Case Studies for HR fraternity with ESIC as Scenario

Ankit · December 31, 2020, 4:46am

Let’s together solve some real life situations.

1. Please use & state those assumptions wherever used and required
1. Mention the Reference - Act or Law wherever used

XYZ Company provides Health Insurance to all Non-ESIC Employees and the premium is borne by the company for all employees. During the pandemic, Employees under ESIC were not able to get the required benefit and thus, Head of Operations suggested to extend the Health Insurance to those Employees.

To reduce the cost burden on Company, he suggested below options: -

a. We should stop payment of ESIC as Employees are not getting benefit OR
b. Recover the Premium amount from respective employees.

As an HR Manager, what Solutions you will suggest to Top Management and step-by-step execution strategy .

Dinesh · December 21, 2020, 4:21am

A nice case study - let me try answering some.

Introduction:

Employer provided health coverage has become the standard foundation benefit for the platform of many companies. It could even be true that younger generations won’t even know what it’s like to work for an employer that doesn’t offer a medical plan.

Basic health benefits: Outpatient and inpatient care, coverage for dependents, international/regional coverage, inclusion of pre-existing conditions.
Popular additional benefits: Maternity and fertility coverage, vision and dental insurance.
Extended/comprehensive benefits: Health checks and immunizations, general wellness, and mental health support.

Problem Statement:

Employees were not able to get ESIC benefit due to Pandemic and non accessibility to some resources.
Can ESIC be stopped?
Can the amount be recovered from employees?

Suggestions:

Accessibility to hospitals or medical care during pandemic was really tough and majority of them faced several issues while getting treated for OPD. But ESIC is still opened and employees can get benefit which are far more than a Private Policy offers (https://www.esic.nic.in/attachments/files/faq.pdf)
But - ESIC benefits cannot be stopped - as they prevail to be a mandatory one for the eligible candidates as per the employment rules (https://knowledge.greythr.com/display/GOIN/ESI+FAQ) I recommend the same not to stop as their coverage is vast and can be really be beneficial for someone in need.

When we compare a private health insurance with ESIC I would recommend ESIC for employees within ESIC limit, but once ESIC eligibility limit is crossed by an employee and when an employee can afford better - it’s advisable to move to some well known insurance agency.

Conclusion:

We will not be able to retrieve the money / or it’s not advisable to ask employees to pay for the same - as ‘Health Insurance’ is perk offered by the company.

But there are plenty of options to reimburse / write off to ESIC tied up hospitals etc which can be looked out.

I tried my best. other please leave your comment.