Fed up with MEDISEP

THIRUVANANTHAPURAM: No hospitals, no treatments, and constant rejection of claims. This is the messed up state of MEDISEP health insurance, which expires on June 30th. If the situation remains unchanged, pensioners and government employees want the government not to compel them to renew the plan. However, the norm suggests employees should compulsorily join the scheme.

5.45 lakh employees and 5.81 lakh pensioners should pay Rs 500 per month for the scheme. Whether you are receiving a lump sum pension or a salary of lakhs, the premium amount is the same. There are 30.26 lakh beneficiaries, including 19 lakh dependents.

Hospitals with specialty facilities are not being made part of MEDISEP. Take, for example, a person suffering from a serious disease. By the time he finds a hospital that accepts MEDISEP, things would have gotten worse. Some hospitals with MEDISEP are involved in fraudulent practices, making people pay for treatment despite having the policy.

Most medical emergencies will not be considered for reimbursement. Only heart attacks and accidents will be considered emergencies, and reimbursement will be allowed. If medical claims are rejected, a complaint should be filed with the Ombudsman.

The Dr. Sriram Venkitaraman Committee, appointed by the government to study the shortcomings in the administration of MEDISEP and make new suggestions, will submit its report within two weeks. The government will study the report and will then proceed with steps if needed. The next step is to revise the conditions and rates and call for tenders.

MEDISEP started in June 2022 for three years. The government provides 500 crores per year to Oriental Insurance Company. However, in the first year itself, claims worth 717 crores were received.