ESIC eases conditions for women to avail sickness benefit, decides to set up more health facilities

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New Delhi: The Employees State Insurance Corporation (ESIC) has taken steps, such as relaxing contributory conditions for insured women to avail sickness benefit and decision to set up more hospitals, for improving delivery of services for insured persons under its health insurance scheme.

“The Employees’ State Insurance Corporation (ESIC), during its 184th meeting held on February 22, 2021, under the chairmanship of Santosh Kumar Gangwar, Minister of State for Labour and Employment (Independent Charge)…has taken several significant decisions to improve its service delivery mechanism and to strengthen the medical infrastructure benefiting its insured workers,” the labour ministry said in a statement.

The ESIC on February 22 decided to give relaxation in contributory conditions to avail sickness benefit to the insured women availing maternity benefit.

After the enhancement in duration of maternity benefit to 26 weeks from 12 earlier, in some cases insured women were not eligible to avail sickness benefit in the corresponding benefit period after availing maternity benefit. This is because the mandatory contributory conditions of minimum 78 days were not met being the insured women under receipt of maternity benefit and leave.

In such cases, it has been now decided that an insured women will be qualified to claim sickness benefit in the corresponding benefit period if the contribution in her respect were paid or payable for not less than half the number of days available for working in such shorter contribution period, it said.

The relaxation will be effective from January 20, 2017, the date from which the enhanced duration of maternity benefit is effective.

The ESIC also gave relaxation in contributory conditions to avail sickness and maternity benefits for the benefit period of January to June this year.

The country was placed into lockdown in March 2020 to curb the spread of the COVID-19 pandemic, which resulted in the closure of factories/establishments for several months. It resulted in non-entitlement to avail sickness and maternity benefits for many insured persons and women as the mandatory days of contribution could not be met.

The ESIC has now decided to extend the relief to the insured persons (IPs) by relaxing the contributory conditions for availing the sickness and maternity benefits for the benefit period of January 1, 2021 to June 30, 2021, it said.

Now, an insured woman (IW) will be entitled to avail maternity benefit, if the contributions in respect of her were payable not less than 35 days in immediately preceding two consecutive contribution periods.

In case of IPs or IWs appointed before the contribution period April-September 2020, the eligibility condition to avail sickness benefit will be decided on the basis of their contribution in the previous contribution period (September 2019-March 2020).

However, the IPs or IWs appointed during the contribution period (April-September 2020) will be eligible for sickness benefit in the benefit period of January-June 2021 if contribution in respect of them were payable for not less than half the number of days available for working to them during the contribution period (April-September 2020).

The ESIC has decided to construct a 300-bed hospital, including 50 superspecialty beds at Haridwar, Uttarakhand. The hospital will provide medical care services to around 2.55 lakh insured workers and their family members.

The ESIC has also decided to construct 350-bed hospital at Vishakhapatnam, Andhra Pradesh. The proposed hospital, after construction, will provide medical services to around 14 lakh beneficiaries covered under the ESI scheme in Vishakhapatnam and surrounding areas.

The ESIC has also decided establishment of a negative pressure ICU (intensive care unit) at ESIC Super Specialty Hospital & Medical College at Hyderabad, Telangana. The decision to establish the negative pressure ICU at ESIC Super Specialty Hospital and Medical College at Hyderabad, Telangana, was also taken during the meeting.

The establishment of the negative pressure ICU will decrease the burden of infection to the healthcare workers and will also decrease secondary infections to other critically ill patients admitted in the ICU.

The ESIC has also approved the revised estimates and budget estimates for the year 2020-21 and 2021-22, and performance budget for the year 2021-22 during the meeting.

Besides these, around 25 other agenda items pertaining to improvement in service delivery mechanism were also reported and approved by the ESIC.