Dated: 15/07/2011 To The Regional Director, Employees' State Insurance Corporation, All Regional Directors

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1 ! Speed Post HQRS.OFFICE EMPLOYEES' STATE INSURANCE CORPORATION PANCHDEEPBHAVAN,CIG ROAD, NEW DELHI-II clir-pnd(a,esic.nic.in, Phone I Fax-O : VOIP no.-l No. A-45/20/1/2011-P&D Dated: 15/07/2011 To The Regional Director, Employees' State Insurance Corporation, All Regional Directors Subject: Submission of Brief Note on working of ESI Scheme in the Regions. Sir, The Ministry of Labour & Employment many times calls for information on the functioning of ESI Scheme in different regions for visits of Parliamentary Standing Committee on Labour or Hon'ble Minister of Labour & Employment or other senior officers at short notices. This office is required to furnish requisite data to the Ministry on urgent basis. It has been observed that in respect of most of regions, the up-dated data is not readily available in Hqrs. Office. (2) Accordingly a proforma of brief Note on the functioning of the scheme has been prepared and is enclosed herewith. The desired information as on 31/3/2011, on prescribed proforma, may kindly be furnished to the Hqrs. Office by to: dir-pnd@esic.nic.in in microsoft word format within 15 days of this letter alongwith one hard copy of the same. The information as on 31 st March on prescribed form may kindly be furnished every year by 31 st May positively. It may kindly also be noted in calendar of returns to be submitted to the Hqrs. Office. Enc1: as above. This has the approval of Insurance Commissioner. Yours faithfully, / [H.K.MEHTA) Deputy Director (P & D) Copy to: Joint Director (System). It is requested that this cir-vlar may kindly be uploaded on website. \ \ '\./v~.~~.. Deputy Director (P&D)---

2 1 I Brief Note in respect of working of ESI Scheme in the State of A-Brief Note on ESI Scheme in the Region. B-Establishment. Name & Address of Regional Office Telephone No./Fax No.& VOIP Nos.ofRD Name(s) & Address(s) of Sub-Regional Officers), if any. Telephone No./Fax No.& VOIP Nos. of JD (l/c) (1) (2) Furnish the details in form Total number of Branch Offices in the Annexure-l enclosed herewith Region: Region/SRO /Div.Office -wise separately. Telephone Name & Address of the No./Fax No.& Percentage of ESIC Model Hospital in VOIP Nos. of Number of Beds Bed Occupancy the State Medical Su perin tendent

3 2 C-Information regarding State Government. 1 Name, address & telephone Telephone & Fax Numbers. including fax number of the Chairman, Regional Board. 2 Name, address & telephone Telephone & Fax Numbers. including fax number of the Secretary, Labour/Health in charge of ESI Scheme in the State. 3 Name, address & telephone Telephone & Fax Numbers. including fax number of the Director, Health Services (ESI) in the State. D-General Information in respect of Region Sr. Year Year Year No. Rs. Rs. Rs. 1 Number of centres 2 Number of Insured Persons (incl.iws) 3 Number of Insured Women 4 Number of Employees 5 Number of Beneficiaries. 6 Number of Employers. 7 Revenue Income of Region (in crores) incl. Recovery) 8 Amount of Revenue Recovery (in crores) 9 Expenditure on Cash Benefits (in crores) 10 Expenditure on Medical Benefits (in crores) 11 Other information, if any

4 3 E-Information regarding Medical facuities. Sr.No. Description Remarks Number of ESI Telephone & Fax Numbers of Medical Hospitals & Annexes Superintendents. Please furnish details of ESI 1 run by the State Hospitals & Annexes run by State Govt. in Govts. alongwith Annexure-2 their addresses. Hospitals= Annexes= Number of ESI Kindly furnish complete addresses & details in 2 dispensaries in the Annexure-3. State: 3 Numbers of Panel Clinics 4 Numbers of Tie -up Hospitals (Please furnish the list in Annexure-4) 5 Other information, if any. F-Information regarding Projects under Construction in Region. Sr.No. Name & description of Estimated Estimated date Remarks, if Project in Brief amount of of completion any. Project 1 2 G-Issues pending with the State Government, if any. Sr.No. Detail of action pending, if any, in brief. End: Annexures 1,2,3 & 4. H-Other remarks, if any. Place: Dated:- Signatures of the Regional Director

5 4 Annexure-1 List of Branch Omces 8&addresses thereof in Region (Including in respect of Sub-Regional/Divisional Omces) as on 31 st March. Sr.No. Name Address Phone VOIP Number Branch number, if Office any L Annexure-2 List of ESI Hospitals 8&Annexes run by State Govts. in Region. (Including in respect of Sub-Regional/Divisional Omces) as on 31 st March. Sr.No. Name ESI Address Phone number VOIP Number Percentage Hospital/ An of Medical Number, of Beds of bed nexe Su perintendent if any of occupancy MS. -_.-. Annexure-3 List of ESI dispensaries 8&addresses thereof in Region (Including located in Sub-Regional/Divisional Omces) as on 31 st March. Sr.No. Name ESI Address Numbers of Phone VOIP Number, Dispensary Medical number, if if any. Officers any I

6 5 Annexure-4 List of Tie-Up Hospitals where arrangements made for medical facilities for Insured Persons and their dependants in Region.(lncluding located in Sub-Regional/Divisional Offices) as on 31 st March. Sr.No. Name Address Number Specialty for Phone Hospital of Beds which tie-up number /Institut arrangements ron made.