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act 034 of 1948 : Other Beneficiaries and Members etc. Scheme, 2010

Other Beneficiaries and Members etc. Scheme, 2010

ACTNO. 34 OF 1948
08 April, 2010

In exercise of the powers conferred by Section 73-B read with Section 73-D of the Employees' State Insurance Act, 1948 (34 of 1948), and in supersession of the Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2008, except as respects things done or omitted to be done before such supersession, the Central Government hereby makes the following scheme, namely

Section 1. Short title and commencement

(1) This scheme may be called the Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2010.

(2) It shall come into force from the date of its publication in the Official Gazette.

Section 2. Application

This scheme shall apply to other beneficiaries and members of their families registered under any scheme, other than the Employees' State Insurance Scheme, framed by the Central Government.

Section 3. Definitions

In this scheme, unless the context otherwise requires,

(a) Act means the Employees' State Insurance Act, 1948 (34 of 1948);

(b) Corporation means the Employees' State Insurance Corporation;

(c) Person means a person, including members of their families, registered under any scheme, other than the Employees' State Insurance Scheme framed by the Central Government;

(d) All other words and expressions used and not defined in this scheme shall have the meaning respectively assigned to them in the Act.

Section 4. Registration

A person desirous of availing medical treatment and attendance under the scheme shall be required to

(a) fill a registration form containing such particulars in respect of himself and members of his family as may be specified by the Corporation;

(b) produce the Identity Card issued to him by the Corporation or issued under any other scheme framed by the Central Government.

Section 5. Benefits

Persons registered under this scheme shall be provided medical treatment and attendance from the underutilized Employees' State Insurance Hospitals.

Section 6. User Charges

(1) Persons availing medical treatment and attendance under this scheme shall be required to pay user charges at such rates as may be notified by the Corporation in consultation with the Central Government.

(2) The user charges collected under sub-paragraph (1) shall be deemed to be contribution and shall form part of the Employees' State Insurance Fund.

Section 7. Time and Manner of the Medical Facility

The time and manner in which the medical facilities may be availed by other beneficiaries shall be such as may be specified by the Corporation from time to time.

Section 8. Maintenance of Register and Records

The concerned hospitals shall maintain separate register and record of the persons availing medical treatment and attendance under this scheme and user charges collected from them in such form and manner as may be specified by the Corporation.

ESIC, Noti. No. 12/13/1/2019-P&D, dated July 2, 2019 and published in the Gazette of India, Extra., Part III, Section 4, dated 22nd July, 2019, p. 2, No. 256.

Whereas draft notification further to notify the rate of user charges and other details of the scheme was published as required under sub-section (1) of Section 97 of the Employees' State Insurance Act, 1948 (34 of 1948) in the Gazette of India Part III, Section 4 dated 15-4-2019 for inviting objections and suggestions from all persons likely to be affected thereby till the expiry of period of thirty days on which the notification was published, are made available to the public

And whereas, the said Gazette Notification was made available to the Public on 27-5-2019;

No objections and suggestions were received from any of the person likely to be affected;

Now therefore in exercise of the powers conferred under sub-para 6 of the Other beneficiaries and members of their families medical facilities scheme 2010 as notified vide G.S.R. 654(E) in the Gazette of India Extraordinary [Part II Section 3(i)] dated 04th August 2010, the Director General, Employees' State Insurance Corporation hereby notifies the rate of user charges and other details of the scheme referred to in Section 73-D of the Employees' State Insurance Act, 1948 (34 of 1948) as the Central Government has approved the availment of medical services in the under-utilised ESIC Hospital by Non-Insured Persons as other beneficiaries in the Other Beneficiaries and Members of Their Families Medical Facilities Scheme 2010 framed under Section 73-B of the ESI Act, 1948

1. Out-Patient Department (OPD) Consultation at the rate of Rs 10/- (Rupees Ten Only) per consultation.

2. In-Patient Department (IPD) care at the rate of 25% (Twenty Five per cent) rates of Central Government Health Scheme (CGHS) packaged rates applicable for the city (If not available the rate of the neighbouring city or the State).

3. Medicines shall be provided (if available) at the actual cost.

4. An underutilised Hospital for the purpose of this notification shall be the ESIC Hospital where the bed occupancy is less than 60% during the last two financial years.

5. The name of underutilised hospitals and their operational modalities shall be as specified by Director General from time to time.

STATE RULES UNDER THE EMPLOYEES' STATE INSURANCE ACT, 19482

1. Andhra Pradesh Employees' Insurance Courts Rules, 1958

2. Andhra Pradesh Employees' State Insurance (Medical Benefit) Rules, 1955

3. Assam Employees' Insurance Courts Rules, 1959

4. Assam Employees' State Insurance (Medical Benefit) Rules, 1958

5. Bihar Employees' Insurance Courts Rules, 1952

6. Bombay Employees' State Insurance (Medical Benefit) Rules, 1954

7. Bombay Employees' Insurance Courts Rules, 1959

8. (Bombay) Terms of Service for Insurance Medical Practitioners

9. Gujarat Employees' State Insurance (Medical Benefit) (Panel System) Rules, 1963

10. M.P. Employees' State Insurance Courts Rules, 1963

11. M.P. Employees' State Insurance (Medical Benefit Services System) Rules, 1959

12. Meghalaya Employees' State Insurance Courts Rules, 1980

13. Orissa Employees' Insurance Courts Rules, 1951

14. Orissa Employees' State Insurance (Medical Benefit) Rules, 1951

15. Punjab Employees' State Insurance (Medical Benefit) Rules, 1953

16. Rajasthan Employees' State Insurance (Medical Benefit) Rules, 1955

17. Rajasthan Employees' State Insurance Courts Rules, 1959

18. Tamil Nadu Employees' Insurance Courts Rules, 1951

19. Uttar Pradesh Employees' State Insurance Courts Rules, 1952

20. Uttar Pradesh Employees' State Insurance (Medical Benefit) Rules, 1951

21. West Bengal Employees' Insurance Courts Rules, 1955

22. West Bengal Employees' State Insurance (Medical Benefit) Rules, 1974

1. Vide Noti. No. G.S.R. 654(E), dated August 4, 2010, published in the Gazette of India, Extra., PartII, Section 3(i), dated 4th August, 2010, p. 2, No. 432.

2. For State Rules, see Srivastava, K.D., Commentaries on Employees' State Insurance Act, 1948 (4th Edn., 1991).