How to manage ESIC claims and ensure your employees can access benefits

ESIC provides significant benefits to covered employees — medical treatment, hospitalisation, sickness benefits, maternity benefits, disability benefits, and dependant's benefit on death. But many employees don't know these benefits exist or how to access them, which means the employer is paying the contribution without the employees getting the value.

IP card (Insurance Person card): every ESIC-registered employee should have an IP card (now a biometric Aadhaar-linked card). This card is required to access ESIC medical facilities and claim benefits. Ensure every covered employee has their IP card — the registration is done through the ESIC portal and the card is issued within 3 months.

Medical benefits: ESIC covers medical treatment for the insured person and their family at ESIC dispensaries and hospitals. In practice, ESIC medical facilities vary significantly in quality. Where ESIC facilities are inadequate, employees often use private treatment and then struggle to claim reimbursement. Inform your team about the process and their rights.

Sickness benefit: employees who are sick and unable to work are entitled to 70% of their average daily wages for up to 91 days in a two-year period, subject to having contributed for a minimum period. The benefit is claimed through the ESIC dispensary.

Maternity benefit: female employees are entitled to maternity benefit through ESIC (26 weeks fully paid for first two children), which means the employer does not separately bear the maternity leave cost for ESIC-covered employees. Understanding this reduces employer confusion about maternity leave funding.

Filing obligations: ESIC returns must be filed half-yearly (April–September and October–March). The return covers employee details, wages, and contributions. Late filing attracts penalties. Maintain accurate employee records throughout the period to make return filing straightforward.