ESIC Expands Healthcare: Superannuated Members Now Eligible

What is the ESIC Scheme?

The Employees’ State Insurance Corporation (ESIC) is a statutory body that provides social security and health insurance to workers in India. The ESIC scheme covers workers earning up to Rs 30,000 per month and provides them with medical care, cash benefits, maternity benefits, disability benefits and pension benefits.

Who are the Superannuated Insured Persons?

Superannuated insured persons are those who retired at higher wages than the ceiling limit of the ESIC scheme, even if they had contributed to the scheme for at least five years. Until recently, these workers were not eligible for any medical benefits from the ESIC after retirement.

How will they Benefit from the New ESIC Scheme?

In a landmark decision, the ESIC has decided to extend medical benefits to superannuated insured persons who retired at higher wages, subject to certain conditions. The decision was taken at the 193rd meeting of the ESIC under the chairmanship of Union Minister Bhupender Yadav on February 10, 2024 .

According to the official statement, persons who were in insurable employment for at least five years after April 1, 2012 and superannuated or took voluntary retirement on or after April 1, 2017 with wages up to Rs 30,000 per month will be benefited under the new scheme .

However, the superannuated insured person will have to contribute at the rate of 3% per month of the wage ceiling at the time of enrollment to avail the ESIC medical facilities for self and the spouse. It is estimated that the scheme will benefit 0.56 million people and the funds inflow to ESIC under the scheme will be Rs 423.36 crore a year.

What are the Medical Benefits Available?

The new scheme will provide medical benefits to superannuated insured persons and their spouses from the ESIC network of hospitals and dispensaries across the country. The medical benefits will include consultation, diagnosis, treatment, medicines, surgeries and hospitalization.

The new scheme will also provide access to Panchkarma, Kshara Sutra or thread therapy and AYUSH or traditional treatment techniques in existing ESIC hospitals for holistic wellbeing of the insured persons and their dependents.

Why is this Scheme Important?

The new scheme will enhance the social security and health coverage of superannuated insured persons who were previously excluded from the ESIC scheme due to higher wages. The new scheme will also encourage more workers to join and contribute to the ESIC scheme as they will be assured of medical benefits even after retirement.

The new scheme is a win-win situation for both the ESIC and its beneficiaries. It is a commendable initiative by the ESIC that reflects its commitment to provide social security and health insurance to all workers in India.

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