ESIC

Pragati (Insurance)

Revenue

December 12, 2013

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Introduction- Revenue
Revenue mainly comprises of Monthly Contribution & Live List Action on Defaulters Inspection & Survey Pre-Implemention Survey & Implementation Other processes which are also captured are BIFR Write Off Process Winding-up process Specific interface with other modules are mentioned in the respective processes. However, HRMS would be a common interface across Insurance Module.
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Introduction
Employers have to remit the contributions on a monthly basis to ESIC. This includes 1.75 % of Employees and 4.75% of Employers share adding up to 6.5 % of the monthly wage of the Employee. The Employer upon accessing Form 6 online, selects the month for which payment is being made. Upon doing so, the details of the Employees are furnished (based on Form 3). Thereafter the Employer has to only fill up the wage details of each Employee. This form may also be used in lieu of CCP. Contribution details are calculated based on the number of days worked and total wages paid. Upon submission of the details in Form 6, a challan may be generated for the total/partial amount of contribution. On submission of the challan, a unique challan number is generated. A facility to print the challan is also provided. Using this procedure monthly contributions can be tracked on a monthly basis and the process of submission of RC shall not be required after IT roll-out. On the basis of the Contributions received, Live List will be generated

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Entry Triggers

Employer is registered with ESIC Submission of Form 6 Monthly contribution becomes due

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Workflow
Employer Logs in the portal Selects the month for which contribution payable

Employee details are populated

Employer fills details of no. of days worked & wages Challan generated Total Contribution amt determined

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The Process
Monthly Contribution Employer Login
Logs in using the User Id and Password Form 6 format is available online Offline filing of Monthly Contribution details is also possible (e-forms which can be downloaded, filled offline & then uploaded ) OR upload of contribution data using CSV format Generate the challan based on Form 6 Deposit the challan with the Bank Generate Live List Employer selects the month

Live List
Checks if IP is Eligible for Medical Benefit

Reconciliation and Realization

Receives Challan & Bank statement

Challan Updation

Employer HIS

Updates challan deposited date. Updates corresponding Challan with Challan credited date and amount. Receipt Voucher will be generated and considered in books of account.

F&A

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Exit Triggers

Inspection of the Employers defaulting on payment of contribution as well as those paying on time is scheduled.

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Exception Process
When the Employer is exempted, he is not required to remit Monthly Contribution IPs making contributions under rule 60 & 61 Medical benefits are provided to insured person who ceases to be in an insurable employment on account of permanent disablement on payment of Rs.120 per annum. Medical benefits to retired insured person on payment of Rs.120 per annum.

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Process related Reports

Live List List of ESB/TDB Cases List of IPs under Rule 60/61

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Screens

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Interface
This module will have interface with F&A When the challan is submitted, a unique challan number will be generated. This number will be used while remittance. In case of cheque bounce, F&A will intimate the details of the bounced cheque for Action on defaulter / Recovery. HIS All the IPs eligible for Medical Benefit will be provided through the Live List. While availing the Medical Benefit, HIS will be able to check eligibility for Cash Benefit. In case of Super Speciality benefit, eligibility criteria can be checked. Portal Employer should be able to login using Internet Access to Form 6 & Challan should be available for the Employer.

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MIS Reports
Following MIS Reports can be generated Monthly Contribution received Region-wise contribution received No. of Defaulters

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Introduction
Every month the defaulting Employers are identified. Employer who fails to make complete contribution for the month before 21st of next month is treated as defaulter. If an Employer makes payment for defaulted period, then the employer is removed from the Defaulter list. Interest and Damages will be charged to the employer as per the case. Employers will be marked to Initial Defaulter list if Employer defaults up to 3 months. 1st , 2nd and 3rd default notice letters are sent to the employer for 1, 2, 3 months default respectively. If Employer continues to default and has defaulted for 4 months, then Employer will be marked as Main Defaulter. Once Employer is identified as Main Defaulter following actions are undertaken simultaneously:
C-18 ad hoc or C-18 Actual is issued (C-18 Adhoc is issued if Monthly Contribution Details are not available for defaulting periods else C-18 Actual is issued) The Employer is marked for Inspection. SCN against the employer is sent to JD(I/c)/RD for approval. Employer is called for Personal Hearing(PH) Revenue Branch if receives the Inspection report(IR) then issue C-18 Actual if IR is conclusive. Employer will be issued C-18 Actual/Speaking Order/Exparte Order as per outcome of PH.

If C-18 Adhoc is issued

Recovery certificates are created if Employer defaults to clear dues within 15 days of issue of C-18 Actual, Speaking Order or Exparte order. Employer Defaults in Self-certificate submission, then employer is marked for inspection.
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Entry Triggers

Monthly contribution is not paid/partially paid Self Certificate is not submitted on time

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Workflow
Employer defaults monthly Contribution payment Initial Defaulter list
Defaulted More than 3 months

Default Notices

Employer defaults SelfCertification

Main Defaulter List Simultaneously Inspection C-18 Adhoc/Actual

Only for C-18 Adhoc

If Employer didnt co-operate during Inspection As per Inspection Report findings

Show Cause Notice

if no valid explanation from employer

C-18 (Adhoc) Personal Hearing Ex-parte Order

Sanction Memo to Legal Dept

C-18 Actual

Speaking Order

if payment not done within 15 days of issue

Recovery Certificates
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The Process
Revenue Branch Employer
Employer defaults in Monthly contribution Employer defaults self-certification Issues Default Notice Letter Issues C-18 Adhoc Issues C-18 Actual Issues Speaking Order Issues Ex-parte Order Issues C-18(i) Issues D-18 Issues C-19, C-19(i), D-19 (Recovery Certificates) Generation of Default letter (notices) /C-18 Adhoc/C-18 Actual/Speaking Order/Exparte Order/C-18(i)/D-18 , Recovery Certificates User to edit and save the notice/letter in the system. Above notices/letters are also sent via email if Employer email-ID is available in the system. Recovery Certificates are sent to Recovery officer for further action. Initiate action as per Inspection Report.

Inspection
Intimation to Inspection Division sent

Inspection Report is available for the Inspector to submit Report

Recovery
Intimation to Recovery Officer Recovery Officer Employer Recovery Certificates are available to the Recovery Officer in-charge for the area Revenue Branch Officer Inspector

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Exit Triggers

Employer remits the arrears of Contribution and Interest and Damages and employer is removed from Defaulters list. Sanction Memo is issued against the Employer and sent to the Legal Branch for Legal Proceedings against the employer OR Sanction Memo is dropped against the Employer. Recovery Certificates are issued against the employer

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Process related Reports

C-18 Adhoc Report C-18 Actual Report Speaking Order/Exparte Order Report C-18(i) and D-18 Report Initial Defaulters Report Main Defaulters Report SCN issued Report Sanction Memo Report

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Interface
This module will have interface with Legal Upon issue of a Sanction Order, the same will be sent to Legal Branch for Legal proceedings F&A Payments towards arrears

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Screens

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Screens (contd)

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Introduction
Inspection ensures proper compliance of the provisions given in the ESI Act. The inspection of factories and establishments is one of the most important activity in ESIC and is carried out by Insurance Inspectors. When an investigation of a Unit takes place after the successful registration of the Unit under ESIC, it is called Inspection. When an investigation is conducted to determine if the Unit is coverable under ESIC, it is termed Survey. Short Inspections are inspections conducted to determine the contribution details and to check if all the Employees eligible under ESIC are covered Test Inspections are inspections conducted on an already Inspected Unit and serves as a quality check on Inspections. It is usually done by Test Inspecting Officers appointed by the RD or JD I/C.

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Entry Triggers

Survey is conducted upon a 3rd party reference or by an Inspectors own initiative The reasons for Inspection are:
New Employer registrations Closure of Units Non-payment of Contribution Random checks on complying Employers Employers identified in Periodical Survey Register Examination of complaints received

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Workflow
Inspection conducted by Inspector

Inspection Observation Note

Inspection Report

Scrutiny of Inspection Report by DA of Revenue Branch

Action taken based on IR

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The Process
Insurance Inspector
Prepares list of Inspections to be conducted

Inspection of Unit
Employer provides documents needed for Inspection(manual) Insurance Inspector conducts the inspection Prepares Inspection Observation Note and submits to employer Submits re-captures Observation Note and Inspection Report online If Inspection could not be performed on specified date, revises date /issues Annexure A, B or C

Sends intimation to the Employers about the date of Inspection

Report Scrutiny
Verifying and validating the Report

Employer Inspector Dealing Assistant

Same Report Screen is available for the DA to Scrutinize the IR If the DA finds discrepancy in report requests clarification from II. If the DA approves the report and discrepancies found with Employer necessary action is taken.

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Exit Triggers

After approval of Survey Report, Employer code is generated and requested to submit Form 01 online if found coverable

Upon update of FDC, C-18 ad hoc may be issued to recover contributions as per the revised dates

C-18 actual is issued and rest of the action on defaulters is initiated

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Process related Reports

Inspections conducted by Insurance Inspector Pending at the beginning of the month Added during the month Dealt during the month Pending at the end of the month Inspection reports received & dealt by DA Pending at the beginning of the month Added during the month Dealt during the month Pending at the end of the month

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Inspection & Survey - Interface

Legal Upon issue of a Sanction Order, the same will be sent to Legal Branch

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Inspection & Survey - Screens

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Inspection & Survey - Screens

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Introduction
Pre Implementation survey is the survey done to assess an area for implementation of the ESI scheme. Based on the initial information gathered, a survey is conducted to gather the details of the coverable Employers, Employees and the nature of Industries in a particular center.

The Head Quarters office, P&D branch prepares and circulates the phased program annually on the basis of proposals received from the RD/State Government.
Based on the survey report medical arrangements and arrangements for banking, cash disbursement and registration are finalized. Once approval from Ministry of Labour is received and draft notification is published in the Gazette, Employer Registration is initiated from the date of Implementation

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Entry Triggers

Regional Office gathers information of areas where there is a concentration of industries. Decision to conduct pre-implementation survey (PIS) is made on the basis of information gathered by the Regional Office.

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Workflow
Areas identified as not covered PIS conducted; proposal requested for from identified State Governments

Annual phase program is prepared; State Govt.. Requested to make arrangements for medical facilities
Draft Notification & Confirmation of facilities received at HQ; Cost estimate requested from Actuarial Approved by IC and forwarded to Ministry of Labour Notification in Gazette
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Registration of Employers begin

The Process
Regional Office P&D branch Head Quarters
Identifies Area for Survey and assigns tasks to Insurance Inspector Interacts with State Government to get proposal for medical arrangement Makes arrangement for cash, banking & registration. Prepares Draft Notification Coordinates with State Govt. Regional Offices & Actuarial Dept to consolidate arrangements for Implementation

Compile Annual Phased Program for Implementation Requests State Governments to send proposals for Medical arrangements Request for Cost Implications from Actuarial Dept. Forward recommendations to IC for approval along with Draft Notification and details of arrangement made

Insurance Commissioner
Approves an area for Implementation Forwards to Ministry of Labour for Govt. approval and publication in gazette

Actuarial
Analyses the viability

Regional Office Coordn .branch Officer P&D Head Quarters Officers

Details of the basis of the financial implication arrived by the Actuarial Branch and sent to Head of Planning & Development

Actuarial Officers

Insurance Commissioner

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Exit Triggers

Employer & Employee registration

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Process related Reports

Notification Register Pre-Implementation Survey Report

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Interface

Actuarial Financial Implication is calculated for Proposed Implementation

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MIS Reports
Following MIS Reports are generated Target Vs Actual Implementation

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Pre-Implementation Survey & Implementation- Screens

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Thank You

December 12, 2013

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