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Esi Scheme and CGHS: Mrs. Namita Batra Guin Associate Professor Deptt. of Community Health Nursing

The ESI Scheme and CGHS provide health insurance and medical benefits to employees in India. The ESI Scheme covers medical, sickness, maternity, disability and dependent benefits for industrial workers. It has been expanded to include various establishments. The CGHS provides comprehensive healthcare to central government employees and pensioners through outdoor treatment facilities, medicines, tests and specialist care. It aims to provide extensive medical facilities and save costs for the government. Both schemes work to provide social security and healthcare support to large beneficiary groups in India.

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2K views

Esi Scheme and CGHS: Mrs. Namita Batra Guin Associate Professor Deptt. of Community Health Nursing

The ESI Scheme and CGHS provide health insurance and medical benefits to employees in India. The ESI Scheme covers medical, sickness, maternity, disability and dependent benefits for industrial workers. It has been expanded to include various establishments. The CGHS provides comprehensive healthcare to central government employees and pensioners through outdoor treatment facilities, medicines, tests and specialist care. It aims to provide extensive medical facilities and save costs for the government. Both schemes work to provide social security and healthcare support to large beneficiary groups in India.

Uploaded by

livelinami
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ESI SCHEME AND CGHS

Mrs. Namita Batra Guin


Associate Professor
Deptt. of Community Health Nursing
ESI SCHEME
INTRODUCTION

• The E.S.I. Act (Employees State Insurance) passed in 1948 (amended in 1975,
1984, 1989 and 2010) is an important measure of social security and health
insurance in this country.

• It provides for certain cash and medical benefits to industrial employees in


case of sickness, maternity and employment injury.

• The act extends to the whole of India. The E.S.I. Act of 1948 covered all power
using factories other than seasonal factories wherein 10 or more persons were
employed
SCOPE

• The provisions of the E.S.I. (amendment) act of 1975 were extended to the
following new classes of establishments:-

 Small factories employing 10 or more persons, whether power is used in the


process of manufacturing or not.
 Shops
 Hotel and restaurants
 Cinemas and theatres
 Road-motor transport establishments
 Newspaper establishments
 The scheme has been extended to private medical and educational institutions
employing 20 or more persons in some states.
BENEFITS TO EMPLOYEES

 Medical benefits
 Sickness benefits
 Maternity benefits
 Disablement benefits
 Dependant’s benefits
 Funeral expenses
 Rehabilitation allowance
MEDICAL BENEFITS

 DIRECT PATTERN: In areas having a concentration of 1000 or more employee’s


family units, service dispensaries are established with full time medical and
paramedical personnel.

• In areas where the employees are less than 750, part time ESI dispensaries are
established.
• If the residential concentration of employees is scattered over a long distance,
mobile dispensaries are established.

 INDIRECT PATTERN/ PANEL SYSTEM: Registered medical practitioners


designated as Insurance Medical Practitioners are appointed to provide medical
care.
SICKNESS BENEFITS

 EXTENDED SICKNESS BENEFIT: In addition to 91 days of sickness benefit,


insured persons suffering from certain long-term diseases are entitled to
extended sickness benefit, for a maximum period of 2 years. 34 diseases for
which extended sickness benefit with effect from 1.1.2000 is payable, in case
where the insured person has been in continuous employment for 2 years.

 ENHANCED SICKNESS BENEFIT: is payable to insured women for 14 days


for tubectomy and for 7 days in case of vasectomy in respect of male IPs.
The amount payable is double the standard sickness benefit
MATERNITY BENEFIT

 The benefit is payable in cash to an insured women for


confinement/miscarriage or sickness arising out of pregnancy/
confinement or premature birth of child or miscarriage.
 For confinement, the duration of benefit is 12 week(84 days), for
miscarriage 6 weeks and for sickness arising out of confinement etc.
30 days.
 The benefit is allowed at about full wages.

 The rate of confinement expenses has been increased from Rs. 2,500
to 5,000 per confinement.
DISABLEMENT BENEFIT

 The Act provides for cash payment , besides free medical


treatment, in the event of temporary or permanent disablement as a
result of employment injury as well as occupational diseases.

 The rate of temporary disablement benefit is about 90 percent of the


wages as long as the temporary disablement lasts.

 In case of total permanent disablement, the insured person is given life


pension worked out on the basis of loss of earning capacity
determined by a medical officer
DEPENDANT’S BENEFIT

 In case of death, as a result of employment injury, the dependants of


an insured person are eligible for periodical payments.

 Pension at the rate of 90% of the wages is payable, shared by


dependants in a fixed ratio, on monthly basis in accordance with the
prescribed share.

 An eligible son or daughter is entitled to dependant’s benefit up to the


age of 18; the benefit is withdrawn if the daughter marries earlier.
FUNERAL EXPENSES

 Funeral benefit is a cash payment payable on the death of an insured


person towards the expenses on his funeral, the amount not
exceeding Rs. 10,000.
REHABILITATION

 On monthly payment of Rs. 10, the insured person and his family
members continue to get medical treatment after permanent
disablement or retirement
BENEFITS TO EMPLOYER

 Exemption from the applicability of Workmen’s Compensation


Act, 1923.
 Exemption from Maternity Benefit Act, 1961.
 Exemption from payment of medical allowance to employees and
their dependent's or arranging for their medical care.
 Rebate under the Income Tax Act on contribution deposited in
the ESI account.
 Healthy work-force
CGHS SCHEME
INTRODUCTION

• Central Government Health Scheme is providing comprehensive medical


care to the Central Government employees and pensioners enrolled under the
scheme.
• It was introduced in Delhi in 1954.
• CGHS is the model Health care facility provider for Central Government
employees & Pensioners and is unique of its kind due to the large volume of
beneficiary base, and open-ended generous approach of providing health
care.
OBJECTIVES

• To give extensive medical facilities too


central government employees and their
family members
• To save the government from heavy
expenses on medical refund.
BENEFICIARIES

• Central government employees and their family members


• Members of parliament
• Judge of supreme court and high court
• Freedom fighters
• Pensioners of central government semi government organizations
• Journalists
• Governors and ex- Vice presidents
• Work Charged and Industrial Staff working in establishments run by
various Ministries or Departments of Central Government.
• Employees of Ordnance Factory Board Headquarters
• Employees of Kendriya Vidyalayas Sangathan
FACILITIES

• Outdoor treatment facilities in all medical systems


• Emergency services in allopathy system
• Free medication
• Facilities for laboratory tests and radiological tests
• Treatment facilities for serious patients at their home
• Specialist consultation facilities
• Treatment facilities in the government or government recognized private institutes.
• Facilities for 90 percent advanced payment, in case of need.
• Family Welfare, Maternity and Child Health Services.
• Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha
system of medicines (AYUSH)
• Cashless facility available for treatment in empanelled hospitals and diagnostic centers for Pensioners
and other identified beneficiaries.
• Tele-consultation
THANK YOU

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