Latest news with #MEDISEP
The Hindu
06-08-2025
- Health
- The Hindu
Kerala Cabinet gives approval for MEDISEP Phase 2
The second phase of the Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) will offer enhanced insurance coverage, a larger and more comprehensive package of procedures, and improved coverage of catastrophic illnesses. The State Cabinet which met here on Wednesday approved Phase 2 of MEDISEP, which has been revamped as per the recommendations of the expert committee formed by the government. If the basic insurance cover in the first phase of MEDISEP was ₹3 lakh, in the second phase, the basic cover is being enhanced to ₹5 lakh. The Cabinet also approved in principle the recommendation that MEDISEP be extended to employees and pensioners in public sector undertakings, corporations, autonomous and statutory bodies and the cooperative sector, where the health insurance cover might be poor or inadequate due to the high premiums and poor beneficiary packages offered by private health insurance companies. In a State where catastrophic health expenditure has been impoverishing families, this extension of the State's health insurance cover to a chunk of the middle class is expected to reduce out-of-pocket expenditure on health. Treatment packages The enhanced scope of Phase 2 of the scheme means that the premium and treatment packages are also going to go up. However, if the scheme is extended to more categories of the population, this increase in the overall risk pool might still help to keep the premium at reasonable levels. MEDISEP, which was initially launched in July 2022, offered a basic insurance cover of ₹3 lakh at a monthly premium of ₹500. It covered over 30 lakh individuals, including some 5.45 lakh government employees, 5.89 lakh pensioners and their dependents. However, the scheme had run into rough weather because of the non-participation of private sector specialty hospitals, which claimed that the treatment package rates for various medical procedures were 'impractical and unrealistic.' The expert committee constituted by the government to revamp the scheme, recommended that the scheme be overhauled on the basis of Health Benefits Package (HBP) 2022, the latest and scientific health costing package formulated by the National Health Authority. 2,100 procedures The basic treatment package will offer over 2,100 treatment procedures in 41 specialties. Surgical procedures like hip and joint replacement will be covered under the basic package. The catastrophic health package under MEDISEP 2 will have 10 treatments, including organ replacement surgeries. The insurance company will be asked to set aside a corpus fund for the same, to the tune of ₹40 crore, for two years. Continuous day-care procedures such as dialysis or chemotherapy will also be reimbursed, for which a one-time registration can be made on the insurance portal. Medical and surgical packages may be clubbed and given approval. Pre-hospitalisation expenses will be reimbursed for three days and post-hospitalisation expenses for five days. The ceiling on hospital room rent for private hospitals will be increased to ₹5,000 a day, while the ceiling for payward room rent in government hospitals has been fixed at ₹2,000 a day. The government has decided to include only public sector insurance companies, which had been found technically qualified during the tendering process for Medisep 1, in the second phase tender process also. Under Medisep 2, the definition of 'emergency procedures' ( road traffic accidents, heart attack and stroke) for which reimbursement may be offered even if the treatment were in non-empanelled hospitals, has been expanded to include 10 more conditions. A three-tier grievance redressal mechanism at district/State-level and an appellate authority will be set up.
New Indian Express
16-06-2025
- Health
- New Indian Express
MEDISEP govt insurance scheme to continue in present form till new deal
THIRUVANANTHAPURAM: The MEDISEP insurance scheme for government employees and pensioners will continue in its current format for the time being. The government's agreement with Oriental Insurance, which ends on June 30, 2025, has been extended until a new arrangement is finalised. Recently, an expert committee submitted major recommendations to make the scheme more attractive. At present, Oriental Insurance is the service provider and the annual premium for a beneficiary is Rs 5,664 including 18% GST. The government makes advance payment of the premium amount to the insurance company in four installments a year. This amount will be recovered from the salary or pension of beneficiaries in 12 installments. The agreement with the insurance company is from July 2022 to June 30, 2025. It is learnt that the expert committee has recommended to hike the monthly premium amount from Rs 500 to Rs 750 and to enhance the coverage to Rs 5 lakh. Another recommendation is to collect premiums from only one person in a family having more than one government employee. Employees should be given the option to stay away from the scheme. The package should be revised to attract more private hospitals, especially speciality hospitals, to join the scheme, it said. At present, the scheme is mandatory for employees and pensioners. The government has directed Additional Chief Secretary (Finance) K R Jyothilal to take further steps on the report. The health secretary will also be asked to submit recommendations. New scheme to offer better packages, says minister Finance Minister K N Balagopal said the MEDISEP's second edition will be more attractive. 'We want more hospitals, especially major private institutions, to join the scheme. The treatment packages will be revised for this,' he told TNIE. On whether the premium would see an increase, he said: 'The present rates were fixed some three years ago. A decision on increasing the premium would be taken after consultations with stakeholders.' The minister said the insurance provider for the next edition will be selected through a fair and transparent bidding process. At a glance Claims approved (From Jan 1, 2025 to June 6) Total claims: 10.18 lakh Amount: Rs 1,863.22 crore Private hospitals Claims: 9.43 lakh Amount: Rs 1,745.36 crore Government hospitals Claims: 74,000 Amount: Rs 117.86 crore Total beneficiaries covered Employees and pensioners: 11.44 lakh Dependents: 19.49 lakh
The Hindu
23-05-2025
- Health
- The Hindu
MEDISEP revamp: expert panel recommends enhanced insurance coverage
The expert committee constituted by the government to revamp the Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) has recommended enhanced insurance coverage, a larger and more comprehensive package of procedures and improved coverage of catastrophic illnesses under the scheme. The committee has 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. However, while the HBP 2022 costing might attract more private hospitals to empanel under the scheme, it would also mean that the current premium would have to be increased by 50% to accommodate this costing. This means that the current monthly premium could go up from ₹500 to ₹750. Adoption of HBP 2022 would mean that many pre-hospitalisation investigative procedures like CT scans and high-cost injections etc. would also get covered under MEDISEP. New conditions under 'emergency procedures' The committee has also recommended expanding the definition of 'emergency procedures' (which earlier included only road traffic accidents, heart attack and stroke), to include 10 more conditions, including electric shock, poisoning, animal attacks, burns, snake bites or drowning. MEDISEP, which was launched in July 2022, offered a basic insurance cover of ₹3 lakh, at a monthly premium of ₹500. It covers over 30 lakh individuals, including some 5.45 lakh government employees, 5.89 lakh pensioners and their dependents. The scheme, which was envisaged as a comprehensive health insurance cover for a significant section of the population, ran into rough weather despite its high uptake, because of the non-participation of private sector speciality hospitals. The scheme came under much criticism because the package rates for various medical procedures were felt to be 'impractical, non-uniform and unrealistic', making MEDISEP unattractive for the private sector. 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 under Sriram Venkitaraman, Joint Secretary and Officer on Special Duty (Finance Resources) to study the scheme and recommend appropriate revisions. The expert committee has recommended that the HBP 2022 costing be adopted for MEDISEP, with an increase of 1.5 times of Tier One city rates for private hospitals. However, for government hospitals, the HBP 2022 packages will be accepted as such. The committee has also recommended that MEDISEP be extended to employees and pensioners in public sector undertakings, Corporations, autonomous, statutory bodies and the cooperative sector, where the health insurance cover might be poor or inadequate because of the high premiums and poor beneficiary packages offered by private health insurance companies. This is one way the government can keep the premium or costs down, while increasing the overall risk pool. Slashing policy period Another recommendation is that the policy period be made two years instead of the current three years so that any costing/package rates changes that may arise may be accommodated, which will also make the scheme more sustainable and attractive as far as the private health sector is concerned. The committee has recommended that the ceiling on hospital room rent for private hospitals be increased from the current ₹2,000 to ₹5,000. The rates for ICU/ ventilator admissions will be as per the HBP2022 rates. A proper grievance redressal mechanism, with the inclusion of representatives from private hospitals associations and IMA has also been recommended by the committee to deal with issues of claim rejection, delays in claims settlement or complaints regarding package rates. All hospitals with 10 beds or more will be encouraged to empanel under MEDISEP. The recommendations will be presented before the Cabinet soon for approval.
