India: Eligibility for Employees' State Insurance Clarified

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By Madhur Singh

India's Employees' State Insurance Corporation, which provides health care to industrial workers and their dependents, has clarified that member-employees who lost and regained coverage due to wage hikes and wage ceiling revisions are eligible for benefits during the intervening period.

Many insured employees lost ESIC coverage when their wages went above the 15,000 rupee ($232) per month ceiling that applied until Dec. 31, 2016.

When the ceiling was increased to 21,000 rupees ($325) per month Jan. 1, many employees became eligible for state insurance again.

In a May 30 letter to all ESIC regional and subregional offices and affiliated hospitals, ESIC Deputy Director (Benefits) S.S. Srivastava said his office had taken note of cases where employees were facing difficulty in accessing benefits because of doubt over whether they could be deemed to have remained members during the intervening period.

Srivastava cited a December 1999 resolution that states: “A Person in insurable employment may go out of coverage due to enhancement of wages and may be brought under coverage subsequently. The period of interruption should also be taken as insurable employment for the purpose of the Term ‘Continuous Service.'”

All regional ESIC offices and affiliated hospitals have been directed to ensure that eligible members are not denied the benefits due them.

To contact the reporter on this story: Madhur Singh in Chandigarh at correspondents@bna.com

To contact the editor responsible for this story: Rick Vollmar at rvollmar@bna.com

For More Information

For more information on Indian HR law and regulation, see the India primer.

The text of ESI's May 30 letter is available

here.

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