MEDiSEP becomes liability for govt employees and pensioners

THIRUVANANTHAPURAM: MEDiSEP health insurance has become a liability for government employees and pensioners in the state as it does not even provide partial coverage for their medical expenses. Many procedures, such as knee and hip surgeries, have been excluded from MEDiSEP coverage by private hospitals themselves. Private super-speciality hospitals are also hesitant to accept the scheme.

MEDiSEP was launched on July 1, 2022. Beneficiaries have to pay a premium of Rs 500 per month. However, the claim for the past two years has exceeded the annual premium. Oriental Insurance, the operator of the scheme, has stated that it cannot move forward without increasing the monthly premium amount. The company claims that while they were expecting to pay around Rs 450 crore annually, they have ended up paying more than Rs 600 crore.

Under the MEDiSEP scheme, each family is provided with coverage of Rs 3 lakh per annum for the policy period of three years. Of this, approximately Rs 1.5 lakhs must be utilized every year. Otherwise, the unused amount will lapse, as per the agreement.

Patients forced to pay money out of their pockets for treatment
MEDiSEP supposedly provides comprehensive coverage for all illnesses. However, upon hospitalization, the reality differs. Several treatments listed are not included in the package, and patients must pay a substantial portion of medical expenses out-of-pocket. Despite being marketed as a cashless program, MEDiSEP now falls short of this promise, leading to widespread complaints. For instance, if the medical bill amounts to Rs1 lakh, the patient will have to pay the entire amount upfront and get discharged. Later, after several days, MEDiSEP will reimburse only about one-third of the amount as part of their claim settlement process.

More than 29 lakh members
Government employees covered under MEDiSEP- 5,33,618
Pensioners- 5,53,338
Dependents- 18,32,059
People who have sought treatment so far- 2,87,489 (Employees: 1,57,768, Pensioners: 1,29,721)
Total amount collected in a year- Rs 652.17 crores
Assistance provided so far: Rs 1485 crore