Overview The Employees' State Insurance (ESI) Scheme is a multidimensional social security system in India designed to provide socio-economic protection to workers in the organized sector. Managed by the Employees' State Insurance Corporation (ESIC), an autonomous body under the Ministry of Labour and Employment, Government of India, the scheme provides health care and financial assistance in the event of sickness, maternity, disablement, or death due to employment injury. Legislative Framework The scheme is governed by the Employees' State Insurance Act of 1948. This was the first major legislation on social security for workers in independent India. The Act was formulated following the recommendations of the Adarkar Report (1944), which suggested a compulsory insurance scheme for industrial workers to mitigate the financial risks associated with health and employment. Applicability and Coverage Establishments Covered The ESI Act applies to factories and other establishments such as hotels, restaurants, cinemas, road motor transport undertakings, newspaper establishments, and private medical and educational institutions that employ 10 or more persons. In some states, the threshold remains at 20 employees. Employee Eligibility Employees drawing wages up to ₹21,000 per month are entitled to social security cover under the ESI Act. For persons with disabilities, the wage limit for coverage is ₹25,000 per month. Contribution Structure The ESI scheme is self-financing, with funds primarily generated through contributions from employers and employees. The current contribution rates (effective from July 2019) are: Employer’s Contribution: 3.25% of the wages payable to employees. Employee’s Contribution: 0.75% of the wages payable. Total Contribution: 4.00% of the wages. Employees earning less than a specific daily average wage are exempted from paying their share of the contribution, though the employer must still pay their portion. Key Benefits Medical Benefit Full medical care is provided to an insured person and their family members from the day they enter insurable employment. There is no ceiling on expenditure on the treatment of an insured person or their family member. Sickness Benefit Insured workers are entitled to cash compensation at the rate of 70% of their wages during periods of certified sickness for a maximum of 91 days in a year. To qualify, the worker must have contributed for at least 78 days in a six-month period. Maternity Benefit For confinement or pregnancy, maternity benefit is payable for 26 weeks, which is extendable by one month on medical advice at the rate of full wages, subject to contribution conditions. Disablement Benefit Temporary Disablement Benefit (TDB): From day one of entering insurable employment and irrespective of having paid any contribution, in case of employment injury. Payable at 90% of wage as long as the disability continues. Permanent Disablement Benefit (PDB): Payable at 90% of wage in the form of monthly payment depending upon the extent of loss of earning capacity as certified by a Medical Board. Dependants' Benefit In the event of death due to employment injury or occupational disease, a monthly pension is paid to the dependants of the deceased insured person at the rate of 90% of the wages. Other Benefits Funeral Expenses: A lump sum amount is paid to the eldest surviving member of the family or the person who actually incurs the expenditure on the funeral. Confinement Expenses: Paid to an insured woman or an insured person in respect of his wife in case confinement occurs at a place where necessary medical facilities under ESI Scheme are not available. Unemployment Allowance: Under schemes like the Atal Beemit Vyakti Kalyan Yojana (ABVKY) and Rajiv Gandhi Shramik Kalyan Yojana (RGSKY), cash compensation is provided to workers who become unemployed. Infrastructure and Administration The ESIC operates a massive network of infrastructure across the country, including hundreds of ESI hospitals and thousands of dispensaries. The administration is handled by the Corporation, which consists of representatives from the Central Government, State Governments, employers, employees, the medical profession, and the Parliament. The Director General is the chief executive of the Corporation and an ex-officio member. 1. Eligibility (2026 Criteria)Establishments: Any factory or establishment (shops, hotels, cinemas, etc.) with 10 or more employees.Wage Limit: Employees earning a gross salary of up to ₹21,000 per month (₹25,000 for persons with disabilities).Contributions: * Employee: 0.75% of gross wages. Employer: 3.25% of gross wages. 2. Application ProcessThe application is primarily handled by the Employer, but as an employee, you must ensure your data is captured correctly. For the Employer (Registration):Sign-up: Register on the ESIC Portal or Shram Suvidha portal.Form-1: Fill out the Employer’s Registration Form with business details.Employee Enrollment: The employer enters your details (name, joining date, salary, and Aadhaar number—which is now mandatory for digital validation in 2026).IP Number: Once registered, you are assigned a unique Insurance Number (IP Number).For the Employee (Getting your Card):Pehchan Card: Your employer will download and print your "e-Pehchan" (Identity) card from the portal.Validation: Ensure your family members' photos and details are uploaded so they can also access medical benefits. Benefit What you get Eligibility / Process Medical Benefit - Full medical care for self and family.Available from Day 1 of joining - No upper limit on treatment costs. Sickness Benefit - 70% of wages in cash during certified sickness.Must have contributed for at least 78 days in a 6-month period. Maternity Benefit-100% of wages for 26 weeks.Must have contributed for 70 days in the last two periods Disablement (TDB)-90% of wages for injury at work.Available from Day 1 of employment. Unemployment-50% of wages for up to 2 years (RBPY/ABVKY).For those lost jobs due to closure or retrenchment. 4. Claim ProcessA. Medical Claims (Cashless)Visit Clinic: Go to your assigned ESI Dispensary or ESI Hospital with your Pehchan Card and Aadhaar.Referral: If specialized treatment is needed, the ESI doctor will refer you to an empanelled private hospital.Cashless Treatment: The bills are settled directly between the hospital and ESIC; you pay nothing.B. Cash Benefit Claims (Sickness/Maternity)Medical Certificate: Obtain a "Certificate of Sickness" from an ESI medical officer.Online/Offline Submission: Submit this certificate along with Claim Form 9 to your local ESIC Branch Office. In 2026, many of these claims can be initiated via the ESIC IP Portal.Direct Transfer: Once verified, the money is credited directly to your bank account via DBT (Direct Benefit Transfer).C. Reimbursement (Emergency)If you are forced to go to a non-ESI hospital in a life-threatening emergency: Pay the bills upfront.Submit all original bills, discharge summary, and an emergency certificate to the ESIC Branch Office within 30 days.The amount is reimbursed as per CGHS rates.Note for 2026: Ensure your Bank Account (with IFSC) and Mobile Number are updated in the ESIC system to avoid delays in cash benefit transfers.