Claiming ESIC (Employees’ State Insurance Corporation) benefits online in 2025 involves a few steps that both employers and employees need to follow.
Here’s a detailed guide on how employees can claim their ESIC benefits (such as medical benefits, sickness benefits, maternity benefits, etc.) and the steps employers should take:
1. Employee Registration on the ESIC Portal
Before an employee can claim any benefits, they must be registered with ESIC. Most formalities can be done online through the ESIC portal by the employer by collecting related information and documents from the employee by visiting ESIC website https://www.esic.nic.in
After successful registration, an ESIC number (ESIC IP No.) is generated for the employee, which is crucial for any future claims.
2. Claiming Medical Benefits
Employees covered under the ESIC scheme are entitled to medical benefits. These are available at ESIC hospitals and dispensaries. To claim medical benefits online, follow these steps:
a. Visit the ESIC Website
Go to the ESIC login page (https://www.esic.in).
Click on the ‘Insured Person’ (IP) tab to access services related to medical benefits.
b. Create or Log into Account
If you have not registered, create an account by providing your ESIC number, password, and other details.
If you are already registered, log in using your credentials.
c. Request for Medical Treatment or Consultation
Once logged in, you can request online consultation or an appointment at an ESIC hospital or dispensary. The portal provides a list of nearby ESIC medical facilities.
d. Claim for Reimbursement (if applicable)
If you avail of treatment outside the ESIC network (like private hospitals), you can file a reimbursement claim for medical expenses through the portal.
Submit the required documents, including hospital bills, prescriptions, and medical reports, for reimbursement.
e. Track the Claim
Once the claim is submitted, you can track its status through the portal.
The reimbursement process, if applicable, may take some time and will be processed after review.
3. Claiming Sickness Benefits Online
Sickness benefits can be claimed by insured employees if they are unable to work due to sickness or injury.
a. Eligibility Check
Ensure you have contributed to the ESIC fund for a sufficient period (usually at least 78 days in the preceding 6 months).
You must also be certified sick by an ESIC-recognized doctor.
b. Submit Sickness Certificate
The sickness certificate issued by an ESIC medical officer or authorized doctor should be uploaded to the ESIC portal.
The certificate should detail the nature of the sickness and the period of incapacity.
c. Apply for Sickness Benefits
Log into the ESIC portal and access the sickness benefit section.
Upload the sickness certificate and any required documents (such as the employee’s ID and wage details).
Submit the claim for sickness benefits online.
d. Track Claim Status
Once submitted, you can check the status of the claim in your ESIC dashboard.
4. Claiming Maternity Benefits Online
Female employees covered by ESIC are entitled to maternity benefits after contributing to the scheme for a certain period.
a. Eligibility Criteria
Ensure that you have contributed to the ESIC fund for at least 70 days in the last two contribution periods (about 6 months).
You must be under ESIC coverage before applying for maternity benefits.
b. Submit Maternity Benefit Form
Log into your ESIC account and navigate to the maternity benefits section.
Fill in the online maternity benefit form with your details, and upload the maternity leave certificate or doctor’s recommendation.
c. Additional Documents
Submit other documents such as your ESIC card, marriage certificate, and any proof of delivery (if applicable).
d. Receive Maternity Benefits
Once your claim is processed, the maternity benefits are typically transferred to the employee’s bank account.
5. Claiming Other Benefits (Disability, Dependent, etc.)
Disability Benefits: If an employee suffers a work-related injury or disability, they can apply for disability benefits through the ESIC portal by submitting a disability certificate from an ESIC medical officer.
Dependent Benefits: In the unfortunate event of an employee’s death, their dependents (spouse, children, or parents) can claim benefits by providing death certificates, proof of relationship, and other documents.
6. How Employers Can Help Employees with Claims
Employers have a role in ensuring that employees can access ESIC benefits:
Register Employees on Time: Employers should ensure that employees are registered with ESIC when they join the company.
Submit Documents: Employers must submit accurate personal details of employee, their wages, attendance, and contribution history to the ESIC portal.
Verify Eligibility: Employers can also verify that the employee meets the eligibility criteria for various benefits.
7. General Guidelines for Online Claims
Use the ESIC Portal and Mobile App: The ESIC provides a mobile app for employees to check eligibility, submit claims, and track benefits.
Timely Claims: Claims must be submitted within specific timelines to ensure eligibility. For sickness benefits, it should be within 2 months from the date of sickness.
Maintain Updated Information: Ensure your ESIC details (such as bank account, address, contact) are updated on the portal to avoid any delays in processing claims.
8. Troubleshooting
If you face difficulties while filing a claim:
Check the Help Section: The ESIC website has a dedicated help section with FAQs and troubleshooting guides.
Customer Support: You can contact ESIC helplines or use the chat support option on the ESIC portal for assistance.
Conclusion
Claiming ESIC benefits online in 2025 is straightforward if you follow the steps provided on the ESIC portal. Both employees and employers have critical roles in ensuring proper documentation and timely submissions. As an employee, always keep your ESIC details updated, and as an employer, ensure compliance with the ESIC guidelines to facilitate smooth claims for your employees.
