Kerala govt nod for MEDISEP, new insurance scheme to commence from New Year

The insurance scheme will be effective from January 1. Representative image/Shutterstock

Thiruvananthapuram: The Kerala Council Of Minister has approved its new medical insurance scheme, named MEDISEP, which ensures free treatment up to Rs 3 lakh yearly for government employees and pensioners.

(MEDISEP stands for Medical Insurance for State Employees and Pensioners.)

The insurance scheme will be effective from January 1. But it may take two more months to get reimbursement and cashless services at hospitals due to procedural delay.

MEDISEP membership is must for all government employees and pensioners except civil service officers. The employees, pensioners and family pensioners of establishments such as universities and local bodies which receive state funds, are also members of the scheme.

Spouse of pensioners excluded
As per the scheme government employees can include spouse, parents and children below the age of 25 years as dependents.

But pensioners are allowed to include only the spouse. Though various pensioners' unions urged the government not to discriminate them, the Cabinet did not consider their plea. The government pointed out that as per the Kerala Service Rules, spouse is the only dependent of a pensioner.

OP treatment not covered
There will be no coverage for treatment availed at the Out-Patient (OP) Department under this scheme. Hence the medical reimbursement scheme for all government employee for OP treatment at government hospitals and super specialty hospitals like the Regional Cancer Centre (RCC), Thiruvananthapuram; Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram; Malabar Cancer Centre, Thalassery; and Cochin Cancer Research Centre at Kalamassery would continue as per the Kerala Government Servants Medical Attendance Rules.

Digital IDs, cashless treatment
Digital IDs would be provided to every Kerala government employee and pensioner eligible for cover under the new medical insurance. Oriental Insurance Company Ltd, the firm implementing the scheme, will be sending them to the insurees.

Beneficiaries will be able to avail cashless treatment at hospitals with a printout of the cards, digital copy saved in mobiles or details in the mobile app.

Meanwhile, data collection of government employees and pensioners is continuing in the state with December 31 as the deadline. The government would be handing over the data to Oriental Insurance only after this date. Later, the IDs would be prepared and claims settled by Third-Party Administrators (TPAs) such as Vidal Health and Family Health Plan Ltd, which is a part of the Apollo Group.

Around 350 hospitals have tie-ups with these TPAs. However, less than half of these health institutions are expected to be included for MEDISEP. Authorities said that the TPAs were continuing discussions to bring more hospitals under the scheme.

A three-tier mechanism would be set up to settle disputes regarding claims. A nodal cell under the Finance Department is in overall charge of the insurance scheme.

Government officials also informed that the scheme would be fully functional only after a case filed by Reliance Insurance before the High Court against its exclusion from the tender procedures was settled.

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