Re: Is ESI Benefits Applicable If The Gross Salary Is Higher Than RS 15000

Hi all,

I have recently claimed ESI for a heart surgery. I underwent the surgery in the month of April when I was eligible for ESI. However, I have now received a salary appraisal, and my gross salary is more than 15000. Can I still claim the medical expenses for the surgery under ESI?

1. Sir, I understand that you will be eligible for medical facilities from ESIC until the close of the relevant benefit period. However, since the provisions of the ESI Act, 1948, and the rules/regulations framed thereunder are statutory in nature and not optional, I presume that (as mentioned by you regarding your wages exceeding Rs. 15,000), from the relevant benefit period, you will not be eligible for benefits under the said Act.

2. I suggest that you please contact your nearest Branch Office of ESIC to which you are attached, discuss the matter, and get an idea about the continuity of your eligibility until which period. It is only the Branch Office of ESIC that can provide you with the correct position based on records relating to your contributions under the said Act.

3. I hope for your speedy recovery.

Hi,

If in April you were eligible for ESI benefits, then you should still be eligible now. It's advisable to first check with your HR department and then approach the ESI officials.

Certainly, here is the corrected version of the user's input:

"You can definitely claim for medical expenses from ESIC. For example: If your salary crosses 15,000 in April 2015, you can avail ESIC facilities for 6 months until October 2015."

Please let me know if you need any further assistance.

Yes, Kavya, you are eligible for benefits even though your salary hike is from April to September because the contribution period is from April to September. So, if your salary increase is in May, then your E.S.I. contributions will continue until September. However, you must receive compulsory treatment at an E.S.I. hospital or consult with an E.S.I. doctor.

Yes, you are 100% eligible for claiming your medical expenses based on the below contribution and benefit periods:

Contribution Period:
1st April to 30th September

Benefit Period:
1st January of the year following to 30th June

Contribution Period:
1st October to 31st March of the year following

Benefit Period:
1st July to 31st December

Thanks & Regards,
Nabil Shaikh

Yes, you are 100% eligible for claiming your medical expenses based on the following contribution and benefit periods:

Contribution period:
- 1st April to 30th September
- 1st October to 31st March of the following year

Benefit Period:
- 1st January to 30th June of the following year
- 1st July to 31st December

Thanks & Regards,
Nabil Shaikh

I doubt because nowadays everything is online, so they just check your last ESIC contribution. If there is no contribution for the preceding month, then you may not be eligible for the benefit.