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Date: 2025-04-02 Category: Extra Ordinary State: Union Government Country: India

The following draft of certain regulations further to amend the Employees State Insurance General Regulations

Issued by Employees State Insurance Corporation · Not Applicable

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Executive Summary & Key Takeaways

What it means

  • The gazette notification proposes amendments to the Employees’ State Insurance (General) Regulations, 1950, specifically regarding medical benefits for retired beneficiaries.
  • It introduces a new Regulation 103 AA to provide medical benefits to certain retired employees and their spouses.

Key Changes

  • A new regulation, 103 AA, is to be added to the Employees’ State Insurance (General) Regulations, 1950.
  • Employees who have contributed for at least five years after 01.04.2012, ceased to be covered due to exceeding the wage limit, and retired on or after 01.04.2017 with wages up to Rs. 30,000 per month are eligible for medical benefits after retirement.
  • Eligibility extends to those who superannuate, retire under a Voluntary Retirement Scheme, or take premature retirement.
  • To receive the benefit, the retired employee must fulfill the conditions of the scheme notified by the Corporation, produce a certificate from the employer, and pay the contribution as specified by the Corporation.
  • Insured persons already availing medical benefits under Rule 60 and 61 of ESI (Central) Rules, 1950, can also receive medical benefits under the new regulation, subject to fulfilling scheme conditions and contribution payment.
  • Employers are required to issue a certificate to their employees on demand, as specified in the regulation.

Impact Analysis

Impact on Employees

  • Employees need to ensure they meet the scheme conditions, obtain the necessary certificate from their employer, and make the required contributions to avail of the benefit.

Impact on Employers

  • Employers need to understand the conditions of the scheme to provide accurate information and certificates to retiring employees.

Impact on ESIC

  • ESIC may experience an increase in administrative workload due to the expanded coverage.

Suggested Action Items

  • Submit objections or suggestions regarding the draft regulation to Shri Deepak Joshi, Insurance Commissioner (Benefit) within 30 days of the gazette being made available to the public.

Key Entities Referenced

Employees’ State Insurance Corporation (ESIC): The governing body responsible for administering the Employees’ State Insurance scheme. Employees’ State Insurance Act, 1948: The primary legislation governing the Employees’ State Insurance scheme in India. Employees’ State Insurance (General) Regulations, 1950: The regulations that provide detailed rules and procedures for the implementation of the Employees’ State Insurance Act, 1948. Rule 60 and 61 of ESI (Central) Rules, 1950: Existing rules under which insured persons are already availing medical benefits. Shri Deepak Joshi, Insurance Commissioner (Benefit): The ESIC official to whom objections and suggestions regarding the draft regulation can be addressed.
Official Source Record View Original Source →
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रजिस्ट्री स.ं डी.एल.- 33004/99 REGD. No. D. L.-33004/99 सी.जी.-डी.एल.-अ.-03042025-262243 xxxGIDHxxx CG-DL-E-03042025-262243 xxxGIDExxx असाधारण EXTRAORDINARY भाग III—खण् ड 4 PART III—Section 4 प्राजधकार स ेप्रकाजित PUBLISHED BY AUTHORITY स.ं 272] िई दिल्ली, बुधिार, अप्रैल 2, 2025/ चत्रै 12, 1947 No. 272] NEW DELHI, WEDNESDAY, APRIL 2, 2025/ CHAITRA 12, 1947 कर्चम ारी राज्य बीर्ा जिगर् अजधसचू िा िई दिल्ली, 4 र्ाचम, 2025 फा. स.ं आर-12/16/9/2022-िीजत-जितलाभ-II.— कर्मचारी राज्य बीर्ा (सार्ान्य) जिजियर्, 1950 र्ें आग े और संिोधि करिे के जलए कुछ जिजियर्ों का जिम्नजलजखत प्रारूप, जिसे कर्मचारी राज्य बीर्ा जिगर् िे कर्मचारी राज्य बीर्ा अजधजियर्, 1948 (1948 का 34) की धारा 97 के तित प्रित्त िजियों का प्रयोग करते हुए बिािे का प्रस्ट्ताि दकया ि,ै एतद्द्वारा उि धारा की उप-धारा (1) द्वारा अपेजित प्रभाजित िो सकिे िाले सभी व्यजियों की िािकारी के जलए प्रकाजित दकया िाता ि ैऔर एतद्द्वारा सूचिा िी िाती ि ै दक उि प्रारूप जिजियर्ों पर उस तारीख से तीस दििों की अिजध की सर्ाजि के बाि जिचार दकया िाएगा, जिस दिि आजधकाररक रािपत्र की प्रजतयां जिसर्ें यि अजधसूचिा प्रकाजित की गई ि,ै आर् ििता के जलए उपलब्ध कराई िाती ि:ैं 1. कोई भी आपजत्त या सुझाि, िो ऊपर जिर्िमष्ट अिजध के भीतर उि प्रारूप जिजियर् के संबंध र्ें दकसी भी व्यजि से प्राि दकया िोता ि,ै कर्मचारी राज्य बीर्ा जिगर् द्वारा उस पर जिचार दकया िाएगा। 2. आपजत्तयां और सुझाि, यदि कोई िों, श्री िीपक िोिी, बीर्ा आयुि (जितलाभ) कर्मचारी राज्य बीर्ा जिगर्, पंचिीप भिि, सीआईिी र्ाग,म िई दिल्ली-110002 को भेिे िा सकते ि ैं(ई-र्ेल: ac-benefit@esic.nic.in). प्रारूप जिजियर् 1. इस जिजियर् को कर्मचारी राज्य बीर्ा (सार्ान्य) संिोधि जिजियर्, 2025 किा िाएगा। 2. कर्मचारी राज्य बीर्ा (सार्ान्य) जिजियर्, 1950 र्ें, एक िया जिजियर् 103 एए जिम्नािुसार िाजर्ल दकया िाएगााः- 2312 GI/2025 (1)2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] जिजियर् 103 एए: सिे ाजििृत्त लाभार्थयम ों को जचदकत्सा जितलाभ 1. कर्मचारी जिसके संबंध र्ें अंििाि दििांक 01.04.2012 के बाि कर् से कर् पांच िर्षों के जलए िेय ि ै या था और बाि र्ें िेति सीर्ा से अजधक िोिे के कारण अजधजियर् के अंतगमत व्याि ििीं दकया गया ि ैतथा दििांक 01.04.2017 को या उसके बाि प्रजत र्ाि तीस ििार रुपये तक के िेति के साथ, अजधिर्र्षमता की आयु प्राि करिे पर सेिाजििृत्त िोता/िोती ि,ै या स्ट्िैजछछक सेिाजििृजत्त योििा के तित सेिाजििृत्त िोता/िोती ि,ै या सर्यपूिम सेिाजििृजत्त लेता/लेती ि,ै स्ट्ियं और अपिे पजत या पत्नी के जलए जचदकत्सा जितलाभ प्राि करिे के जलए जिम्नजलजखत ितों के अधीि पात्र िोगा/िोगी : i. जिगर् द्वारा अजधसूजचत योििा की अन्य ितों को पूरा करता/करती िो। ii. जियोिा से उस प्रपत्र र्ें प्रर्ाणपत्र प्रस्ट्तुत करिािा जिसे इस उद्देश्य के जलए र्िाजििेिक द्वारा जिजिर्िमष्ट दकया गया िो । iii. अंििाि का उस िर और रीजत से भुगताि करिा जिसे जिगर् द्वारा योििा र्ें यथाजिजिर्िमष्ट दकया गया िो। बिते दक बीर्ाकृत व्यजि िो कर्मचारी राज्य बीर्ा (केंद्रीय) जियर्ािली, 1950 के जियर् 60 और 61 के अंतगमत जचदकत्सा जितलाभ प्राि कर रिा/रिी ि,ै भी योििा की अन्य ितों को पूरा करिे और अंििाि का उस िर और रीजत जिसे जिगर् द्वारा योििा र्ें यथाजिजिर्िमष्ट दकया गया िो, से भगु ताि करिे पर स्ट्ियं और अपिे पजत /पत्नी के जलए उप-जिजियर् (1) के अिुसार जचदकत्सा जितलाभ प्राि करिे का पात्र िोगा/ िोगी। 2. जियोिा उसके द्वारा जियोजित व्यजि को र्ांग ेिािे पर उप जिजियर् (1) र्ें संिर्भमत अिुसार प्रर्ाणपत्र िारी करेगा। िीपक िोिी, बीर्ा आयुि (यो. ि जि.) [जिज्ञापि-III/4/असा./05/2025-26] EMPLOYEES’ STATE INSURANCE CORPORATION NOTIFICATION New Delhi, the 4th March, 2025 F.No. R-12/16/9/2022-Policy-Bft-II.—The following draft of certain regulations further to amend the Employees’ State Insurance (General) Regulations, 1950, which the Employees’ State Insurance Corporation proposes to make in exercise of the powers conferred under section 97 of the Employees’ State Insurance Act, 1948 (34 of 1948), is hereby published as required by sub-section (1) of the said section for information of all persons likely to be affected thereby and notice is hereby given that the said draft regulations will be taken into consideration after expiry of a period of thirty days from the date on which copies of the Official Gazette in which this notification is published, are made available to the public:- 1. Any objection or suggestion, which may be received from any person in respect of the said draft regulation within the period specified above, will be considered by the Employees’ State Insurance Corporation. 2. The objections and suggestions, if any, may be addressed to Shri Deepak Joshi, Insurance Commissioner (Benefit) Employees’ State Insurance Corporation, Panchdeep Bhawan, C.I.G. Marg, New Delhi- 110002 (e.mail: ac- benefit@esic.nic.in). DRAFT REGULATIONS 1. This Regulation may be called Employees’ State Insurance (General) Amendment Regulations, 2025. 2. In the Employees’ State Insurance (General) Regulations, 1950, a new Regulation 103 AA shall be inserted as under: Regulation 103 AA: Medical benefit to retired beneficiaries 1. An employee in respect of whom contribution is or was payable for not less than five years after 01.04.2012 and who subsequently ceased to be covered under the Act due to exceeding the wage limit, superannuating on attaining the age of superannuation, retiring under a Voluntary Retirement Scheme or taking premature retirement with wages up to rupees thirty thousand per month on or after 01.04.2017, shall be eligible to receive medical benefit for self and his/her spouse, subject to: i. the fulfilment of other conditions of the scheme notified by the Corporation ii. production of certificate from the employer in the form which may be specified by the Director General for the purpose. iii. the payment of contribution at the rate and manner as notified in the scheme by the Corporation[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 3 Provided that an Insured person who is availing medical benefit under Rule 60 and 61 of ESI (Central) Rules, 1950 shall also be eligible to receive medical benefit as per sub-regulation (1) for self and his/her spouse on fulfilment of other conditions of the scheme and payment of contribution at the rate and manner as notified in the scheme by the Corporation. 2. An employer shall, on demand, issue the certificate as referred to in sub-regulation (1) to person employed by him. DEEPAK JOSHI, Insurance Commissioner (P&D) [ADVT.- III /4/Exty./05/2025- 26] Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.

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