The second phase of Medical Insurance Scheme for State Employees and Pensioners (MEDISEP), with insurance cover increased to ₹5 lakh from ₹3 lakh, will become operational from February 1, a month after the original roll-out date of January 1.

Government employees, service-family pensioners, employees and pensioners of universities and local self government institutions, and their dependents will be beneficiaries of the scheme. Nearly 32 lakh are expected to benefit.

The monthly premium, which was Rs 500 during the first phase, will be ₹687. Nonetheless, it will be lower than the ₹810 announced earlier. Service and employee organisations had vehemently opposed the increase in premium amount.

The yearly premium amount will be ₹8224. Oriental Insurance Company will continue to implement the scheme. The update was given by the office of Finance Minister K N Balagopal.

"The treatment packages newly included in the scheme are based on the nationally approved Health Benefit Package 2022. As a result, more hospitals will provide MEDISEP services," the finance minister's office said. All empanelled hospitals will have cashless treatment.

"Not only are additional hospitals empanelled, the agreements struck with hospitals in the second phase will have clauses that empanel all possible departments in each hospital," the minister's office said.

If in the first phase there are 1920 medical and surgical packages, the second phase will cover 2516 packages.  

The room rent will be met up to ₹5000 in the new 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.

In this phase, there will be simultaneous coverage for both medical and surgical packages.

Though MEDISEP coverage is restricted to the empanelled public and private hospitals, in case of emergencies like accidents, heart attack and stroke, coverage will be provided even if done in non-empanelled hospitals. In such instances, the insurance company will pay the hospitals.

Insurance cover for hip and knee replacements, which in Phase-I were restricted to government hospitals, will be available in private hospitals too.  

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. There is also a clause in Phase-II that will allow reimbursement for treatments taken at Sree Chithira Thirunal Institute of Medical Sciences and Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER).

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.

The extra cover for 10 'extremely grave' and organ replacement surgeries will be available in Phase-II also.  There will be no age limit to join the scheme. People of any age will be given membership in MEDISEP.