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Section 56 Employees’ State Insurance (ESI) Act 1948: Medical Benefit

Section 56 (Medical benefit) under the Chapter V (Benefits) of the Employees’ State Insurance Act 1948

❝(1) An insured person or (where such medical benefit is extended to his family) a member of his family whose condition requires medical treatment and attendance shall be entitled to receive medical benefit.

(2) Such medical benefit may be given either in the form of out-patient treatment and attendance in a hospital or dispensary, clinic or other institution or by visits to the home of the insured person or treatment as in-patient in a hospital or other institution.

(3) A person shall be entitled to medical benefit during any Period for which contributions are payable in respect of him or in which he is qualified to claim sickness benefit or maternity benefit or is in receipt of such disablement benefit as does not disentitle him to medical benefit under the regulations:

 Provided that a person in respect of whom contribution ceases to be payable under this Act may be allowed medical benefit for such period and of such nature as may be provided under the regulations:

 Provided further that an insured person who ceases to be in insurable employment on account of permanent disablement shall continue, subject to payment of contribution and such other conditions as may be prescribed by the Central Government, to receive medical benefit till the date on which he would have vacated the employment on attaining the age of superannuation had he not sustained such permanent disablement:

 Provided also that an insured person, who has attained the age of superannuation, and his spouse shall be eligible to receive medical benefit subject to payment of contribution and such other conditions as may be prescribed by the Central Government.

 Explanation.—In this section, “superannuation”, in relation to an insured person, means the attainment by that person of such age as is fixed in the contract or conditions of service as the age on the attainment of which he shall vacate the insurable employment or the age of sixty years where no such age is fixed and the person is no more in the insurable employment.❞




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Notes:

The Employees’ State Insurance Act, 1948 was amended by the:
- the A.O. 1950;
- the A.O. (No. 3) 1956;
- the A.O. (No. 4) 1957;
- the Employees' State Insurance (Amendment) Act, 1951 (Act No. 53 of 1951);
- the Employees' State Insurance (Amendment) Act, 1966 (Act No. 44 of 1966);
- the Employees' State Insurance (Amendment) Act, 1975 (Act No. 38 of 1975);
- the Employees' State Insurance (Amendment) Act, 1984 (Act No. 45 of 1984);
- the Employees' State Insurance (Amendment) Act, 1989 (Act No. 29 of 1989);
- the Employees' State Insurance (Amendment) Act, 2010 (Act No. 18 of 2010).

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