ESIC — Employees' State Insurance Corporation: Complete Guide

The Employees' State Insurance Corporation (ESIC) is a self-financing social security scheme that provides medical care, cash compensation and pension benefits to workers in the organised sector. It is governed by the ESI Act, 1948 and currently covers establishments with 10 or more employees earning up to ₹21,000 per month (₹25,000 for persons with disabilities).

Who is covered under ESIC?

• Employees earning up to ₹21,000 per month in factories with 10+ workers
• Employees in notified establishments — shops, hotels, restaurants, road transport, cinemas, newspapers, educational and medical institutions
• Domestic workers in select states (Karnataka, Maharashtra, Gujarat)
• Contract labour in covered establishments

Contribution rates

Employee contribution is 0.75% of gross wages; employer contribution is 3.25%, totalling 4% of gross. The wage ceiling for the employee's contribution is ₹21,000 per month. Once enrolled, the worker remains covered for sickness, maternity and disability benefits for life under specific cap rules.

Benefits at a glance

• Medical benefit — free OPD/IPD treatment for self and family at ESI dispensaries and tie-up hospitals
• Sickness benefit — 70% of average daily wages for up to 91 days per year
• Extended sickness benefit — 80% of wages for up to 2 years for 34 specified long-term diseases
• Maternity benefit — 100% of average daily wages for 26 weeks
• Temporary disablement benefit — 90% of wages from day 1 of injury
• Permanent disablement benefit — life pension as per disability percentage
• Dependants' benefit — monthly pension to dependents on death due to employment injury
• Funeral expenses — ₹15,000 to dependents
• Vocational and physical rehabilitation

ESI dispensaries and hospitals

ESIC operates over 1,500 dispensaries and 150 hospitals across India. Insured Persons (IPs) must register with a specific dispensary using their ESI card. Treatment is free for the IP and family. For specialty care, IPs are referred to ESI hospitals or empanelled tie-up hospitals.

How to claim sickness benefit

Obtain Form 9 (first certificate) and Form 10 (subsequent certificates) from your ESI Insurance Medical Officer (IMO). Submit the forms at your local ESI branch within 7 days of the medical event. Cash benefit is paid directly into the IP's bank account within 21 days of submission.

Maternity benefit process

Women IPs with at least 70 days of contribution in the immediately preceding two contribution periods are eligible. Apply through Form 17 with the medical certificate from the ESI IMO. Benefit is paid for 26 weeks (12 weeks for miscarriage, 6 weeks additional for illness arising from pregnancy).

Pehchaan Card and online services

Every Insured Person receives a biometric Pehchaan Card with photos and family details. The ESIC portal (esic.in) allows online challan generation, contribution history, family declaration updates, and grievance registration.