ESIC makes it easier for women to access health benefits

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NEW DELHI : The State Insurance Company of Employees (ESIC) on Tuesday took measures, such as easing the contribution conditions for insured women to receive health benefits and the decision to create more hospitals, to improve service delivery to policyholders under its health insurance plan.

<< The State Insurance Company of Employees (ESIC), at its 184th meeting held on February 22, 2021, chaired by Santosh Kumar Gangwar, Minister of State for Labor and Employment (independent office) ... has taken several important decisions to improve its service delivery mechanism and strengthen medical infrastructure for the benefit of its insured workers, ”the Ministry of Labor said in a statement.

The ESIC decided on Monday to grant an easing of the contribution conditions to benefit from sickness benefits to insured persons receiving maternity benefits.

After increasing the duration of maternity benefits to 26 weeks from 12 weeks earlier, in some cases insured women were not eligible for sickness benefits during the corresponding benefit period after receiving benefits from maternity. Indeed, the compulsory contribution conditions of 78 days minimum were not fulfilled since the insured women benefit from maternity benefits and leave.

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In such cases, it has now been decided that an insured woman will be able to claim sickness benefit during the corresponding benefit period if the contribution to her is paid or payable for at least half of the number of available days. to work during this shorter period. contributory period, he said.

The easing will be effective from January 20, 2017, the date from which the extension of the duration of maternity benefits takes effect.

The ESIC has also relaxed the contribution conditions for receiving sickness and maternity benefits for the benefit period from January to June of this year.

The country was placed on lockdown in March 2020 to curb the spread of the COVID-19 pandemic, which has resulted in the closure of factories / establishments for several months. This resulted in the denial of sickness and maternity benefits for many insured persons and women, as the mandatory contribution days could not be respected.

The ESIC has now decided to extend the relief to insured persons (PI) by relaxing the contributory conditions for receiving sickness and maternity benefits for the benefit period from January 1, 2021 to June 30, 2021, a-t- he declares.

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From now on, an insured woman (IW) will be entitled to a maternity benefit, if the contributions for her were payable at least 35 days during the two immediately preceding consecutive contribution periods.

In the case of IPs or IWs appointed before the contribution period from April to September 2020, the eligibility condition for receiving sickness benefits will be decided on the basis of their contribution during the previous contribution period (September 2019-March 2020).

However, PIs or IWs appointed during the contribution period (April-September 2020) will be eligible for sickness benefits during the January-June 2021 benefit period if the contribution in respect of them was payable for at least half of the number of days available. for working with them during the membership period (April-September 2020).

ESIC has decided to build a 300-bed hospital, including 50 super-specialized beds in Haridwar, Uttarakhand. The hospital will provide medical care services to approximately 2.55 lakh insured workers and their family members.

ESIC also decided to build a 350 bed hospital in Vishakhapatnam, Andhra Pradesh. The proposed hospital, after construction, will provide medical services to approximately 14 lakh beneficiaries covered by the ESI program in Vishakhapatnam and surrounding areas.

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ESIC also decided to set up a negative pressure intensive care unit (intensive care unit) at ESIC Super Specialty Hospital & Medical College in Hyderabad, Telangana. The decision to establish a negative pressure intensive care unit at ESIC Super Specialty Hospital and Medical College in Hyderabad, Telangana was also taken during the meeting.

Setting up the negative pressure intensive care unit will reduce the burden of infection on health workers and also decrease secondary infections in other critically ill patients admitted to the intensive care unit.

The ESIC also approved the revised forecasts and budget forecasts for the years 2020-21 and 2021-22, as well as the performance budget for the year 2021-22 at the meeting.

In addition to these, around 25 other agenda items related to improving the service delivery mechanism were also flagged and approved by ESIC.

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