Latest news with #MedicalInsuranceSchemeforStateEmployeesandPensioners
The Hindu
2 days ago
- Health
- The Hindu
Monthly premium for Phase 2 of Medisep enhanced to ₹750
The State has issued a government order (GO) approving Phase 2 of Medical Insurance Scheme for State Employees and Pensioners (Medisep), specifying that the monthly premium for the Phase 2, including taxes, will be enhanced to ₹750, subject to the finalising of the bid. The monthly premium during Phase 1 had been ₹500. The scheme covers over 30 lakh individuals, including some 5.45 lakh government employees, 5.89 lakh pensioners and their dependents. The State Cabinet had earlier approved Medisep 2, with enhanced insurance cover and a larger package of procedures and larger coverage of catastrophic illnesses. The Cabinet which met here recently had approved Phase 2 of Medisep, which has been revamped as per the recommendations of the expert committee that the government had entrusted it to, offers an enhanced basic coverage of ₹5 lakh. The policy period will be for two years and a 5% increase in premium and package rates will be allowed for the second year The GO has approved in principle, the expert committee's recommendation that Medisep be extended to employees and pensioners in public sector undertakings, Corporations, autonomous, statutory bodies and the cooperative sector who do not have the Employees' State Insurance (ESI) benefit. The respective institutions should directly approach the selected insurance company with necessary data and ensure premium payment for enrolling the beneficiaries. The beneficiaries (employees and pensioners) will be provided insurance coverage at the same terms and conditions of Medisep 2 More than 2,100 procedures are included in the basic benefit package for availing around 41 specialised treatment. Medisep 2 has been revamped on the basis of Health Benefits Package (HBP) 2022, the latest and scientific health costing package formulated by the National Health Authority. The expert committee had also suggested essential empanelment of specialised national-level institutions like the Sree Chitra Tirunal Institute for Medical Sciences and Technology. If empanelment is not feasible, all the treatments availed from these institutions will be reimbursed by the insurer to the beneficiaries based on the package rates of the revised scheme.
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.
The Hindu
18-06-2025
- Business
- The Hindu
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.
