Introduction

The Employees’ State Insurance Corporation (ESIC) is a social security organization that provides a range of benefits to employees and their families. These benefits include medical care, disability benefits, maternity benefits, and death benefits. The ESIC also provides financial assistance to families of insured employees in the event of death or disability. To be eligible for ESIC benefits, an employee must be registered with the ESIC and must have paid the required contributions. The family members of an insured employee are also eligible for certain benefits under the ESIC scheme. In this article, we will discuss the various benefits available to family members of an insured employee and the eligibility criteria for these benefits.

ESIC Benefits for Family Members & Eligibility Criteria

The Federal Employees Health Benefits (FEHB) Program is a comprehensive health insurance program that provides coverage for federal employees and their families. The FEHB Program is administered by the Office of Personnel Management (OPM).

The FEHB Program offers a variety of health plans, including the Federal Employees Dental and Vision Insurance Program (FEDVIP), the Federal Employees Group Life Insurance Program (FEGLI), and the Federal Employees Health Benefits Program (FEHB).

The FEHB Program provides coverage for family members of federal employees, including spouses, children, and stepchildren. Eligibility for FEHB coverage for family members is based on the employee’s eligibility for FEHB coverage. To be eligible for FEHB coverage, the employee must be a full-time, permanent federal employee, or a part-time, permanent federal employee who works at least 20 hours per week.

In addition, the employee must be enrolled in the FEHB Program and must have paid the required premiums for at least one full year. If the employee meets these requirements, then their family members may be eligible for FEHB coverage.

Family members who are eligible for FEHB coverage include spouses, children, and stepchildren. Spouses must be legally married to the employee, and children must be under the age of 26. Stepchildren must be under the age of 26 and must be the natural or adopted child of the employee’s spouse.

The FEHB Program provides comprehensive health coverage for family members, including preventive care, hospitalization, prescription drugs, and mental health services. The FEHB Program also offers a variety of optional benefits, such as vision and dental coverage, which may be purchased at an additional cost.
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Employee state insurance scheme (ESI) is one of the most useful schemes for the employees in India whose monthly gross salary is less than 21000 Rs. Under the ESI scheme, both employee and family members of employees will get treatment in ESIC hospitals, not only treatment this scheme provides so many other benefits to the members and their family members. Here we will know about what are the ESIC benefits available for the family members of the insured person.

How many family members covered in ESI

There is no specific number for ESIC family members. The below-listed family members of insured persons who don’t have any income source are eligible for ESIC medical treatment.

Spouse
Minor Dependent Son Up to 25 Years
Dependant Unmarried Daughter Up to 25 Years
Dependant Infirm Son
Dependant Infirm Unmarried Daughter
Dependant Father
Dependant Mother
Minor Brother ( When there are no parents)
Minor Sister (When there are no parents)

Family Definition As Per ESIC Act 1948

Eligibility Age for ESIC Family Members

The age limit of ESIC dependant children is increased from 18 years to 25 years w.e.f 01-06-2010 as per the ESIC amendment act 2010.

Also read: How to get ESIC Pehchan card

ESIC Benefits for Family Members / Dependents

i) Medical Benefits

From the first day of entering in ESIC scheme both insured person and family members will become eligible for ESIC medical treatment in ESIC dispensaries and hospitals. Even though employees get retired or permanently disabled still they can get medical treatment by just paying an annual token fee of 120 Rs to the ESIC.

How to Claim ESIC Medical Benefits

The family members of insured persons can get treatment in their ESIC dispensary by just showing the ESIC Pehchan card or ESIC temporary ID card (print counterfoil).

ii) Dependents Benefit

Whenever the death of the insured person occurs due to employment injury or occupational hazard then 90% of wage will be paid as monthly payments to the dependents of the deceased insured person.

How to claim ESIC Dependents Benefits

In order to claim ESIC dependents benefit the dependents of deceased member need to submit ESIC dependent benefit claim form to the ESIC branch office along with ESIC Pehchan card of the deceased member.

iii) Funeral Expenses

A funeral expense of 10000 Rs is payable to the dependents or the person who performs the last rites of an insured person

How to Claim ESIC Funeral Expenses

To claim ESIC funeral expenses the relatives of the deceased member should need to submit ESIC funeral expenses claim form 22 and ESIC Pehchan card of the deceased member to the ESIC branch office within 6 months after the completion of final rituals.

There are so many other benefits which ESIC is providing to the insured persons. But the above mentioned Three benefits are mostly related to the family members of the insured person.

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ESIC Benefits for Family Members & Eligibility Criteria

Employees’ State Insurance Corporation (ESIC) provides a range of benefits to the family members of its insured persons. These benefits include medical care, cash benefits, and other services. To be eligible for these benefits, the family members must meet certain criteria.

Eligibility Criteria for ESIC Benefits for Family Members

To be eligible for ESIC benefits for family members, the following criteria must be met:

The family member must be a dependent of the insured person.
The family member must be a citizen of India.
The family member must be registered with the ESIC.
The family member must be between the ages of 18 and 59.
The family member must not be employed or self-employed.