Six Benefits provided to the employees who are insured under the employees’ state insurance act

1. Sickness Benefit:

An insured employee, whose sickness is certi­fied by a duly appointed medical practitioner, is given periodical payment.

Sickness Benefit is given to an insured person on the following condi­tions:

(1) The insured person should be eligible for the benefit. His eligibility depends on the following two factors:

(a) Sickness occurring during any benefit period;

(b) Contribution for the corresponding contribution period payable with regard to the insured person for not less than thirteen weeks.

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(2) The benefit shall not be payable to any person for more than fifty- six days in any two consecutive benefit periods.

(3) No benefit shall be paid for the first two days of sickness, if a person has been given the sickness benefit once and he again falls sick at an interval of not more than fifteen days.

(4) Any claim for his benefit must be supported with a medical certificate given by an Insurance Medical Officer. The Corporation may accept any other evidence of sickness if it feels satisfied about the circumstances of the case.

2. Maternity Benefit:

Periodic payment is given to an insured woman in case of confinement, miscarriage, sickness arising about of pregnancy or premature birth of a child.

Under the maternity benefit, an insured woman employee, if she satis­fies the necessary conditions laid down in the Act, shall get the following benefits :

She can get maternity benefit for a period of 12 weeks. Of these 12 weeks not more than 6 weeks can precede the expected date of delivery.

She is paid 75 paise per day or the sickness benefit, whichever is higher.

If an insured woman dies during her confinement or during the period of six weeks immediately after her confinement, leaving behind the new born child, her nominee or legal representative shall be entitled to claim maternity benefit for that period.

If both the insured woman and the child die during the confinement period, benefit shall be payable for the days up to and including the days of the death of the child.

If an insured woman has a miscarriage, the maternity benefit is payable if she is entitled to it and she gives sufficient proof of miscarriage.

Maternity benefit for an additional period not exceeding one month is payable for all days she did not work, if she fulfils the conditions for entitlement and produces sufficient proof in support of her claim. The benefit can be claimed for :

(a) Sickness arising out of pregnancy

(b) Confinement

(c) Premature birth of a child

(d) Miscarriage

3. Disablement Benefit:

An insured person will get periodic pay­ment if he suffers from:

(i) Disablement, (ii) disablement from an employment injury and (iii) he sustained the employment injury as an employee under the conditions men­tioned in the Act. The injury should be certified by the Insurance Medical Officer.

4. Dependant’s Benefit:

If an insured person dies because of an injury caused to him while he was on duty, the dependant’s benefit becomes payable to dependant of the deceased employee.

Whether he was getting any periodical payment on account of that injury or not, is not taken into consid­eration for this purpose. Only those dependants who have already been specified can have the right of any such benefit.

If no dependant whose name have been specified is alive at the time of the death of the insured person, the dependant’s benefit shall be paid to other dependants of the deceased accord­ing to the rules.

5. Medical Benefit:

When an insured person or any other member of his family, who is entitled for this benefit, falls sick and his condition requires medical treatment and attendance, the medical benefit is given. Medical benefits is given in the following forms:

(i) Outpatient treatment; or

(ii) Attendance in a hospital, dispensary, clinic or other institution; or

(iii) By doctor paying visits to the home of the insured person ; or

(iv) Treatment as an in-patient in a hospital.

Scale of Medical Benefit:

An insured person and his family (in cases where such benefit is extended to them) is entitled to following benefits:

(1) Medical benefit as may be provided by the State Government or the Corporation.

(2) Medical benefit of such scale as may be provided by State Govern­ment or the Corporation.

(3) Medical treatment provided by the dispensary, hospital, clinic or other institution to which the insured person or his family is at­tached as outpatient, visit to home of injured, or as in-patient.

All these benefits are provided according to rules. No claim for reim­bursement from the Corporation is entertained for the expenses on medical treatment which are not covered under the regulations.

6. Funeral Benefit:

In event of death of an insured employee, the funeral benefit is paid to the eldest surviving member of the family or to such person who spends money on the funeral of the deceased.

The claim for the funeral benefit must be made within three months of the death of the insured person. The Corporation or any other competent official may allow extension of period of such claim. A maximum amount of Rs. 100/- is payable under this benefit.