ESIC Medical Facilities Scheme for Other Beneficiaries, 2026: Expanding Healthcare Access Through Better Utilisation of ESIC Infrastructure
The Ministry of Labour and Employment has notified the Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2026 vide S.O. 2355(E) dated 8 May 2026. The Scheme has been framed under Section 44 of the Code on Social Security, 2020 and became effective from the date of its publication in the Official Gazette.
The initiative marks a significant step towards expanding access to healthcare by making optimum use of the extensive medical infrastructure developed by the Employees’ State Insurance Corporation (ESIC).
Background and Objective
The Employees’ State Insurance Corporation operates a large network of hospitals and medical institutions across the country. In several regions, some ESIC hospitals and healthcare facilities remain underutilised. Recognising this, the Central Government has introduced the Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2026, enabling eligible beneficiaries covered under other Central Government schemes to access medical facilities available at such underutilised ESIC hospitals.
The Scheme seeks to achieve two important objectives:
- Optimum utilisation of existing ESIC healthcare infrastructure.
- Expansion of quality healthcare access to a wider section of beneficiaries.
Applicability of the Scheme
The Scheme applies to:
- Beneficiaries registered under any scheme framed by the Central Government, other than the regular Employees’ State Insurance Scheme; and
- Members of their families.
Accordingly, the Scheme does not cover regular insured persons already receiving benefits under ESIC. Instead, it creates a separate framework for specified categories of beneficiaries to avail treatment through designated ESIC medical institutions.
Registration Process
Individuals intending to avail medical treatment under the Scheme are required to complete a registration process.
The applicant must:
- Submit the prescribed registration form electronically or through any other specified mode;
- Furnish details relating to himself or herself and family members; and
- Produce an identity card issued either by ESIC or under the relevant Central Government scheme, as applicable.
This mechanism ensures that medical facilities are extended only to eligible persons and their dependants.
Medical Benefits Under the Scheme
Registered beneficiaries will be entitled to receive medical treatment and attendance from underutilised ESIC hospitals.
This provision is expected to:
- Enhance the utilisation of available healthcare infrastructure;
- Improve accessibility to quality medical services;
- Reduce pressure on other public healthcare institutions; and
- Strengthen the social security framework envisaged under the Code on Social Security, 2020.
User Charges and Contribution to ESIC Fund
Beneficiaries availing treatment under the Scheme will be required to pay user charges at rates to be notified by the Employees’ State Insurance Corporation in consultation with the Central Government.
Importantly, the Scheme provides that such user charges shall be treated as contributions and credited to the Employees’ State Insurance Fund.
Thus, while extending healthcare services to additional beneficiaries, the Scheme also creates a mechanism to support and strengthen the financial resources of the ESIC system.
Maintenance of Separate Records
To ensure transparency and effective administration, ESIC hospitals are required to maintain separate electronic records relating to:
- Beneficiaries receiving treatment under the Scheme; and
- User charges collected from such beneficiaries.
Separate record maintenance will facilitate proper monitoring and ensure clear segregation between regular ESIC insured persons and beneficiaries covered under this Scheme.
Implications for Employers and Compliance Professionals
Employers and HR professionals should note that the Scheme does not alter or replace existing ESIC obligations applicable to employees under the social security framework.
Regular ESIC compliance requirements—including registration, contribution payments and statutory filings—will continue independently.
The present Scheme is intended solely to provide medical access to beneficiaries covered under other Central Government schemes by utilising underused ESIC healthcare facilities.
From a broader perspective, the Scheme reflects the Government’s continued emphasis on strengthening social security and extending healthcare support to a larger segment of society through efficient use of existing resources.
Conclusion
The Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2026 represents a progressive initiative aimed at widening healthcare access while ensuring optimal utilisation of ESIC hospitals and infrastructure. By permitting eligible beneficiaries under other Central Government schemes to access treatment at underutilised ESIC hospitals, the Government has introduced a structured framework supported by registration procedures, user charges and separate record-keeping requirements.
For employers, HR professionals and labour law practitioners, the notification should be viewed as part of the evolving social security architecture under the Code on Social Security, 2020, rather than as a change in the existing ESIC compliance framework. The Scheme reinforces the Government’s objective of expanding healthcare accessibility while maintaining financial and administrative discipline within the ESIC ecosystem.