ESIC Claim Process India 2025 — Medical, Sickness, Maternity Benefits
- ESIC covers employees earning up to ₹21,000/month basic
- Employee contributes 0.75%, employer 3.25% of wages
- Entire family gets free medical treatment at ESIC facilities
- Sickness benefit after 78 days contribution in IP period
- Disablement pension — monthly for permanent partial/total disability
ESIC (Employees' State Insurance Corporation) is India's most comprehensive social security scheme for low and mid-level employees. Your 0.75% contribution (and employer's 3.25%) buys you extensive medical and cash benefits. Here's how to actually use them.
Who is Covered Under ESIC?
Employees earning up to ₹21,000 per month (basic + DA) in establishments with 10 or more employees are mandatorily covered. Some states have 20-employee threshold for certain industries. Also covered: employees earning up to ₹25,000 if they are disabled.
ESIC Benefits — Full List
| Benefit | What You Get | Condition |
|---|---|---|
| Medical benefit | Free treatment — self + family | From Day 1 of coverage |
| Sickness benefit | 70% of daily wages | 78 days contribution in 2 IP periods |
| Extended sickness benefit | 80% of wages for up to 2 years | Long-term illness (34 specified diseases) |
| Maternity benefit | 100% wages for 26 weeks | 70 days contribution before delivery |
| Disablement benefit | 90% of wages (monthly pension) | Work injury — temporary/permanent |
| Dependant benefit | 90% of wages (to dependants) | Employee death due to work injury |
| Unemployment allowance | 50% of wages for up to 2 years | Rendered unemployed due to closure/retrenchment |
How to Get Medical Treatment Under ESIC
- Get your ESIC insurance card (e-Pehchan Card) from employer or ESIC portal
- Go to the nearest ESIC dispensary (Pehchan Card needed)
- For specialist or hospital treatment: get referral from dispensary doctor
- Tie-up hospitals also provide cashless treatment with ESIC card
ESIC covers the insured person, spouse, dependent parents, and children — no age limit for children in higher education (up to 25 with some conditions). Dependent parents have no income limit in many cases.
How to Claim Sickness Benefit
- Get sick — doctor issues First Certificate of Incapacity
- Submit the certificate to ESIC branch office (within 3 days of falling sick)
- Subsequent certificates submitted for each period of incapacity
- Final certificate when recovery or max period reached
- Cash benefit credited to bank account linked with ESIC
Maximum sickness benefit: 91 days per year at 70% of wages. Extended sickness (long-term diseases like TB, cancer, etc.) — up to 2 years at 80% with specialist's certificate.
How to Claim Maternity Benefit Under ESIC
- Submit maternity claim form to employer or ESIC branch
- 100% of average daily wages for 26 weeks (first 2 children)
- 12 weeks for 3rd child
- 6 weeks in case of miscarriage or MTP
- 12 weeks for adoptive mothers (child below 3 months)
ESIC Pehchan Card — How to Get It
- Employer registers you on ESIC portal and generates IP (Insured Person) number
- Login to esic.in with your ESIC credentials
- Go to "e-Pehchan Card" and download/print
- Aadhaar linking makes the Aadhaar card itself work as ESIC identity at facilities
ESIC Grievance — If Benefit is Denied
If ESIC claim is rejected or benefit not received:
- File grievance at pgportal.gov.in (ESIC under Ministry of Labour)
- Or directly approach ESIC branch manager
- For disputed claims: appeal to ESIC Court (Medical Board for disability disputes)
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