Dear Sir,

Let me clarify this case. If an employee (male/female) has taken a long leave due to bad health or some other health issue, he/she underwent treatment under ESIC Benefits. In this case, during their leave period, are they eligible for salary? If yes, how many days will they be entitled to?

Kindly revert to me.

Regards,
Chandra
9676286674

An employee on ESI leave is not eligible for any salary from the employer. He/she will receive the monetary benefits from ESIC, subject to the conditions outlined in the ESI regulations/rules.

Varghese Mathew
varghese21283@gmail.com

If I join the new organization on 16 Jan 2017 and contribute to ESIC from Jan 2017, and I discover I am pregnant in the month of March, am I eligible for maternity leave? Please reply.

Dear member, it would be better if you could clarify whether you had contributed to and were covered under the ESI Act, 1948 in your previous organization?

In case you were not covered under the said Act in your previous employment, then your benefit period will start from 16/10/2017, but only if you have contributed to ESIS for the minimum number of days required for eligibility for the said benefit.

Since eligibility for a particular benefit is a matter of fact, I hope you will contact the appropriate Branch Office of ESIC as well as the ESIS dispensary to which you are attached. I also hope you will obtain the necessary medical certification from the concerned ESIS dispensary.

With best wishes.

Thank you, Mr. Harshkumar. I was not covered under ESIC in my previous organization. My tentative maternity leave starts from October 2017. Please advise on the procedure.

Dear member,

I have already suggested in my reply as above that the claimant insured woman/person should contact the appropriate ESI dispensary as well as ESIC Branch Office. Please do not forget to carry your ESIC Pehchan Card while visiting the above offices.

Hello!

What is the clear procedure to claim medical benefits? What are the documents required, where to submit them, and how much will I get if my salary is $8000?

Kindly provide a detailed answer.

Thanks in advance.

Dear member, you can visit ESIS dispensary to which you are attached, show them your PEHCHAN CARD, and discuss the issues with the doctors and staff posted therein. In addition, you can also visit and approach the ESIC Branch Office to which you are attached, show your PEHCHAN CARD to them, and discuss the entire issues with them.

I think you will get suitable guidance and replies from the staff of the above offices. You can also download necessary literature on ESIC Benefits from the website of ESIC. In order to claim maternity benefit under ESI Act, 1948, an insured woman must have contributed for the minimum number of days as required in the said Act and the rules/regulations framed therein.