Latest news with #Medisep
The Hindu
3 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.
New Indian Express
3 days ago
- Health
- New Indian Express
Insurance company told to reimburse liver transplant cost of Medisep beneficiary at non-empanelled hospital
THIRUVANANTHAPURAM: In a landmark ruling, the Permanent Lok Adalat for Public Utility Services has directed the Oriental Insurance Company to reimburse the cost borne by a Medisep beneficiary for liver transplant at a non-empanelled hospital. The complainant, a pensioner, was diagnosed with a chronic liver disease with hepatocellular carcinoma. He underwent a deceased donor liver transplant on July 8, 2022, at a private hospital in Thiruvananthapuram. Though the Medisep scheme came into existence with effect from July 1, 2022, the insurance company had not published the list of empanelled hospitals then, the pensioner said in his complaint. The total hospital expenses was Rs 20,54,901. He also had a health insurance policy issued by New India Assurance. As the claim under Medisep was not allowed, he submitted a claim with New India Assurance and the latter remitted Rs 3,69,367 at the hospital. He paid the balance amount. However, due to chronic ailments, he was hospitalised two times again for which Rs 1,21,656 was spent. These claims too were rejected by Medisep. The Additional Chief Secretary (Finance) submitted that the petitioner was not entitled to claim benefit for treatment at a non-empanelled hospital. Liver transplant was a planned procedure and not an emergency procedure (for which non-empanelled hospitals will be considered). The insurance company rejected the allegation that the list of empanelled hospitals was not published at the time. The case was considered by the Lokpal bench comprising members V N Radhakrishnan and E Mohammed Shereef. The petitioner was represented by advocates S Reghukumar, P Babu and Threya J Pillai. The Lokpal observed that the surgery was done in an emergency situation as there was no alternate option for the petitioner's survival. The insurance firm failed to empanel two private hospitals for transplant surgeries under Cluster-3 of the Medisep Scheme. At the time, the organ of a deceased donor was available only at the hospital where he sought treatment. Hence, the petitioner is entitled for the reimbursement of treatment expenses up to the package cost in Annexure-2 of the scheme. It directed the firm to pay Rs 18 lakh to the petitioner with 6% interest from April 18, 2023, and Rs 10,000 as costs.
Time of India
07-08-2025
- Health
- Time of India
Medisep Phase-II gets cabinet nod, basic cover to be 5 lakh
Thiruvananthapuram: Cabinet granted approval for second phase of medical insurance scheme (Medisep) for state govt employees and pensioners. In the second phase, basic insurance coverage will increase from Rs 3 lakh to Rs 5 lakh. Over 2,100 treatment procedures for 41 specialty treatments will be included in the basic treatment package. In Medisep first phase, two treatments that were included in the catastrophic package (Cardiac Resynchronisation Therapy with defibrillator – Rs 6 lakh, ICD dual chamber – Rs 5 lakh) were excluded. These will now be added to the additional package. Knee and hip replacement surgeries will be included in the basic benefit package. The insurance scheme will also have 10 critical/organ transplant treatment packages. The insurance company must set aside a corpus fund of Rs 40 crore for two years. Room rent will be allowed up to 1% (Rs 5,000/day) of basic insurance coverage. In govt hospitals, pay ward rent will be provided up to Rs 2,000 per day. Employees and pensioners of various public sector institutions, boards, corporations, autonomous institutions and cooperative sector in state, not receiving ESI benefits, have received in-principle approval to be included in Medisep second phase. The policy period has been reduced from the current three years to two years. There will be an increase in premiums and package rates in the second year. Only public sector insurance companies that achieved technical qualification in Medisep first phase will be eligible to participate in the tendering process for second phase. The existing provision for reimbursement of emergency treatments in non-empanelled hospitals will include 10 additional treatments along with the current three treatments (heart attack, stroke and road accident). One-time registration on insurance portal will be allowed for day-care procedures like dialysis and chemotherapy that require continuous treatment. Approval will be given by combining surgical and medical packages simultaneously. Pre- and post-hospitalisation expenses will be available for three and five days, respectively. A three-tier grievance redressal system will be implemented at the district, state and appellate authority levels. A QR code system will be included on Medisep card to quickly access beneficiary information. The insurance company must prepare a standard operating procedure to take strict action against hospitals deviating from the contract. The services of clinical establishment authority will also be utilised to control exploitation such as overcharging by private hospitals. Box Claims overview In first phase until 1 July this year: - 10,52,121 claims - Rs 1,911.22 crore - 2,256 organ transplant treatment claims – Rs 67.56 crore - 1,647 reimbursement claims – Rs 9.61 crore - Amount sanctioned to company (including 18% GST) – Rs 1,950.00 crore - Actual premium (excluding GST) – Rs 1,599.09 crore
News18
06-08-2025
- Health
- News18
Digital University VC appointment: Kerala cabinet approves draft ordinance
Thiruvananthapuram, Aug 6 (PTI) The Kerala government on Wednesday approved a draft ordinance to amend the provisions of the Kerala Digital Sciences, Innovation and Technology Act, 2021, in connection with the appointment of the Vice Chancellor of the Digital University Kerala. A cabinet meeting chaired by Chief Minister Pinarayi Vijayan gave the nod to the draft ordinance amidst an ongoing tussle between the LDF government and Governor Rajendra Vishwanath Arlekar over the appointment of vice chancellors in various universities in the state. Ministers P Rajeev and R Bindhu visited Arlekar on Sunday and held discussions with him to resolve the deadlock over the appointment of VCs, days after the Supreme Court directed both parties to settle the dispute amicably. According to the Chief Minister's Office (CMO), the draft ordinance was approved by the cabinet to amend the Act in accordance with the UGC rules and recent court orders. It was also decided to recommend the Governor for promulgation of the ordinance, the CMO said in a statement. Among other decisions, the cabinet meeting also approved the second phase of the medical insurance scheme (Medisep) for state government employees and pensioners. The basic insurance cover will be increased from Rs 3 lakh to Rs 5 lakh, it said. Over 2,100 procedures for 41 specialty treatments will be included in the basic treatment package, the statement added. PTI LGK KH view comments First Published: August 06, 2025, 18:00 IST Disclaimer: Comments reflect users' views, not News18's. Please keep discussions respectful and constructive. Abusive, defamatory, or illegal comments will be removed. News18 may disable any comment at its discretion. By posting, you agree to our Terms of Use and Privacy Policy.
New Indian Express
06-08-2025
- Health
- New Indian Express
Kerala's Medisep insurance basic coverage to be Rs 5 lakh in phase-II
THIRUVANANTHAPURAM: The Cabinet meeting on Wednesday approved the second phase of the Medisep insurance scheme for government employees and pensioners. Basic insurance coverage will be enhanced from the present Rs 3 lakh to Rs 5 lakh. Employees of public sector enterprises will also be brought under the scheme's coverage, said an official statement. The basic treatment package will include 2100 procedures for 41 speciality treatments. Cardiac Resynchronisation Therapy (CRT with Defibrillator- Rs 6 lakh, ICD Dual Chamber - Rs 5 lakh) will be included in the additional package. Knee replacement and hip surgery will be included in the basic benefit package. The new scheme will cover ten types of serious illnesses/ organ transplant treatment packages. To meet this, the insurance company will be asked to set apart a corpus fund of Rs 40 crore for two years. Upto 1 pc of the basic insurance coverage, Rs 5000, will be granted as room rent. Upto Rs 2000 will be granted for pay ward room rent in government hospitals. The Cabinet gave in-principle approval to include non-ESI staffers and pensioners in public sector enterprises, boards, corporations, autonomous institutions and cooperatives. The policy period will be enhanced from the present two years to three years. Premium and package rates will be increased in the second year.
