Policy Note 2004 - 05 - Labour & Employment Department, Tamil Nadu, India

13.1 Employees State Insurance Scheme of India is an integrated Social Security scheme tailored to provide protection to workers in the organised sector and their dependents in contingencies such as sickness, maternity, death and disablement due to an employment injury or occupational disease as detailed below:-

1	Medical Benefit	Medical facilities for self and dependents are admissible from the day of entering insurable employment. Primary, Specialist and Super Speciality services are provided through a network of ESI Dispensaries and ESI Hospitals.
2	Sickness Benefit	Sickness Benefit is payable to an Insured Person in cash in the event of Sickness resulting in absence from work and duly certified by an authorised Insurance Medical Officer.
3	Maternity Benefit	Maternity Benefit is payable to Insured Women in case of confinement or miscarriage or sickness related to Maternity (Maximum 85 Days)
4	Disablement Benefit (By Cash)	Disablement Benefit is payable to Insured Employees suffering from physical disablement due to employment injury or occupational disease. In addition, the Insured Person is eligible for coverage under Workman's Compensation Act.
5	Dependent's Benefit (By Cash)	Dependent's Benefit is payable to dependent of a deceased Insured Person where death occurs due to Employment injury or occupational disease.
6	Extended Sickness Benefit (By Cash)	Extended Sickness Benefit is payable to Insured Persons for the period of certified sickness in case of specified 34 long term diseases that need prolonged treatment and absence from work on Medical advice.
7	Enhanced Sickness Benefit (By Cash)	Enhanced Sickness Benefit is payable to Insured Persons in the productive age group for undergoing Sterilization operation viz. Vasectomy / Tubectomy.
8	Temporary Disablement Benefit (By Cash)	Temporary Disablement Benefit at 70% of wages is payable till temporary disablement lasts and is duly certified by authorised Insurance Medical Officer.
9	Permanent Disablement Benefit (By Cash)	Permanent Disablement Benefit is payable for life
10	Funeral Benefit (By Cash)	Funeral Benefit on death of an Insured Person is payable to a maximum of Rs. 2500/-

13.2 Free supply of physical aids such as Crutches, Wheel Chairs, Dentures, Spectacles and such physical aids are offered under this scheme. Preventive Health Care Services such as Immunisation, Family Welfare Services, HIV/AIDS Detection Treatment etc are available. Medical Bonus at Rs. 250/- is paid to an Insured Woman or the wife of an Insured Person, in case she does not avail hospital facilities of the scheme for child delivery.

13.3 The Scheme is implemented in this State in accordance with the provisions of the ESI Act 1948. Towards this objective, the scheme of health insurance provides full medical facilities to insured persons and their dependents, as well as cash benefits to compensate for any loss of wages or earning capacity in times of physical distress.

13.4 The scheme is administered by a duly constituted corporate body called the Employees State Insurance Corporation as provided under the ESI Act 1948.

13.5 Employees of covered units and establishments drawing wages up to Rs.7500/- per month come under the purview of the ESI Act 1948 for multi-dimensional social security benefits. The ESI Scheme is mainly financed by contributions raised from employees covered under the scheme and their employers at a fixed percentage on wages, a sum equivalent to 1.75% and 4.75% of wages respectively.

13.6 In Tamil Nadu, medical facilities are provided through a network of 181 ESI Dispensaries, 9 ESI Hospitals, 5 Mobile Dispensaries, and 2 Utilisation Dispensaries with 2363 beds.

13.7 Utilisation Dispensaries are run by the employer. The standards of equipments and treatment provided at the Dispensaries shall be as normally provided by the State Government to the beneficiaries under ESI Scheme at the ESI Dispensaries. The employer is paid capitation fee at the rates prescribed by ESI Corporation from time to time. At present, the rate is Rs.60/- per Insured Person / Year. At present, there are 2 Utilisation Dispensaries in Tamil Nadu.

1. Utilisation Dispensary, Dalmia Cements (Bharat) Limited, Dalmiapuram, Tiruchirapalli District

2. Utilisation Dispensary, E.I.D. Parry (India) Ltd., Ranipet, Vellore District.

Expenditure on the medical facilities is initially borne by the State Government. 7/8^th of the expenditure subject to a ceiling of Rs.750/- per Insured Persons is reimbursed by the ESI Corporation.

13.8 ESI Hospital, K.K. Nagar is run by ESI Corporation, New Delhi. The Occupational Research Centre for South is established in this hospital. The Bed Strength of this hospital is 330.

13.9 Employees covered under the scheme are entitled to medical benefits for self and their family members. They are also entitled to cash benefits in the event of specified contingencies; resulting in loss of wages or earning capacity. The insured women are entitled to maternity benefit for confinement. In the event of death of an insured employee due to employment injury or occupational disease, the dependents are entitled to family pension.

13.10 A new ESI Dispensary was opened at Singampuneri, Sivaganga District on 1.10.2003.

13.11 During the year 2003-2004, the following new areas were covered by attachment with the existing ESI Dispensaries.

Sl. No	Name of the areas/District	Name of the ESI Dispensary to which attached	Date from which functioning
1.	Kalikkampatti Dindigul District	ESI Dispensary Begambur	1.4.2003
2.	Thirumudivakkam Kancheepuram District	ESI Dispensary Pallavaram	1.5.2003
3.	R.Vadipatti and Pappampatti Peripheral villages Dindigul District	ESI Dispensary Neikkarapatti	1.6.2003
4.	Injar Virudhunagar District	ESI Dispensary Sivakasi	1.10.2003
5.	Sivakasi suburbs T.Salvarpatti Virudhunagar District	ESI Dispensary Sivakasi and Thayalpatti	1.12.2003
6.	Madurai, Ponnagaram Madurai District	ESI Dispensary Ponnagaram	1.1.2004
7.	Pollachi Suburbs Sholavampalaiyam and Sozhanur Coimbatore Dt.	ESI Dispensary Pollachi Othakalmandabam	1.2.2004
8	Nilavarapatti Salem	ESI Dispensary Annadanapatti at Seelanaickenpatti	1.3.2004

13.12 Proposals for extending ESI Scheme to the following new areas by attachment in a phased manner during the year 2004-2005 are under active consideration of the Government.

Sl. No.	Name of the Areas/District	Name of the ESI Dispensary to which attached/ to be attached
1.	Uthamacholapuram (Nagapattinam)	ESI Dispensary Nagapattinam and shifting to Nagore
2.	Vedasanthur suburbs (Dindigul)	Vedasanthur (implemented with effect from 1.4.2004)
3.	Thiruchengode suburbs (Namakkal)	Thiruchengode
4	Coimbatore areas (Coimbatore)	Tiruppur.I, Avinashi, Chinnampalayam, Karamadai and Mettupalayam
5	Gangaikondan area (Tirunelveli)	Upgradation of ESI Dispensary at Thalayuthu from one doctor to two doctor type
6	Tirunelveli suburbs (Tirunelveli)	Vannarpet
7	Tiruvallore suburbs (Tiruvallore)	Tiruvallore
8	Peripheral area of Kanyakumari (Kanyakumari)	Nagercoil

13.13 The Government of India have given their concurrence for opening of two doctor type Dispensary at Sriperumbudur in Kancheepuram District.

13.14 The proposals for extending ESI Scheme under IMP system to the following new areas are under consideration of the Government during the year 2004-2005.

S.No.	Name of the Place	District
1	Panruti	Cuddalore
2	Vaduganthangal & Pallikonda	Vellore
3	Tindivanam	Villupuram
4	Paramakudi	Ramanathapuram
5	Sivaganga	Sivaganga
6	Seshanchavadi (Vazhappadi & Karipatti)	Salem
7	Ramanathapuram	Ramanathapuram

SUPER SPECIALITY SERVICES

13.15 Government have issued orders sanctioning equipments to open Nephrology Department in ESI Hospital, Ayanavaram and Coimbatore. The medical arrangements are under process. On completion of medical arrangements and draft notification from the ESI Corporation, New Delhi, Nephrology units will be opened.

13.16 ESI Corporation, New Delhi has given its concurrence for opening of five diagnostic centres in ESI Dispensaries, Ambattur, Pallavaram, Rajapalayam, Thudiyalur and Ranipet and the same is under the active consideration of the Government.

13.17 Siddha units are at present functioning in ESI Hospitals at Ayanavaram and Coimbatore. ESI Corporation has given its concurrence to start Siddha wing in three more ESI Hospitals, namely Madurai, Vellore, and Salem and are under active consideration of the Government. Opening of Siddha units at ESI Hospital, Sivakasi, Trichy and Hosur will be considered by the ESI Corporation and the Government in due course.

13.18 YOGA is the best practice to cure most of the diseases. The proposals for inclusion of YOGA in ESI Hospital, Ayanavaram and Coimbatore are under active consideration.

13.19 The Government have examined the long procedures of sanctioning reimbursement of medical expenses to ESI patients. To reduce the delay, Government have ordered to operate Revolving Fund. The Regional Director, ESI Corporation, Chennai, will operate the fund and issue the cheques in the name of the Insured Person through the Medical Officer in charge of the ESI Dispensary. Further, the financial powers of the Director of Medical and Rural Health Services (ESI) to sanction reimbursement claims have been enhanced from Rs. 5,000/- to 75,000/- per Insured Person. Due to this, the bills are sanctioned immediately. Time limit has been fixed for processing the Reimbursement claim at different stages for early settlement of claims to the Insured Persons concerned. A number of diseases and investigations have been included in the purview of Revolving Fund, besides adopting the diseases and Hospitals mentioned in G. O. Ms. No. 400, Finance (Salaries) Department, Dated. 29.8.2000.

13.20 During the year 2003-04, a sum of Rs.2,14,69,575 /- has been sanctioned to Insured Persons who underwent major surgeries related to Heart, Kidney Transplantation, Ortho Transplantation, Spinal Cord and Cancer.

Sl,No		Name of the Region	Static Dispen-sary	Mobile Dispen-sary		Utilisation Dispen-sary		Dispensary Building				Total Dispen- saries
								Own		Rented
	1	Chennai	39						27		12		39
	2	Madurai	55		1		-		14		42		56
	3	Coimbatore	37		2		-		14		25		39
	4	Salem	50		2		2		12		42		54
		Total	181		5		2		67		121		188

Sl. No.	Name of the Hospital	Place	Bed Strength
1	ESI Hospital	Ayanavaram, Chennai-23	616
2	ESI Hospital	Coimbatore	506
3	ESI Hospital	Madurai	209
4	ESI Hospital	Vellore	50
5	ESI Hospital	Salem	50
6	ESI Hospital	Sivakasi	100
7	ESI Hospital	Hosur	50
8	ESI Hospital	Trichy	50
9	ESI Hospital	K.K. Nagar, Chennai-78 (Under the Control of ESI Corporation, New Delhi)	330
10	ESI Annexes		136
11	Allotted in Govt. Hospitals		266
	Total		2363

S. No	Details	2001-2002	2002-2003
1	No.of Out-Patients treated	73,44,038	65,44 ,208
2	No. of In-patients treated	3,14,413	3,09,272
3	Total No. of cases treated	76,58,451	68,53,480