Section 17: Administration of ESI Hospitals and Medical Services

Overview

Section 17 of the Code on Social Security, 2020, deals with the Employees’ State Insurance (ESI) scheme, specifically focusing on the administration of ESI hospitals, dispensaries, and medical units. This section ensures insured persons and their families receive quality medical care funded through the ESI corpus. It outlines the roles and responsibilities of the Employees’ State Insurance Corporation (ESIC), State Governments, and empanelled private healthcare providers in delivering these services.

Who is Covered?

• The ESI scheme generally covers employees earning up to a specified wage ceiling (currently ₹21,000 per month, but subject to change).
• It applies to factories and other establishments employing 10 or more persons. The specific establishments covered are detailed in the ESI Act, 1948.
• Eligibility requires continuous employment and contribution to the ESI fund for a certain period, as defined by ESI regulations.

Benefits and Contributions

• Employee Benefit: Access to comprehensive medical care, including hospitalisation, specialist consultations, and medicines, through ESI hospitals and empanelled medical facilities.
• Employer Contribution: Employers contribute a percentage of the employee’s wages to the ESI fund. The exact percentage is determined by the ESIC and can vary.
• Employee Contribution: Employees earning below the wage ceiling also contribute a percentage of their wages to the ESI fund.
• Government Contribution: The Central Government may contribute towards certain medical benefits and administrative expenses of the ESI scheme.

Procedure and Compliance

Section 17 doesn’t directly detail contribution or claim procedures. However, it mandates that ESIC ensures efficient administration of medical facilities. This includes:

1. Staffing: Ensuring adequate qualified medical and paramedical staff are available.
2. Quality Standards: Maintaining high standards of medical care and hygiene in ESI facilities.
3. Telemedicine: Utilizing telemedicine services to expand access to healthcare, particularly in remote areas.
4. Digital Health Records: Implementing and maintaining digital health records for efficient patient management.
5. Infrastructure: Continuously improving infrastructure and equipment in ESI hospitals and dispensaries.
6. Audits & Inspections: Conducting regular audits and third-party inspections to assess the quality of services.
7. Patient Feedback: Establishing systems for collecting and addressing patient feedback.

Practical Examples

• Example 1: An employee, Ramesh, working in a factory covered under the ESI Act, develops a serious illness. He is able to receive free medical treatment, including hospitalisation and surgery, at an ESI hospital, funded by the ESI contributions made by his employer and himself.
• Example 2: A factory owner, Mr. Sharma, fails to remit the ESI contributions deducted from his employees' wages to the ESIC. This constitutes non-compliance and can lead to penalties, including fines and legal action by the ESIC.

Disclaimer

This article is for basic understanding of social security law and should not be treated as legal advice. For specific legal guidance, please consult with a qualified legal professional.