Thiruvananthapuram:The Kerala Cabinet has given the green light to the second phase of the Medical Insurance Scheme for State Employees and Pensioners (MEDISEP), introducing a host of new features and benefits aimed at providing greater relief to beneficiaries. The most significant change is the increase in the basic insurance coverage from the current Rs 3 lakh to Rs 5 lakh.
The updated scheme, which will have a policy period of two years, includes several key provisions:
- Increased Coverage and Premium: The basic insurance coverage is enhanced to Rs 5 lakh. To support this, the monthly premium for government employees will be raised from Rs 500 to Rs 750.
- Expanded Treatment Packages: The basic package has been significantly expanded to cover over 2,100 treatment procedures across 41 specialty areas. This includes major surgeries like knee replacement and hip replacement, which were not part of the first phase. High-cost cardiac treatments such as Cardiac Resynchronisation Therapy and ICD Dual Chamber will also be included in a new additional package.
- Corpus Fund for Serious Illnesses: A dedicated package for the treatment of 10 types of serious illnesses and organ transplants has been created. The insurance company will allocate a corpus fund of Rs 40 crore for two years to cover these treatments.
- Inclusion of Public Sector Employees: The cabinet has given in-principle approval to extend the scheme to employees and pensioners of public sector undertakings, autonomous bodies, boards, corporations, and cooperative sectors who are not covered under the ESI scheme.
- Emergency Reimbursement: The provision for reimbursement for emergency treatments in non-empanelled hospitals will be expanded. In addition to the existing three conditions (heart attack, stroke, and road accident), 10 more treatments will be eligible for reimbursement.
- Streamlined Processes: A one-time registration system will be introduced on the insurance portal for day-care procedures like dialysis and chemotherapy, which require continuous treatment. The new policy also allows for combined approvals when both surgical and medical treatments are involved.
- Revised Room Rent: Room rent will be covered up to 1% of the basic insurance coverage, which is Rs 5,000 per day. For pay wards in government hospitals, the rent will be covered up to Rs 2,000 per day.
- Grievance Redressal: A three-tier grievance redressal mechanism will be established at the district, state, and appellate levels to address beneficiary concerns more effectively.
- Policy Period: The new policy period has been shortened from three years to two years. There will be an increase in both the premium and package rates in the second year of the new policy.
These changes are expected to provide more comprehensive and accessible healthcare to a larger number of beneficiaries, addressing some of the shortcomings of the first phase of the scheme. The government has also mandated that only public sector insurance companies that were technically qualified in the first phase will be allowed to bid for the second phase.
