MediSep facelift: Public sector, autonomous and cooperative employees outside ESI also included; 40 lakh people to be benefited
THIRUVANANTHAPURAM: The MediSep insurance scheme has been revised to provide medical benefits of up to five lakh rupees. The monthly premium will be Rs 750. It will benefit forty lakh people, including government employees, pensioners and dependents. The decision to renew the scheme was taken at a cabinet meeting yesterday. The benefit is currently Rs 3 lakh and the premium is Rs 500. The premium may change depending on the tender of the insurance company. There is also a possibility of increasing the premium every year. The scheme has been reduced to two years. Currently, it is three.
The demand for an opt-out option was rejected. The proposal that the government should bear a certain percentage of the premium was also not accepted. The new one will come into effect as soon as the scheme ends on September 30. The scheme will be expanded to include more people and provide more treatment.
The employees, pensioners and dependents of public sector undertakings, boards, corporations, autonomous bodies and cooperative sectors who are not eligible for ESI benefits will be included. The number of beneficiaries will exceed forty lakh. Currently, it is thirty lakh. In the first phase, while the premium received was Rs. 1950 crore, a claim of Rs. 1988.39 crore had to be paid. The expansion is a solution to this. The current contract is with Oriental Insurance Company.
The changes are being made considering the suggestions received at the meeting of service organisations and the recommendations of the expert committee headed by Sriram Venkitaraman.
Benefits in 41 specialties
- The main change is the inclusion of more than 2100 treatments in the 41 specialty category in the basic package.
- Knee replacement and hip replacement in the basic package. Surgical and medical packages can be added.
- The insurance company should set aside a corpus fund of 40 crores for 10 critical/organ replacement treatment packages.
- Room rent up to Rs. 5000, which is 1% of the basic coverage, and up to Rs. 2000 in government hospitals can be received per day
- The expenses for the three days before and five days after hospitalization will be borne
For long-term treatment
The catastrophic package is for long-term treatment requirements. The additional package will include the installation of a cardiac resynchronization therapy defibrillator worth Rs 6 lakh to correct the pumping of the heart and the provision of a dual-chamber implantable cardioverter defibrillator worth Rs 5 lakh to correct the heart rhythm. Treatments in non-empaneled hospitals will include 10 treatments in addition to heart attack, stroke, and vehicle accident. Single-time registration on the portal for dialysis and chemotherapy.
Three-tier grievance redressal
Three-tier grievance redressal system at district level, state level and appellate authority. QR code on MediSep card to avoid delays. Strict action against hospitals violating contract. Action through Clinical Establishment Authority against hospitals charging extra bills.