Implementation of ESI Scheme in Meghalaya
The Employees’ State Insurance Scheme (ESIS) Meghalaya was implemented from September 1980 in Shillong area and extended to Byrnihat in May 2005.
The ESIS is a multi-dimensional Social Security Scheme for the Welfare of the Labour Class and Weaker Section of Society and all those under coverage are entitled to two types of benefits:-
1. Cash Benefit – comprise of
- Sickness Benefit.
- Extended Sick Benefit.
- Enhanced Sickness Benefit.
- Maternity Benefit.
- Dependent Benefit.
- Disablement Benefit.
- Funeral Benefit.
- These benefits are administered by the ESI Corporation through their Local Offices in Shillong and Byrnihat.
2. Medical Benefit
- The Administrative Head for provision of Medical Benefit to the Insured Persons (IP) in Meghalaya is the Administrative Medical Officer (AMO), ESI Scheme.
- Medical Benefit is provided to the IP’s through Dispensaries established by the State Government.
- The ESI Dispensary, Shillong is manned by the Insurance Medical Officer (IMO) and supporting Staff.
- In Brynihat by the Insurance Medical Officer (IMO), on contract basis, and presently functioning from Dispensary at EPIP.
- The AMO and IMO are presently functioning from a rented building at Lower Lachaumiere, Shillong.
- Establishment covered under Shillong ESI Dispensary :- 361
- Establishment covered under Byrnihat :- 132
- The beneficiaries are entitled to reasonable medical, surgical and obstetric treatment. Treatment is provided to the beneficiaries as per Live List prepared by the Regional Office ESI Corporation.
- There is no ceiling on expenditure on the treatment of an IP or his family members.
- Medical care is also provided to retired and permanently disabled Insured Persons or their spouses on payment of a token annual premium of Rs 120/-.
- Expenditure for administration of the Scheme in the State is on a shareable basis between the Corporation and the state Government in the ratio of 7:1 respectively.
- The total expenditure incurred in administering the Medical Benefits in each State is shared by the State Government and the Corporation in the agreed ratio.
- For purpose of sharing the expenditure, Corporation has with effect from 1st April 1970 prescribed the maximum per capita ceiling on total expenditure on Medical Benefit.
- The ceiling has been periodically revised upwards and the current ceiling with effect from 1.4.2015 is Rs 2150/- per insured person family unit per annum. This will be increase to Rs 3000/- per insured person family unit per annum w.e.f 1.4.2017.
The number of Insured Person in the State of Meghalaya is 9255 as on 31/3/17(as per revised Budget Estimate 2016-17 of ESI Corporation dated 21/03/2017).
- The Insured Person needing Secondary/Speciality care are referred to Government and Private Hospital within the state and expenditures are reimbursed accordingly.
- For Super Speciality Care tie-up with Woodland Nursing Home, Shillong has been done by the Senior State Medical Commissioner of North Eastern Region w.e.f 9/11/2016 . The expenditure of SST is totally borne by the ESI Corporation outside the existing ceiling.
- Medical benefits to the Insured persons and their family members are being provided, as far as practicable, as per the guidelines laid down in the ESI Medical manual and as per the Meghalaya Employees’ State Insurance (Medical Benefit) Rules 1978.
- It is incumbent upon the State Government to provide the Medical benefit as per Section 58 of the ESI Act 1948.
- Other empanelled Hospitals in the North Eastern Region for SST treatment are:-
1. ILS Hospital,
Agartala, Capital Complex Extension,
P.O- New Secretariat,
2. Narayana Super Speciality Hospital,
Near Tularam Bufna Civil Hospital Campus,
Amingaon, Guwahati- 31.
3. Down town Hospital Ltd
4. Hayat Hospital, Odalbakra,
Lalganesh, Guwahati -34.
5. Central Nursing Home,
Survey, Basishtha Road,
6. Agile Hospital Pvt. Ltd,
Beltola, Tripura Road,
7. Sanjivani Diagnostics & Hospitals.
8. Srimanta Sankardeva Hospital & Research Institute.
9. Thyrocare Technologies Ltd Navi Mumbai.
- Telemedicine Services was inaugurated on the 1st December 16 and is providing consultation Services to Insured persons of the State on a daily basis by connecting with Specialist/Super-specialist Doctors of ESIC Hospital, Joka Kolkata.