Big relief for govt employees and pensioners, MEDISEP cover to increase from Rs 3 lakh to Rs 5 lakh

THIRUVANANTHAPURAM: The cabinet has approved the second phase of MEDISEP (Medical Insurance Scheme), a healthcare scheme launched by the government for government employees and pensioners. The basic insurance cover will be increased from Rs 3 lakh to Rs 5 lakh. Meantime, the premium to be paid by government employees has been increased from Rs 500 to Rs 750.

More than 2100 treatment procedures for 41 specialty treatments have been included in the basic package. Surgeries like knee replacement and hip replacement have also been included in the basic package. Cardiac resynchronization therapy and ICD dual chamber, which were in the catastrophic package in the first phase, have been excluded. These will be in the new package. There is also a package for the treatment of 10 types of serious/organ-changing diseases. For this, a corpus fund of Rs 40 crore will be allocated for two years.

Room rent up to one percent of the basic insurance cover (Rs 5,000 per day), ward rent up to Rs 2,000 per day in government hospitals. The cabinet also approved in principle the inclusion of employees and pensioners of public sector undertakings, autonomous bodies, boards, corporations and cooperative sectors who are not eligible for EMI benefits and in the second phase of MEDISEP. However, the policy period has been reduced from three years to two years. There is an increase in the premium rate and package rate in the second year.

Only general insurance companies that have obtained technical qualifications in the first phase of MEDISEP will participate in the second phase of tendering. The system of allowing reimbursement for emergency treatments in non-empaneled hospitals will include 10 more treatments in addition to the existing three treatments (heart attack, stroke, and road accident).

One-time registration will be allowed on the insurance portal for day care procedures such as dialysis and chemotherapy that require continuous treatment. Surgical and medical packages will be clubbed and approved at the same time.

Pre-hospitalization and post-hospitalization expenses will be made available for three and five days respectively. A three-tier grievance redressal system will be in place at the district level, state level and appellate authority.

A QR code system will be included in the MEDISEP card for quick access to beneficiary information. The insurance company should prepare an SOP (Standard Operating Procedure) that will take strict action against hospitals that deviate from the agreement. The services of the clinical establishment authority will also be used to control exploitation by private hospitals such as charging extra bills.

In the first phase so far (up to 01.07.2025)
1911.22 crore for 1,052,121 claims
2256 organ transplant claims 67.56 crores
1647 reimbursement claims 9.61 crores
Amount sanctioned to the company (including 18% GST) 1950.00
crores
Actual premium excluding GST 1599.09 crores

Some other decisions of cabinet meeting
Draft Ordinance approved
The cabinet meeting approved the draft Ordinance to amend the provisions of the Kerala Digital University of Science and Technology Act, 2021 relating to the appointment of the Vice Chancellor of the Kerala Digital University of Science and Technology. The draft ordinance to amend sub-sections (3), (4) and (6) of section 11 in accordance with the UGC Rules, 2018 and recent court orders was approved. It was also decided to recommend to the Governor for promulgation of the ordinance.

Re-appointment
Prof Mini Sukumar, who retired from Calicut University while serving as an expert member of the state planning board under other service conditions, will be re-appointed as an expert member of the planning board.