State issues GO extending Medisep for three more months
The State government's Medical Insurance Scheme for State Employees and Pensioners (Medisep), the first phase of which is drawing to a close on June 30, will be extended till September 30 with the same terms and conditions stipulated in the original Memorandum of Understanding with the insurance firm implementing the scheme.
With the three-year policy period of Medisep coming to an end on June 30, 2025, the government had set up a six-member expert committee to study the scheme and recommend appropriate revisions.
It sought an extension of the original contract with the Oriental insurance company for another three months till it can scrutinise the expert committee's recommendations and float the new tender for the revised scheme
The government order (GO) issued by the Finance department extending Medisep for three more months says that the premium charged for the extended period of the scheme will be ₹1,593, including GST, per family for the entire three months period for the existing number of families covered by Medisep.
Slightly higher
Though this works out to ₹531/month, slightly higher than the current actual premium of ₹472 per month, the government has decided to meet this additional expense from the balance in the corpus fund so that neither the beneficiaries nor the State exchequer will incur any additional payment.
Though the insurance company had earlier taken the stand that while extending the contract, it can provide insurance cover to existing families only for whatever balance sum insured remains as on June 30, the State government re-negotiated with the insurance company
Thus, families who have already exhausted their sum insured or those whose balance sum insured is less than ₹75,000 as on June 30 will also get a basic insurance coverage of ₹75,000 for the next three months. This has been fixed in proportion to the additional premium paid by the government per family for the extended period.
The scheme will provide cashless treatment as well as the benefit of the package to the beneficiaries with the same terms and conditions of the existing Medisep scheme till September 30.
Medisep, launched in July 2022, offered a basic insurance cover of ₹3 lakh, at a monthly premium of around ₹500. It covers over 30 lakh individuals, including some 5.45 lakh government employees, 5.89 lakh pensioners and their dependents.
Enhanced coverage
The expert committee constituted by the government to revise the terms of Medisep had recommended an enhanced basic insurance coverage from ₹3 lakh to ₹5 lakh, based on the framework of the Health Benefits Package (HBP) 2022 formulated by the National Health Authority.
It had also recommended that the Medisep policy period be reduced to two years and that the scheme should be extended to employees and pensioners in public sector undertakings, Corporations, autonomous, statutory bodies and the cooperative sector, so that the increase in the overall risk pool can rein in the premium.
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