Healthcare insurance plans like 'Medisep' aim to provide access to treatment without upfront payment. However, there is a growing concern that Medisep initially launched with great enthusiasm for government employees and pensioners, may not be as beneficial as expected.

Despite the public sector insurance company's management of the project, there seem to be issues that need addressing. Medisep was introduced in 2022 to assist over five lakh government employees, pensioners, and their family members. It imposes a fixed limit on medical expenses, and many policyholders have raised complaints about the insurance company's reluctance to approve claims even when the hospital bill is below this limit.

Just the other day, we highlighted the ordeal of a government employee in Thiruvananthapuram. They received only a meagre reimbursement of five rupees when they submitted a bill exceeding five thousand rupees for essential treatment equipment in the super-speciality department. Employees and pensioners were attracted to the Medisep scheme, thinking it offered treatment without upfront costs, and they willingly paid a monthly premium of Rs 500.

The Oriental Insurance Company, which administers Medisep, envisions the project's potential but realizes that they can only move forward by increasing the premium. They also project that claims will surpass the premiums collected. While it was initially estimated that claims would amount to a maximum of Rs 500 crore in the scheme's inaugural year, the actual claims soared to Rs 697 crore due to the increasing number of beneficiaries. The company is now proposing a premium increase of Rs 1,000, although the government has yet to make a decision, fearing opposition from employees.

In today's world, insurance coverage is essential, given the exorbitant medical expenses. Many people hesitate to utilize their Medisep policy, especially if they have other insurance policies. Pensioners and their families often face more significant medical costs than active employees, as age-related health issues become more prevalent. While there is special consideration for terminally ill individuals, the costs are still a concern.

It would be wise for the government to establish a committee to investigate the complaints about Medisep. If the grievances of employees and pensioners who contribute monthly premiums are found to be valid, prompt corrective measures should be taken to ensure the scheme fulfils its intended purpose.