Thiruvananthapuram: Medical Insurance for State Employees and Pensioners, better known by its acronym MEDISEP, will increase its insurance cover from ₹3 lakh to ₹5 lakh. However, the policy period will be reduced to two years from three. The Cabinet on Wednesday gave its approval for the second phase of MEDISEP. 

The insurance scheme has a basic package and an additional package for 'catastrophic' illnesses, both together for a premium of ₹500 a month. If the amount was uniform for all three years till now, the premium amount will go up in the second year from now on. 

Pre- and post-hospitalisation coverage has also been decreased. Now, expenses incurred for the 15 days till hospitalisation, as well as 15 days after hospitalisation, are being covered. In Phase II, there will be pre-hospitalisation coverage only for three days and post-hospitalisation coverage will be limited to five days.

The insurance scheme was originally conceived for government employees and pensioners. The beneficiary pool will now be expanded to include employees and pensioners of various public sector units, boards, corporations, cooperatives and self-governing bodies.

In the first phase, which began in 2022, a total of 1920 treatments and surgical procedures were covered. In the new phase, the coverage will extend to 2100 treatment procedures related to 41 specialist treatments.

Two treatments that were excluded from the 'Catastrophic Package' in the first phase - Cardiac Resynchronisation Therapy with Defibrillator (₹6 lakh) and dual-chamber ICDs (Rs 5 lakh) - will be included in this phase. CRT is a treatment for heart failure that uses a small, implanted device to help the heart's ventricles contract in a more coordinated way, helping the heart pump blood more efficiently.

Knee and hip replacement surgeries will now be included in the Basic Benefit Package (BBP). In the first phase, the only procedure that cost above ₹3 lakh in the BBB was Aortic Stenting (Single), for which the approved rate was ₹5.78 lakh. In the second phase, there will be more procedures in the ₹4-6 lakh bracket. The patient will have to bear the additional cost, anything above ₹5 lakh.

In the second phase, MEDISEP will also have 10 types of grave illness and organ replacement packages. For this, the insurance company has been asked to set aside a corpus fund of ₹40 crore for two years. 

The room rent will be met up to Rs 5000 in this phase. For pay wards in government hospitals, ₹2000 will be provided. Additional rent will have to be borne by the beneficiary. In the first phase, the maximum reimbursement for room rent was ₹2000.

"Only those public sector insurance companies that had secured technical qualification in the first phase will be allowed to participate in the second phase tender proceedings," an official release said.

Though MEDISEP coverage is restricted to the empanelled public and private hospitals, in case of accidents, heart attack and stroke, coverage will be provided even if done in non-empanelled hospitals. In the second phase, in addition to the three emergencies already covered, reimbursement will be provided for 10 other treatments that are done in non-empanelled hospitals. 

As it stands, dialysis and chemotherapy patients have to register afresh whenever they visit the hospital. In Phase II, there will be 'one-time registration' for continuous day-care procedures like dialysis and chemotherapy.  

In the first phase, the most number of claims was for haemodialysis: 3.75 lakh worth nearly ₹54 crore. Cataract Surgery had the second most number of claims, 98,148, but had the highest claim amount: ₹172 crore.