Cashless treatment of ESIC Employees and cash compensation for loss of wages: Loksabha Q&A
GOVERNMENT OF INDIA
MINISTRY OF LABOUR AND EMPLOYMENT
UNSTARRED QUESTION NO: 875
ANSWERED ON: 21.11.2016
Y. S. AVINASH REDDY
KOTHA PRABHAKAR REDDY
Will the Minister of LABOUR AND EMPLOYMENT be pleased to state:-
(a) whether the Government has stopped/proposes to stop the cashless treatment of ESIC Employees;
(b)if so, the details thereof and the reasons therefor;
(c)the steps being taken by the government to alleviate problems of ESIC employees in this regard;
(d)whether the Health Insurance Scheme run by the Government provides guarantee of income which is necessary for livelihood and if so, the details thereof; and
(e)if not, whether the Government proposes to implement such schemes in future?
MINISTER OF STATE (IC) FOR LABOUR AND EMPLOYMENT (SHRI BANDARU DATTATREYA)
(a) & (c): No, Madam. The employees under ESI Scheme are eligible for cashless treatment in the ESI Hospitals and tie up hospitals. In case of emergency treatment outside the ESI network, the employees are reimbursed on CGHS rates or respective state rates.
(b): Not applicable in view of answer at (a) above.
(d): Yes, Madam. Under ESI Scheme, cash compensation for loss of wages is paid as under:
1. Sickness Leave – For 91 days @ 70% of wages
2. Temporary disablement – Till the spell of sickness lasts @ 90% of wages
3. Maternity leave – For 12 weeks (under revision to 26 weeks) @ 100% of wages
4. Unemployment allowance- @50% for first year and 25% for second year.
(e): Not applicable.
ESIC Employees enhancement of reimbursement ceiling on medical expenditure incurred by State ESI Schemes.
EMPLOYEES’ STATE INSURANCE CORPORATION
(ISO 9001-2008 CERTIFIED)
PANCHDEEP BHAWAN, C.I.G MARG, NEW DELHI – 110002.
E-mail : email@example.com, Website : www.esic.nic.in
File no, Pt.V-13(14)38/09-Med.I(ESIC/SC)
All SSMCs /SMCs/DMD / DMN/RDs / MSs, ESI Corporation
All Principal Secretary Labour/ Health (dealing State ESI scheme)
All DIMSs/AMOs, State ESI Scheme
Sub: Enhancement of reimbursement ceiling on medical expenditure incurred by State ESI Schemes.
Sir / Madam,
Under ESIC 2.0, ESIC, is expanding its medical services with improved quality and equipping its own as well State run. facilities to maximize the medical benefits for ESI beneficiaries. During the meetings held with the State Govts, it was opined that reimbursement ceiling on medical expenditure is insufficient to rollout the medical benefits under ESIC 2.0.
Accordingly, ESI Corporation in its 170th meeting held on 15th December, 2016 has approved the enhancement of ceiling on medical expenditure incurred by State ESI Schemes, as under:
a) Increase in per capita ceiling of sharing expenditure with State Governments u/s 58 (3) from Rs. 2150 to Rs. 3000 per IP with sub ceiling of Rs. 1250 for “Administration” and Rs, 1750 for “Others” for the year 2017-18.
b) From 2018-19 “Administrative” sub-ceiling will be increased in line with CPI within the overall ceiling of Rs. 3000/- per capita.
c). The ceiling of Rs. 3000/- will be fixed from 2017-2018 to 2019-20 and reviewed annually from 2020-21 on the basis of WPI and expenditure pattern of the States.
d). The State Govt. shall present Project Implementation Plan (PIP), in accordance with the guidelines issued by ESIC time to time, by 31st October every year for the next financial year for its inclusion of the Budget of the Corporation. The PIP should contain the proposal for next Financial year and the progress made during the first six months of the current year.
i. No scheme should be included which has not been duly approved by the ESIC,
ii. Should it be proposed, during the course of a financial year, to finance any scheme which has not been included into the estimates of that year, the sanction of the ESIC shall he obtained to the method for financing it.
iii. The funds shall not be appropriated for expenditure on any item which has not been approved,
iv. The PO ESIC, is authorised to re-appropriate funds from one primary unit of appropriation to another.
e) Funds for 2017-18, will be released as per current ceiling of Rs.2150/- for the first quarter. However, the PIPs for the year 2017-18 should be submitted by 31st January, 2017 to the ESIC for release of fund as per revised ceiling.
f) The plan submitted would be duly monitored by ESIC, for effective impiementation. The funds shall be released on quarter]y basis in accordance with the letter No. V-24/11/10/2001-Med-I issued on 19th April, 2016.(enclosed).
This is for your information and further necessary action.
(Dr. Naveen Saxena)
30 lakh to benefit from new EPF limit
The move will help 1.2 crore people who will now be eligible for health care benefits.
The Centre’s move to increase the wage ceiling for employee coverage under the Employees’ Provident Funds and Miscellaneous Provisions Act, 1952, to Rs 25,000 per month from the existing Rs 15,000 per month limit is expected to benefit a larger working population and include approximately 30 lakh more workers to the Employees State Insurance (ESI) pool.
The move would also benefit 1.2 crore more people who will now be eligible for health care benefits at more than 1,500 clinics and hospitals run by the ESIC directly or indirectly. Earlier as of March 31, 2016, there were around 2.1 crore persons who were insured under the ESI Act and a total of over 6 crore beneficiaries. Employees and employers contribute to the Employees’ State Insurance Corporation at the specified rates, which are currently, 1.75 per cent of the wages (employee’s contribution) and 4.75 per cent of the wages (employer’s contribution) paid/payable in respect of the employees in every wage period.
However, the increased wage ceiling is expected to pose a challenge to employers in terms of the wage costs to be borne by them, said Nishith Desai Associates, legal and tax councillors.
Employers, it noted, would now be required to make provisions of cash benefit and health insurance for an extended employee population who draw wages up to Rs 21,000 per month. It also sees this as a challenge for the government to ensure that the quality of medical facilities (including hospital infrastructure) provided under the ESI Act are improved such that the desired benefit is achieved. It is a positive move with the objective of expanding the ambit of social security schemes to a larger working population.
7th CPC Implementations for ESIC Pensioners
EMPLOYEES STATE INSURANCE CORPORATION
PANCHDEEP BHAWAN C.I.G.MARG NEW DELHI
Dated : 22.12.2016
All the Regional Directors/Dir.(I/c)/Jt.Dire(I/c) of Ros/SROs
Dir. (Med.) Delhi/NOIDA/K.K.Nagar
SSMC/SMC of all States.
Dean of all Medical/Dental Educational Institutions.
Medical Superintendents of ESI Hospitals/ESIC Model Hospitals
Subject : Implementation of the recommendation of 7th CPC – reg
Please refer to E-III, Hqrs. Office Memo No.A-27/17/1/7th CPC/2016-E-III dt.01.11.2016 on the above subject. In this connection, the detailed procedure for preparation & sanction of PPO/revision of PPO in r/o pre-2016 pensioners and post 2016 pensioners by the competent authority are as detailed below:
1. For Pre-2016 retirees
a. In case of pensioners (pre-2016) who are drawing pension from Public Sector Banks, the concerned units (Regions / Hospitals / etc.) will authorize the Public Sector Banks for revising the pension / family pension by multiplying factor 2.57 in terms of Para 4.1 and 5 of Deptt. Of P&PW OM No.38/37/2016-P&PPW (A) (ii) dated 04.08.2016 (copy enclosed).
b. The pensioners (pre-2016) who are drawing pension concerned units (Regions / Hospitals / etc.), Head of Office will arrange for re-fixation for pension / family pension by multiplying factor 2.57 in terms of Para 4.1 and 5 of Deptt of P&PW OM No.38/37/2016-P&PPW (A) (ii) dated 04.08.2016.
c. A suitable entry regarding the revised pension / family pension shall be recorded by the Pension Disbursing Authorities (including Public Sector Banks) in both halves of the Pension Payment Order as stipulated in Para 9 of Deptt. of P&PW OM No.38/37/2016-P&PPW (A) (ii) dated 04.08.2016.
d. In order to have effective monitoring of implementation as envisaged in Agenda No. I (3) of Minutes of Meeting issued by Central Pension Accounting Office, Ministry of Finance, Govt. of India vide letter dated 30.08.2016 (copy enclosed), after issuing authorisation for pension revision in case of pre-2016 retirees, the Deputy Director (Fin.) / Assistant Director (Fin.) of concerned units (Regions / Hospitals / etc.) shall check & verify the amount disbursed on account of revised pension / family pension from pension scroll as received from banks in respect of each pensioner. In case of any discrepancy the same shall be brought to the notice of concerned bank immediately to ensure timely correction of such discrepancies at the earliest.
e. As stipulated in Agenda No. I (4) of Minutes of Meeting issued by Central Pension Accounting Office, Ministry of Finance, Govt. of India vide letter dated 30.08.2016 regarding report of revision of cases, in all above cases a certificate along with calculation sheet will be sent by Head of Office of concerned units (Regions / Hospitals / etc.) to Accounts-IV Branch of ESIC Hqrs. Office stating that due care was taken and correctness has been ascertained and also corrective action has been taken thereof.
2. For Post-2016 retirees
a. A reference is also invited to Deptt. Of P&PW OM No.38/37/2016-P&PPW (A) (i) dated 04.08.2016 (copy enclosed) regarding revision of pension of post-2016 pensioners/family, in case of pensioners whose pension was finalized under 6th CPC need to be revised under 7th CPC recommendations after doing the pay fixation under 7th CPC by concerned / respective units (Regions / Hospitals / etc.). Accordingly, for Group C,on pay fixation under 7th CPC, the concerned units will revise above mentioned pension cases of post-2016 retirees and issue revised PPOs after following the due procedures and pre-audit. The concerned units will also calculate the differential amount of gratuity, commutation, etc., based on the revision of each pension cases under 7th CPC recommendations. A separate committee may be constituted at unit level who will verify the pension revision as per 7th CPC / pre-audit each pensioner cases. In all cases a certificate along with calculation sheet will be sent by Head of Office of concerned units (Regions / Hospitals / etc.) to Accounts-IV Branch of ESIC Hqrs. Office stating that due care was taken and correctness has been ascertained and also corrective action has been taken thereof.
b. Similarly, in case of Group A & B, the concerned units (Regions / Hospitals / etc.) will ensure timely preparation of revised pension papers (based on pay fixation under 7th CPC) along with calculation sheet in accordance with the instructions contained in Deptt. Of P&PW OM No.38/37/2016-P&PPW (A) (i) dated 04.08.2016 (copy enclosed) regarding revision of pension of post-2016 pensioners/family for submission to Accounts-IV Branch of ESIC Hqrs. Office for further issue of revised PPOs. In these cases, Accounts-IV Branch of ESIC Hqrs. Office will ensure the compliance of pre-audit of each and individual cases of revision of pension before issue of revised PPOs
It is to further mention that units who have already initiated / undertaken the revision of pension/family pension in reference to E-III, Hqrs. Office Memo No.A-27/17/1/7`h CPC/201.6-E-III dt.01.11.2016 on the above subject are also required to comply with the above procedure at once.
This issues with the approval of Competent Authority.
Yours faithfully ,
Threshold Limit for Coverage under ESIC
The Government, in principle, decided to enhance the threshold limit of wage for coverage under the Employees State Insurance (ESI) Act, 1948 from existing Rs.15,000/- pm to Rs. 21,000/- pm. For this purpose, a Notification had been issued on 06.10.2016 inviting suggestion/objections from all stakeholders.
As on 31.03.3016, the number of Insured Persons(IPs) under ESI Scheme were 2.14 crores. The additional number of IPs on account of wage revision are estimated to be 35 Lakhs.
The ESI Corporation has taken a number of decisions to absorb the increased number of workers under its net like-
Increasing hospital bed strength of ESI Hospitals by 50%, if the bed occupancy of the concerned hospital has been consistently more than 70% in last three financial years.
Up-gradation of its dispensaries into 6 & 30 bedded hospitals in a phased manner.
Partnering with private medical practitioners & private clinics for providing healthcare facilities in those areas where ESI does not have them.
This information was given by Shri Bandaru Dattatreya, the Minister of State (IC) for Labour and Employment, in reply to a question in Rajya Sabha today.
ESIC Approves the Enhancement of Wage Ceiling from Present Rs. 15,000 per Month to Rs. 21,000
The Employees State Insurance Corporation(ESIC) has approved the enhancement of wage ceiling from present Rs. 15,000 per month to Rs. 21,000/-. The draft Rules calling for objections has been published in Gazette of India on 06.10.2016. This enhancement of wage ceiling shall bring more employees under ESIC coverage. In addition, the decision has also been taken to ensure coverage of the Scheme in all districts of the Country.
The ESIC in its meeting dated 07/08/2015 has decided to bear the expenses on super specialty treatment over and above the expenditure of state government.
The ESIC in its 166th Corporation meetings held on 07.08.2015 has decided to consider eligibility of pre existing diseases i.e. for malignancy & dialysis as prospective w.e.f. 30.08.2016.
Further, ESIC has revised eligibility for Super Specialty including the children of Insured Persons with congenital diseases & genetic disorders.
This information was given by Shri Bandaru Dattatreya, the Minister of State (IC) for Labour and Employment, in reply to a question in Lok Sabha today.