ESIC

The Employees' State Insurance Corporation is a statutory body that administers a contributory social insurance scheme. Employers and employees pay in, and insured persons draw medical care and cash benefits out.

It is worth separating three things that get conflated.

• ESIC, the Corporation, which administers the scheme, runs hospitals and dispensaries, and holds the fund.
• The scheme itself, which is the set of benefits and the contribution machinery.
• The statute, which was the Employees' State Insurance Act, 1948 and is now Chapter IV of the Code on Social Security, 2020, in force since 21 November 2025.

The Code replaced the Act and kept both the Corporation and the scheme. So an employer's practical obligations did not change on 21 November 2025; the citation in their documentation did. This is the same pattern as the provident fund side, where the EPFO and its schemes continued under the same Code.

What distinguishes state insurance from provident fund is what the money buys. Provident fund accumulates a balance the member eventually receives. State insurance buys cover: it pays only when something happens, and if nothing happens the contributions are not returned.

Two conditions have to be met, and both are commonly misunderstood.

First, the establishment has to be covered. Coverage depends on the type of establishment, the number of employees and whether the area has been notified as implemented. Coverage has been extended progressively, and the position for a specific district should be checked rather than assumed from an older understanding.

Second, the employee has to be within the wage threshold. Employees earning above it are not insured persons, and contributions are not payable for them. The threshold is prescribed and has been revised.

The rule that catches payroll teams is what happens when an employee crosses the threshold mid-period. Coverage does not stop the moment their wages rise. They continue as an insured person until the end of the contribution period in which the increase occurred, with contributions payable on their actual wages for that whole period. Stopping the contribution in the month of the increment is the single most common state insurance error.

Employees below the prescribed daily average wage are exempted from the employee's own share while the employer's contribution remains payable, which is worth building into the calculation rather than handling as an exception.

The scheme runs on two pairs of six-month windows, and they are offset from each other. Contributions paid in one window entitle the insured person to benefits in a later one.

Neither window is the financial year, and that is the point most often missed. An employer thinking in April-to-March terms will get the coverage continuation rule wrong, because the contribution period does not end in March.

The offset has a practical consequence for employees too. A new joiner is not immediately entitled to the full range of cash benefits, because entitlement depends on contributions in the relevant earlier period. Explaining that at joining avoids a difficult conversation at the point someone actually needs to claim.

Confirm the current period dates and the eligibility conditions for each benefit before relying on them.

• Register the establishment once it becomes coverable, and register each employee so that an insurance number is allotted.
• Compute contributions on wages as defined for the purpose, at the prescribed employer and employee rates.
• Deposit both shares by the prescribed monthly due date. The employee's share is deducted from wages; the employer's is its own cost and cannot be recovered from the employee.
• File the prescribed returns and maintain the prescribed registers.
• Keep an accident book and report employment injuries, which is a separate obligation from the contribution machinery and is frequently overlooked.
• Handle exit correctly, since coverage and the ability to claim depend on the contribution record.

Late deposit attracts interest and damages, and the employer's share is a cost that cannot be passed on. The most expensive failures here are not usually rate errors but coverage errors: an employee who should have been insured and was not has a claim against the employer for benefits they could not draw.

Contributions fall due on the last day of the wage period, and payment follows on a separate clock. Section 29(4) of the Code on Social Security, 2020 puts the due date at the last day of the wage period, with the wage period itself fixed by regulations. Where an employee works only part of a wage period, or works under two or more employers in the same wage period, the Code sends the due date to the regulations as well.

The payment window comes from regulation 31 of the Employees' State Insurance (General) Regulations, 1950, which requires an employer liable to pay contributions to pay them within 21 days of the last day of the calendar month in which they fall due. That is 21 days, not the 15 that is often quoted for ESI. Where a factory or establishment closes permanently, regulation 31 requires the contribution to be paid on the last day of its closure. The same regulation allows an employer to opt, in the manner the Director General prescribes, to pay an amount in advance against contributions, keeping the balance above what is due at the end of each wage period, and to file a six monthly statement in Form 5-A alongside the return of contributions.

Missing the window carries two separate consequences. Regulation 31-A charges simple interest at 12 per cent a year for each day of default or delay. Regulation 31-B allows that interest to be recovered as an arrear of land revenue. Regulation 31-C then allows the Corporation to recover damages by way of penalty on top, at a maximum rate that rises with the delay: 5 per cent a year for less than two months, 10 per cent for two months and above but under four, 15 per cent for four months and above but under six, and 25 per cent for six months and above.

The 21 day rule does not sit in the Code. It sits in regulations made under the Employees' State Insurance Act, 1948, which section 164(1) of the Code repealed with effect from 21 November 2025. What keeps it alive is the saving in section 164(2), and that saving has two limbs that do not say the same thing.

Section 164(2)(a) treats anything done under a repealed enactment, including any rule or regulation, as done under the corresponding provisions of the Code, and keeps it in force to the extent it is not contrary to the Code until it is repealed under the Code. That limb sets no end date. Section 164(2)(b) names the provident fund schemes and the rules, regulations and schemes framed under the Employees' State Insurance Act, 1948, and keeps them in force, to the extent they are not inconsistent with the Code, for one year from the date of commencement of the Code. That limb does set an end date.

Which limb governs the 1950 regulations is not answered on the face of the Code, because the two were commenced separately. Section 164(2)(b) was brought into force on 3 May 2023 by notification S.O. 2060(E), expressed as applying in relation to the Employees' Pension Scheme, 1995. The tranche commenced on 21 November 2025 by notification S.O. 5319(E), which is the one that repealed the ESI Act, brought in section 164(2)(a), (2)(c) and (3), and did not include (2)(b).

On the better reading the 21 day window continues to apply under the open ended limb, until regulations made under the Code replace it. An employer should treat it as a saved position rather than a permanent one and watch for the Code's own regulations.

• Contributions stopped in the month an employee's wages crossed the threshold, rather than at the end of the contribution period.
• An establishment that became coverable through headcount growth and never registered, because nobody was tracking the threshold.
• Coverage assumed not to apply because the area was not implemented, using an understanding that predates the extensions.
• Contract workers at the premises treated as entirely the contractor's concern, when the principal employer is not insulated from the contractor's failure to contribute.
• The employee's share deducted but the employer's share not deposited, which is both a contribution failure and, for the employee's share, holding money that was never the employer's.
• Employment injuries not reported, so an insured person's claim fails on the employer's record rather than on the merits.
• Maternity benefit handled twice or not at all, because the interaction between the scheme and the employer's own obligation was never settled per employee.