Functions & Facilities

Overview of ESI Scheme

The Employees' State Insurance Scheme was introduced under the Employees' State Insurance Act, 1948 as a Social Security measure.

Apart from Industries—large and small, hotels, restaurants, theatres, newspaper establishments, motor or transport establishments, Shop and other establishments employing 20 or more persons have been brought under the purview of the Scheme. The Scheme is applicable to the factories running with power and employing 10 or more persons and also to the factories running without power and employing 20 or more persons. The present upper ceiling of wages for coverage of any employee under the Scheme is Rs. 15,000/- per month. Recently teaching institutions and medical diagnostic centres have come under the preview.

The whole Scheme is administered by the Employees' State Insurance Corporation and the State Government. Medical Benefits and various other benefits including cash benefits are provided under the Scheme. In terms of an agreement with the E.S.I. Corporation the Government of West Bengal is entrusted for administering the E.S.I. Medical Benefit Scheme for the Insured Persons and their families with family size 3.8 (three point eight) in the State of West Bengal.

Objectives

‘To provide for certain benefits to Employees in case of sickness, maternity and employment injury and to make provisions for related matter', the Employees State Insurance Scheme was introduced as a comprehensive social security measure under the Employees' State Insurance Act, 1948. At present it is the largest Social Security Scheme in the country.

The whole Scheme is administered by the ESI Directorate Gov.WB and ESI Corporation. Medical Benefits and various other benefits including cash benefits are provided under the Scheme. In terms of an agreement with the E.S.I. Corporation the Government of West Bengal is entrusted for administering the E.S.I. Medical Benefit Scheme for the Insured Persons and their families with family size 3.8 (three point eight) in the State of West Bengal. The ESI contribution of 6.5% of the annual salary is shared by the Employer (4.75%) and the Employee ( 1.75%).

As per agreement between the E.S.I. Corporation and the State Government the expenditure for running the E.S.I. (M.B) Scheme is to be shared between the E.S.I. Corporation and the State Government in the ratio of 7:1 subject to overall ceiling of the expenditure per I.P/per annum as may be fixed by the E.S.I. Corporation from time to time. The present ceiling of expenditure of Rs.2300/- per I.P./per annum was fixed by the E.S.I. Corporation w.e.f. 1.4.2014. At present there are 12,39,919 number of IPs (as on 01-04-2016). Total number of beneficiaries is approximately 49 Lakhs.

Any establishments employing 10 or more persons have been brought under the purview of the Scheme. The present upper ceiling of wages for coverage of any employee under the Scheme is Rs.15,000/- per month. Private Educational Institutions & Private Health care Institutions are also brought under the purview of the Scheme.

Administrative Setup

The Employees' State Insurance Scheme is administered by a corporate body called the Employees' State Insurance Corporation (ESIC), which has members representing employers, employees, the Central Government, State Governments, members from medical profession and the Parliament.

The Medical Benefit Scheme is administered through the Directorate of Employees' State Insurance (M.B) Scheme under the Administrative Control of the Labour Department. The Director, ESI (M.B) Scheme is the Head of the Organization. He is assisted by the Officers in the rank of Joint Directors, Deputy Directors, Assistant Directors, Administrative Medical Officer, Additional A.M.O. and other Officers and Staff.

There are 13 Hospitals, 59 SDs (Including 17 Tie up SDs), Central Medical Store and 3 Rajya  Bima  Oushadhalayas which  are manned by  staff and Officers under ESI(M.B.) Scheme.

The Directorate of E.S.I. (M.B) Scheme, E.S.I. C.M.S. and A.M.O's Office   are located at P-233, C.I.T. Scheme VII M, Bagmari Road, Kolkata-700054.

Benefits provided to the I.Ps under the E.S.I (Medical Benefit) Scheme.

Under the E.S.I. Scheme, IPs and their family members are entitled full medical care facility with hospitalization, if necessary.

In-patient treatment is provided in the ESI hospitals owned by the State Government or in Private Hospitals (through Tie-ups).

Cash Benefits are disbursed by the Corporation through its Local Offices LOs/ Mini Local Offices (MLOs)/Sub Local Offices SLOs)/pay offices, subject to certain contributory conditions.

Following Medical Care facilities are available in West Bengal under the ESI(MB) Scheme:

Indoor treatment for IP & Family in the hospitals including all specialties.
6 bedded ICCU Unit with facilities for implantation of Permanent Pacemaker.
Super-specialty treatment including facilities of Cardiology, Neurology, Oncology, Hand Surgery and Haemodyalysis in the ESI setup and other super specialty facilities from private institutions through tie-up arrangements.
Collection and supply of Blood through ESI Blood Bank at Manicktala.
Ante-natal and post- natal care to women beneficiaries.
4 Bedded Neo-Natal Care Unit at Kamarhati ESI Hospital.
Family planning and immunisation services.
Outpatient treatment at Service Dispensaries (SD) / Insurance Medical Practitioner's (IMP) clinics.
Specialists' services at the OPD in all the 13 State ESI Hospitals.
Diagnostic facilities like all pathological / radiological investigations including ultrasonography,  Echo-Cardiography, CT Scan, MRI Scan, Angiography, Endoscopies etc. at ESI hospitals and through Tie-up arrangements.
Free supply of drugs and dressings through SDs, RBOs and from Specialist OPDs at each hospital.
Ambulance facilities at all ESI Hospitals.
AIDS prevention, awareness & control through the VCCTCs.
Tuberculosis control through DOTS by participating in RNTCP.
Free supply of Spectacles and Hearing Aids for both IP & Family.
Issue of Certificates in Statutory forms in respect of sickness, maternity etc. to I.Ps only.
Pain Management Treatment at ESI Pain Management Institute, Sealdah.

Out patient treatment facilities

Outpatient treatment facilities are rendered to the Insured Persons through Insurance Medical Practitioners, Service Dispensaries, Tie-Up Diagnostic Centres and Out Patient Departments in different ESI Hospitals.

Implemented Area

ESI has extended its service facilities to many districts over the state including Kolkata, the District of South 24-Parganas, North 24-Parganas, Howrah, Hooghly, certain areas of Nadia District (Kalyani, Haringhata, Fulia, Saguna, Chakdaha and Ranaghat), Burdwan District (Asansol, Ranigange, Durgapur, Burnpur, Barsul, Hirapur P.S.) and some parts of Midnapore.

Haldia and Kharagapur are now covered under full medical care benefits. The Scheme has been extended to Siliguri of North Bengal. Tie up Dispensaries were started at Rampurhat of Birbhum and Burdwan town of Burdwan,  Malda town of Malda and Berhampur  of Murshidabad.

E. S. I. Hospitals run by the State Government :

There are 13 E.S.I. Hospitals which are run by the State Government are providing 3192 beds facilities including some T.B. Beds.

Medicine, Surgery, Orthopaedics, Eye, E.N.T. Gynaecology and Obstetrics, Anaesthesiology, Dermatology, Dental, Psychology, Radiology, Pathology etc are some areas having Indoor treatment facilities.   Additionally  there is one Intensive Coronary Care Unit at ESI Hospital, Manicktala. We have also one Diabetic Clinic, one Hand Surgery Unit and one Psychiatry Unit at ESI Hospital, Manicktala and Kamarhati respectively to enhance the broad spectrum or healthcare delivery.

ESI Hospital at Belur functions as a TB Hospital and Manicktala as a Referral Hospital. Special mention is made for the Pathology Department at ESIH, Kamarhati and the Oncology Department & the Pain Management Clinic of Sealdah ESI Hospital for providing specialized treatment to the IPs.

Report of Indoor admissions and Outdoor attendance in the 13 ESI Hospitals

Srl No Name of Hospital OPD attendance IPD attendance
2013-14 2014-15 2015-16 2013-14 2014-15 2015-16
1 Asansol 31940 35278   3989 3864  
2 Baltikuri 41897 41673   4849 4357  
3 Bandel 42607 43836   6752 7257  
4 Belur 13437 15916   673 743  
5 Budge Budge 73159 85171   7614 7081  
6 Durgapur 56429 56454   9581 9381  
7 Gaurhati 85552 96362   11244 10258  
8 Kalyani 109704 122811   9035 9374  
9 Kamarhati 144098 140088   9002 10817  
10 Manicktala 145189 167025   10937 11729  
11 Sealdah 88513 92129   4918 5709  
12 Serampore 38076 44736   12132 12852  
13 Uluberia 78968 81803   7548 7163  
Total 949569 1023282   98274 100585  

Re-imbursement of expenditure for Medical Treatment

Expenditure incurred by the I.Ps for treatment outside the ESI Hospitals is reimbursed by the Directorate of ESI (MB) Scheme. Two systems of re-imbursement now exists :

(a) Re-imbursement of expenditure relating to general treatment, and

(b) Re-imbursement of expenditure relating to specialty/Super Specialty treatment.

Re-imbursement of expenditure relating to general treatment has been arranged through selected Services Dispensaries, Superintendents, of E.S.I. Hospitals and the Office of the Administrative Medical Officer located at P-233, C.I.T. Scheme No. VII-M, Bagmari Road, Kolkata-700054. All the superintendents have been empowered to pass R.I. claims up to the Rs. 5000/-for both outdoor & inpatient cases.

The service dispensaries have been tagged with the Hospitals for easy access. 12 Service Dispensaries, situated at the premises of ESI Hospitals, have been brought under the direct administrative control of Medical Superintendent of respective ESI Hospital.

Administrative Medical Officer has been empowered to pass RI claim up to Rs. 10,000/- and the Director has been empowered to pass RI claim up to Rs. 1,00,000/- which includes treatment cost of Specialty treatment.

Achievements during Financial Year of 2014-15

Rs. 22.95 Crores of Incentive Fund has been received from ESI Corporation (for the second time this year-2016)on account of 70% or more bed-occupancy rate in each of the state ESI Hospitals.
Walk-in Interview for intake of 956 Group-D Staff in different ESI establishments has been completed. The recruitment procedure is waiting at Departmental level.
A new and updated "Physiotherapy Gym" is now functioning at ESI Hospital, Gaurhati.
One 'Chemotherapy Unit' has been started in Bandel and Baltikuri ESI Hospitals for the benefit of IPs of Howrah and Hooghly.
Paramedical courses like DMLT & DRD have been started at ESI Hospital, Asansol, Serampore, BudgeBudge,Baltikuri. DCCT Course has been started AT Manicktala & Optometry Course at Kamarhati.
One new 500 mA X Ray machine with 'Digital Processor' have been installed in seven ESI Hospitals viz., BudgeBudge, Durgapur, Kalyani, Kamarhati, Sealdah, Serampore, Uluberia ESI Hospital.
USG Machine with Doppler setup have been installed to four ESI Hospitals viz., Durgapur, Gaurhati, Asansol & Uluberia ESI Hospital.
One NICU [Neonatal Intensive Care Unit] has been established at Kamarhati ESI Hospital - the first of its kind in ESI setup.
Dialysis for ESI patients have been started at ESI Hospital Asansol