The ESI Scheme is not devoid of merits as is being claimed / projected and attempted to prove by providing certain misleading facts. It is a Social Security Scheme which has so far been providing comprehensive medical care to the covered employees as well as their dependant family members without any condition of pre-existing disease exclusion criteria which criteria is invariably associated with normal commercial medical insurance products. Besides it also covers and compensates wage losses due to sickness, accidents, maternity, etc. of the employees, for as long as upto two years on affliction with certain serious diseases. The medical treatment for self and dependant family members is as yet without any upper expenditure ceiling limit for any entitled employee or his/her dependant family members, which would not be possible on purchase of an ordinary insurance policy. The payout of 49% indicated by the an author in the Indian Express sometime back is also erroneous, particularly with regard to ESI Scheme, since the ESIC spends over 60% of the contributions on medical treatments and care of the employees and their dependant family members alone. Besides it pays out around 20% in the form of cash benefits and compensation for abstention of the employees, to the dependants of the employees, etc. Remarkably, the ESIC spends less than 10% of the collected funds on its administrative operations including pay and allowances of its own employees, the balance from remaining 10% being kept as reserves for various purposes including infrastructures, developments and expansion of the Scheme in some areas by incentivizing, and special incentives such as to States of North East. The only area of concern is reimbursement of expenditures incurred by the employee in private hospitals visited on their own, which is normally restricted to certain ceilings. This can be and needs to be revisited for reimbursement in full in all genuine cases, given the resources available with the ESIC organization. And for all this the employees’ contribution is only 1.75% of their salary. Of course the employers add another 4.75%. With even the limited computerization in ESIC, the employees’ contribution length is duly account for all the eligible benefits, on a single identifier ESIC number of each employee throughout the country. Further besides its own network of around 1400 Dispensaries and 150 Hospitals, the ESI Scheme has tie up arrangements with over 700 good private hospitals all over the country, including with some renowned Corporate Hospitals for cashless treatment of ESI beneficiaries on referral specially for very expensive super speciality treatments such as cardiology, neurology, nephrology, etc. In some cases the ESIC has sponsored treatment of the beneficiary in hospitals abroad also. Then there are dependants’ pension for dependants of covered employees dying in harness due to employment injury or while commuting to and from the work! Also there is provision of proportionate compensation for permanent physical damage in such situation. Can these beneficiaries be termed hostages? The benefits conceptualized under the ESI Scheme are unmatched- only administration thereof needs continuous up-gradation, synchronization and removal of reimbursement ceiling criteria for treatments taken on their own in any private hospital, particularly in emergency. ESI Scheme is thus a comprehensive social security scheme completely freeing the covered employees of almost all worries on account of sickness, maternity and employment injury and not a general medical insurance as the author tried to make out. The intangible contribution of ESI Scheme is thus invaluable in the industrial production and economic growth of the nation.
Posted on: Tue, 06 Jan 2015 16:26:37 +0000
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