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Employee State Insurance Corporation Scheme (ESI) Forms

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The Employees’ State Insurance (ESI) scheme is a health insurance scheme designed with an intent to protect the interests of workers in times of medical emergencies like maternity, sickness, permanent or temporary physical disablement, employment related death or injury leading to a loss in earnings or the capacity to earn. It is a social security scheme which is self-financed where employers contribute 4.75% and the employees contribute 1.75% of their wages.

The ESI scheme operates under the guidelines of the ESI Act, 1948 and is managed by the Employees’ State Insurance Corporation which is an autonomous body under the Ministry of Labour and Employment. The ESI scheme is meant for workers earning equal to or less than Rs.21,000 a month. Under this scheme, the below benefits are provided:

  • Medical benefit
  • Maternity benefit
  • Sickness benefit
  • Pension benefit
  • Dependent benefit
  • Disablement benefit
  • Funeral and confinement expenses

How to Register for the ESI scheme?

Establishments or firms that employ more than 10 people need to register under the ESI scheme. They can do so by logging into the ESIC portal - www.esic.in and submitting the requested information. On doing so, a code number comprising of 17 digits is generated and sent to the email ID of the employer along with a registration form and the ESIC login credentials. The employer can then login using the credentials and fill up the mandatory information. If there is any issue while registering, the employer can email the ESIC IT desk at itcare@esic.in.

What are ESI forms?

To make claims under the ESI scheme, the beneficiaries have to submit the relevant ESI forms after duly filling it. The form is available on the ESIC portal. Listed below are the details of the various ESI forms available:

Form 72 - This form is used to request for a duplicate ESIC smart card request.

Form 23 - This form is a life certificate form that is required to avail the permanent disablement benefit.

Form 24 - This form is a declaration and certificate for availing disablement benefit.

Form 22 - This form is used for making a claim for funeral expenses.

Form 20 - This form can be used for availing maternity benefits after the death of the insured person.

Form 19 - In order to claim maternity benefits and notice of work, this form has to be submitted.

Form 16 - For making claims for periodical payment of disablement benefit, this form can be used.

Form 15 - This is a form used for making claims for availing dependent benefits.

Form 14 - This is a claim form for permanent disability benefit.

Form 12 - This is an accident report form from the employer.

Form 11 - Accident book.

Form 9 - This form is used for making claims for sickness, temporary disablement benefit, and maternity benefit.

Form 6 - This a register of the employees.

Form 5A - If any beneficiary wishes to make an advance payment for his/her contribution, he/she can do so by submitting this form.

Form 5 - This form is used to return contributions made by the employee.

Form 3 - This is a form for return of declaration.

Form 2 - To make changes in the declaration form, form 2 is used.

Form 1 - This is a declaration form.

Form 01 - Employer’s registration form.

Form 1A - Family declaration form.

Form 142 - This form is used for making claims for compensation for loss of earnings and conveyance allowance.

Form 105 -Certificate of entitlement.

Form 86 - Certificate of employment.

Form 63 - Declaration form with regards to payment to the legal heir.

Form 53 - Application form for change in particulars of insured person.

Form 37 - Certificate of re-employment or continuous employment.

Form 32 - Wage-contributory record for disablement benefit.

All of the above-mentioned ESI forms are available to download from the ESIC portal and can be used for making claims under the Employees’ State Insurance scheme.

ESI Forms Reviews

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  • Apollo Munich Health Insurance
    "Its best insurance for the health"
    0.5 5.0/5 "Blown Away!"
    The claim is easy they approve everything I heard lots of customer using it, the customer support is good they gave me the policy document on time. They gave me Rs. 10 lakhs of medical cover, they have tie up with all the major hospitals like fortis, apollo. They have cash less treatment.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 14, 2018
  • Bajaj Allianz Health Insurance
    "Good Doctor for Health"
    0.5 5.0/5 "Blown Away!"
    My medical policy belongs to Bajaj Allianz, I am working same company hence they gave me best benefits. They do have pre existing disease they got tie up major hospitals, they have helpline of 24/7, the medical value around Rs. 5 lakhs for my entire family.
    Was this review helpful? 0
    , pune
    Reviewed on Dec 14, 2018
  • Future Generali Health Insurance
    "Good and effective policy"
    0.5 5.0/5 "Blown Away!"
    Its a family floater policy. They have given me a coverage amount of Rs. 2 lakhs. The policy has been given by my company. I have gone through the hospital list and many of the hospitals are listed in the cashless treatment facility. My total family has been covered by this policy.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 14, 2018
  • Apollo Munich Health Insurance
    "Good for health "
    0.5 5.0/5 "Blown Away!"
    I have medical policy for the coverage around Rs. 5 lakhs, they do have pre existing disease cover. The process generation is quick, they send the insurance card with the list of hospitals details. I am very fine with Apollo Munich health benefits.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 14, 2018
  • Star Health Health Insurance
    "Its Good"
    0.5 5.0/5 "Blown Away!"
    I have personal health policy with Star Health, the process was smooth, the premium is economical. They have generated the policy without any hassles, I took family policy for Rs. 5 lakhs. They have cash less facility but they don't have pre existing disease cover. They got tie up with many hospitals.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 13, 2018
  • HDFC Ergo Health Insurance
    "Every must need this policy for future"
    0.5 5.0/5 "Blown Away!"
    My health insurance policy was taken with HDFC Ergo. They have provided me a coverage amount of RS. 8 lakhs. I have to pay the premium amount of Rs. 6000 for 4 years till my loan tenure period. When i purchase the loan, they have given this policy. I have not claimed anything from this policy. The hospital list was fine.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Dec 13, 2018
  • HDFC Ergo Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    I have taken Health insurance from Hdfc ergo insurance . Am satisfied with the premium amount which am making the payment yearly . This policy gives good coverage with cashless hospitalization and pre disease cover . Even they have given network list of hospitals .Overall am satisfied with the service
    Was this review helpful? 1
    , faridabad
    Reviewed on Dec 13, 2018
  • National Insurance Health Insurance
    "Good for emergency purpose"
    0.5 5.0/5 "Blown Away!"
    The medical claim around Rs. 5 lakhs, its for my entire family. I used this policy for my father bypass surgery, it was cash less in Asian heart hospital the taken 6 to 7 days to settle 100% of claim. It covers major and minor disease it was corporate plan.
    Was this review helpful? 0
    , mumbai
    Reviewed on Dec 13, 2018
  • ICICI Lombard Health Insurance
    "Good Policy"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance policy with ICICI LOMBARD from last 2 months, there was no claim experience so far with this insurance policy. I am not aware of the premium amount as my company pays it. I have a coverage value of Rs 1 lac for this insurance.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 13, 2018
  • Star Health Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been holding my health insurance with Star health & allied insurance from past one year, they have explain me the policy benefit, and they have tie up with many hospital and they have shared me location as well, and the premium amount they have charged me up to 5000 it is nominal and they charge premium on yearly basis.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 12, 2018
  • Apollo Munich Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    I have taken health insurance from Apollo munich . Am satisfied with the premium amount which am making the payment . This policy covers cashless hospitalization . They have given the network list of hospital . Overall am satisfied with the policy.
    Was this review helpful? 0
    , new delhi
    Reviewed on Dec 12, 2018
  • SBI General Health Insurance
    "Yet to claim the policy"
    0.5 3.0/5 "Satisfactory"
    Total coverage of my medical policy is 2 lakhs. I have purchased a health insurance with SBI General. I make the premium amount of Rs. 9000. Most of the hospitals are covered in all the prime location. I had no claim experience with this policy. Me & my wife are covered in this policy.
    Was this review helpful? 0
    , guwahati
    Reviewed on Dec 12, 2018
  • Apollo Munich Health Insurance
    "Best policy"
    0.5 5.0/5 "Blown Away!"
    I am having a health insurance policy with Apollo Munich from last 3 years, i am not aware of the premium amount as my company pays it. There was no claim experience so far with this insurance policy. This policy has a coverage value of Rs 5 lacs.
    Was this review helpful? 0
    , kolkata
    Reviewed on Dec 11, 2018
  • HDFC Ergo Health Insurance
    "Good health insurance policy"
    0.5 3.0/5 "Satisfactory"
    I have purchased a policy for my family and i bought the policy from HDFC Ergo. I have paid the premium amount of Rs. 13650 yearly once. I have received a coverage amount upto Rs. 3 lakhs. This policy covers for me and my wife. The hospital list was fine. I had no claim experience with HDFC Ergo.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 11, 2018
  • Star Health Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with Star health insurance,there premium they charge is nominal only i use to pay my premium amount on monthly bases and it use to get auto debited with my bank account and they have explain me all policy which is cover in this policy clearly, till now i did not face any issue with this insurance.
    Was this review helpful? 1
    , indore
    Reviewed on Dec 11, 2018
  • Reliance General Health Insurance
    "Better Policy for health"
    0.5 3.0/5 "Satisfactory"
    I don't know about the features of my health policy which provided provided by company, total mediclaim value of Rs. 3 lakhs, it covers for 4 persons. I have received the medical cover, but I didn't interact with the customer support of Reliance. They have not done the medical test. The premium is low for one year.
    Was this review helpful? 1
    , hyderabad
    Reviewed on Dec 11, 2018
  • Royal Sundaram Health Insurance
    "No claim experience with Royal Sundaram"
    0.5 5.0/5 "Blown Away!"
    1 year back i have purchased the health insurance policy with Royal Sundaram and last month i have renewed the policy. They have given me a coverage value of 5 lakhs and they are providing the cashless treatment facility. I have received the no claim bonus.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 11, 2018
  • ICICI Lombard Health Insurance
    "Best health insurance policy"
    0.5 5.0/5 "Blown Away!"
    I'm holding the health insurance policy with ICICI Lombard and i have selected this company because of the services. I can get the cashless treatment facility. I have purchased this policy for myself and my wife. They have given me a coverage amount of Rs. 3 lakhs. I have been paying the premium amount of Rs. 6000 approximately.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 11, 2018
  • National Insurance Health Insurance
    "Its Good"
    0.5 4.0/5 "Great!"
    I have the mediclaim policy with National Insurance for the cover of Rs. 3 lakhs they have major and minor hospitals tie up, they gave me list of hospitals, policy duration is good. There is no pre existing or critical illness cover. They have cover for major diseases, the premium is low with best benefits.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 11, 2018
  • ICICI Lombard Health Insurance
    "Economical policy"
    0.5 4.0/5 "Great!"
    I have a health insurance policy with ICICI Lombard. It is a individual policy. The medical coverage is for ten lakhs and the premium is also economical for me. It is of 510 on a monthly basis. There are cashless facility too. Fortunately I have used it till date.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 11, 2018
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