Employees State Insurance Scheme – Nov-2024: Latest updates about worker enrolled, effectiveness of scheme, initiative for improvements and endeavour for settlement of claims.
GOVERNMENT OF INDIA
MINISTRY OF LABOUR AND EMPLOYMENT
LOK SABHA
UNSTARRED QUESTION NO. 74
TO BE ANSWERED ON 25.11.2024
EMPLOYEES’ STATE INSURANCE SCHEME
74. DR. KALANIDHI VEERASWAMY:
Will the Minister of LABOUR AND EMPLOYMENT be pleased to state:
(a)the details of the current statistics on the number of workers enrolled under the Employees’ State Insurance (ESI) Scheme across the country including Tamil Nadu, State/sector-wise;
(b)the measures that are being taken to increase awareness and enrollment among workers in informal sectors, particularly in rural and semi-urban areas, who may be eligible for the ESI Scheme but remain uninsured;
(c) the manner in which the Government assess effectiveness of ESI Scheme in providing healthcare and social security benefits to enrolled workers and the details of improvements that have been made based on this assessment;
(d)whether there are specific initiatives in place to enhance the quality of healthcare services provided under the ESI Scheme, particularly in terms of accessibility and response times and if so, the details thereof; and
(e)the steps being taken by the Government to address issues related to delays in claims processing and service delivery for workers enrolled under the ESI Scheme?
ANSWER
MINISTER OF STATE FOR LABOUR AND EMPLOYMENT (SUSHRI SHOBHA KARANDLAJE)
(a): The details of employees enrolled under Employees’ State Insurance (ESI) Scheme as on 31.3.2024 in the country including Tamil Nadu is annexed.
(b): ESI Act is applicable to factories and establishments employing 10 or more persons (including factories belonging to the Govt.) other than seasonal factories and drawing wages up to Rs.21,000/- per month (Rs. 25,000/- per month in case of persons with disability) in the notified area. As such, the Act does not apply to the Informal Sectors (unorganized sector). ESIC carries out public awareness about ESI Scheme benefits through its website and various social media handles.
(c) to (e): ESIC has formulated Common Support Mission to review the ESIS medical infrastructure and identify the gap areas for improvement and upgradation of ESIS medical infrastructure. The Medical Commissioners, Zonal Officers visit regularly to the ESI Health facilities to assess effectiveness and suggest remedial measures. Besides, effectiveness is also assessed through regular meetings in the headquarter. Further, ESIC has designed the Service Level to ensure high standards of patient care, safety and service delivery.
ESIC has been regularly monitoring timely settlement of medical reimbursement claim bills of Insured Persons. Field offices have been instructed to settle the medical re-imbursement claim within 30 days from the receipt of the bill.
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