Kerala MEDISEP Scheme is a health insurance scheme for government employees and pensioners. Previously, the 10th Pay Revision Commission had suggested establishing a health insurance program for workers and retirees in Kerala. Based on that, the Finance Minister announced the scheme in the 2017- 2018 budget speech, but he then did not mention it by the insurance scheme name. This is a state program that is solely available to residents of Kerala, and it will assist around 30 lakh people there, making it one of the finest insurance programs the state has ever seen. This article will provide all information regarding Kerala MEDISEP Scheme.
MEDISEP Scheme 2024: Kerala’s Health Insurance Scheme
The MEDISEP Scheme’s full form is Medical Insurance for State Employees and Pensioners and is implemented by the Department of Finance, Government of Kerala. Although this scheme was hinted at in the announcement of the 2017 and 2018 budgets, the chief minister of Kerala state launched this insurance scheme on July 1st, 2024. The key points for this scheme are as follows:
- MEDICSEP Health Insurance Scheme is a state scheme only for the State of Kerala and only for government employees and retired pensioners.
- During its three-year lifespan, this program will assist 30 million people in the state.
- This scheme covers Rs 3 Lakh annually.
- 1920 Diseases covered under this scheme.
- At least 24 hours of hospitalization is needed to get this scheme for eligible people.
- The concerned authorities make a list of hospitals registered under the scheme.
- Total 15 days of coverage with financial aid before and after hospitalization.
- For registration and all details, visit www.medisep.kerala.gov.in.
- The last date to apply for MEDISEP is December 31, 2024.
MEDISEP Scheme: New Hospitals Added to the List
Recently, the Kerala Program, namely the MEDISEP Insurance health scheme, introduced more hospitals to its list of hospitals. There are a total of 31 new hospitals. The Kerala Department of Finance and Oriental Insurance will publish the whole list. On July 1, 246 hospitals joined the scheme, and already 31 private hospitals have been included. Kishealth, Trivandrum and Thiruvananthapuram, KIMSHEALTH, have joined the insurance. KIMSHEALTH will conduct transplant surgeries with MEDISEP initially. In order for hospitals on the list to function properly, the government will withdraw funding if they do not comply with the MEDISEP scheme.
Progress Since the MEDISEP Scheme was Launched
On the website portal, details about each facility’s treatments and charges are shown along with other related details. Up to this point, 23,207 people have used the state insurance facility. They obtained 66 crores in insurance coverage. Private hospitals were compensated with Rs 59 crore for 21,380 claims. The government hospitals received Rs 3 crore (1,684 claims). 143 patients have been granted Rs 3.53 crore for organ transplant surgery.
Kerala MEDISEP Scheme 2024Details in Highlights
| Name of the scheme | MEDISEP Scheme Kerala |
| launched by | Chief Minister Pinarayi Vijayan said |
| Year | 2024 |
| State | Kerala |
| Beneficiaries | Pensioners and employees |
| Official Website | medisep.kerala.gov.in |
Medisep will Empanel More Hospitals
Despite concerted efforts to weaken Medisep, the cashless health insurance program for state government employees and retirees, efforts are ongoing to enlist more hospitals. A few hospitals were avoiding the insurance program on purpose, and the government planned to reveal them soon. Only 396 institutions, including 143 government hospitals, have been empaneled as of yet. since Medisep’s introduction on July 1, 2024, 902 people had profited from it. To settle claims, a total of Rs 1.89 crore has been paid out. The Minister further stated that 1,500 recipients’ claims were being handled. Click to check how to Find a Lost Mobile Phone
Strict action to be taken against Hospitals Scuttling Scheme
Hospitals that are attempting to undermine the government’s Medical Insurance for State Employees and Pensioners (Medisep) system will face strict action, a high-level conference here has agreed. After hearing that several impaneled hospitals were breaking the contract they had with the government, the meeting, called by Finance Minister K N Balagopal, agreed to take strong action. The meeting was also made aware of complaints about some hospitals refusing to provide care in accordance with the agreement, charging higher rates, and changing their minds after signing the agreement. The minister requested that the insurance provider speak with these hospitals and promised that the government would step in if the problem persisted.
The Finance Department has also requested information about potential sanctions against negligent hospitals. The gathering was informed by the minister of health, Veena George, that the required procedures had been made for the successful implementation of Medisep in government hospitals. The conference was also attended by the secretaries of the departments of finance and health. It was intended for the Medisep program, which went into force on July 1 of this year, to cover almost 1,920 medical treatments.
Uncooperative Government Hospitals
However, certain government-run hospitals have come under fire for allegedly not working with Medisep, according to complaints. The government insurance program has not been offering its benefits at the Medical College Hospital in Thiruvananthapuram.
Many employees and retirees who were reliant on the medical college continued to pay astronomical sums for treatment from super-specialty facilities. Authorities allegedly sent patients home on the grounds that Medisep benefits were no longer available.
Since many private hospitals in Thiruvananthapuram have chosen not to collaborate with the government in administering the scheme, Medisep members there must rely more on the medical college. The insurance company has given the personnel of government-run hospitals the software and training they need to implement Medisep. Additionally, a number of district hospitals have not yet enrolled in the federal program. Treatment is provided by medical colleges in Kottayam and Kozhikode under the Medisep program.
Initial Problems
Minister Balagopal in Thiruvananthapuram described the problems at the Medisep-approved hospitals as first glitches. He was responding to Ramesh Chennithala’s State Assembly move to draw attention to something. The minister went on to say that a three-tier grievance redressal procedure has been established to look into the problems that employees and pensioners encounter when utilizing the Medisep program. He stated that compared to the ongoing reimbursement program, the insurance effort covers more employees, both current and past.
In addition, the advance payment for medical expenses would continue. Whereas other health insurance plans would require premium payments of between Rs 10,000 and Rs 12,000 annually, which would exceed Rs 25,000 for people over the age of 50, Medisep would only require Rs 6,000.
Kerala MEDISEP Scheme Objectives
The objective of the MEDISEP program is to offer complete medical insurance protection to all pensioners and active employees of the State Government of Kerala, as well as the High Court of Kerala, who are already protected by the existing Kerala Government Servants Medical Attendant Rules [1960].
Approved the ‘Medisep’ medical insurance scheme as a New Year gift to state government employees, pensioners & their dependents. The project will start in principle from January 1, 2024, & cover the expenses for treatments that include the ones for existing illnesses.— Pinarayi Vijayan (@pinarayivijayan) December 23, 2024
MEDISEP Scheme 2024 Benefits
- Under the medisep scheme, the following benefits are given to the eligible persons of the Kerala state:
- Under the basic package (BBP) This three-year program will benefit 30 million people. It will give 300,000 rupees per year.
- The total number of 1920 treatments and surgical procedures are covered in the MEDISEP scheme. Although the BBP package will consist of 1823 procedures.
- Under the BBP, general surgery therapy packages, the category of “general surgery” has the greatest number of treatment options (197). The segment of cardiology has 168 packages. Surgical oncology contains 156 packages, orthopedics has 144, and dental surgery has 147. Plastic surgery has 111.
- The program pays for hospital-related costs such as lodging, meals, prescription drug costs, doctor and staff fees, and medical expenses.
- A separate package for transplant and catastrophic procedures is included in MEDISEP.
Other Benefits
The MEDISEP scheme provides a cashless facility for the listed procedures. “Cashless facility” means that the insurance provider will pay the hospital where the treatments were performed directly for the services rendered as per the list.
In the event of an accident or any other kind of unexpected medical emergency that is included in the approved list of treatments and procedures, however, coverage will be provided even if it is carried out in a facility that is not on the panel.
The scheme will cover financial expenses for the list given for the period of 15 days before and after hospitalization.
Under this scheme, if the mother of a newborn child is insured under the MEDISEP scheme, then those newborns who are affected by any structural or functional disabilities are covered under this program till the scheme period is over.
The basic plan of the scheme will cover “unspecified procedures” for up to Rs 1.5 lakh.
BBF plan
- The basic benefit package that would be included in the system would include catastrophic secondary and tertiary benefits. care treatments, emergency and trauma care operations, as well as routine care treatments.
- In addition to that, the proposal provides extra coverage for certain treatments for catastrophic diseases, such as organ transplant surgery. Additionally, it will provide coverage for any pre-existing conditions that the recipients may have. Outpatient treatment, on the other hand, will be excluded from coverage under the MEDISEP plan.
- The basic benefit package consists of 1823 procedures.
BBP’s Confirmed Amount
First and foremost, BBP provides beneficiaries with annual coverage of Rs. 3 lakhs. Additionally, another mechanism, MEDICSEP, allows for an increase in coverage of Rs. 6 lakh, which is explained below in the next paragraph.
Basically, BBP has two components. One is fixed, which contains 1.5 lakh, and the other is movable, which is called a floater system. It also contains 1.5 lakh.
The floater system will thus be carried over to the next year if it is not used in the beneficiary’s current year, adding up to a total of 4.5 lakh for the beneficiary in that year. Thus, in three years, if it is not used, it will pile up, and in the last few years, it will be up to 6 lakh rupees.
So the BBP contains a total of three benefits only, which are the room charge, implant cost, and treatment cost.
Then there is the procedure cost, which includes the cost of the key procedures and drugs as well as the cost of the medical advice and treatment before being admitted to the hospital, the cost of the physician’s services, nursing expenses, and post-discharge prescriptions, and after hospitalization reviews.
Nppa will decide how much the implants will cost
The room costs are also covered up in the basic benefit package and are fixed rates, such as the general rooms cost up to Rs. 1000 semi-private rooms cost up to Rs. 1500. Any fee which is above these rates will not be covered by the insurance.
Costly Procedures under the BBP
This scheme covers most of its packages or procedures for the cardio segment and the most expensive treatments are also for cardio surgery, such as from 1 lakh to 2 lakh rupees.
Another expensive surgery covered by the BBP is aortic stenting, which covers expenses up to 5.78 lacs and if they exceed the rest, the patient has to pay himself.
Intracranial balloon angioplasty with stenting, a popular operation, has a ceiling of Rs 2.03 lakh.
Kerala Social Security Mission
Catastrophic Package Costing
- The total price of the catastrophic package takes into account: surgery charges, implant prices, lodging charges, and investigation fees.
- There will be a single fee for each individual package.
- The maximum amount that may be charged, for instance, for liver transplants is Rs. 18 lakh. The price of a kidney transplant in India is three lakh rupees. The cost of a heart-lung transplant is 20 lakh rupees. The price of a cochlear implant is 6.39 lakh Indian rupees. The total cost of hip replacement is four hundred thousand rupees. In addition to this, the cost of implanting an auditory brainstem is 18.24 lakh rupees.
- However, the package will also include coverage for any relevant medical or surgical repercussions, and participating hospitals have been directed not to charge the recipient for the extra expenditures that may be incurred as a result of these consequences.
- A reserve fund with a minimum value of Rs 35 crore has been established by the insurance industry specifically for the treatment of severe diseases.
Contribution to the Plans
- Therefore, the beneficiary is required to make a contribution of Rs. 500 each month from the salary of government employees and the gross entitlement of pensioners, which is Rs. 6000 annually.
- A policy valued at 4,800 rupees (including GST) will be provided to beneficiaries on an annual basis by the additional government.
- If the insurance company discovers that the Rs 35 crore that it has put aside for catastrophic sickness is inadequate, it will utilize the extra money that it has received from the policyholder in order to cover the shortfall.
MEDISEP Scheme: Who will be Benefitted?
- According to the terms of the MEDISEP Scheme, those who will benefit include all of the state government workers who are currently employed and who are working according to the act of 1960, as well as all of the retired people who are receiving pensions.
- And also in service employees which belong to the teaching and nonteaching sector of aided schools and colleges.
- The employees of the universities that have received the grant in aid from the state government and local self-government institutions are on the list of beneficiaries.
- Staff members of the High Court of Kerala are also included.
- Among the pensioners, the teaching and the nonteaching staff of the aided schools and colleges and universities that are all retired and have received grants from the State Government and LSGls are considered beneficiaries of this scheme.
- This plan will also assist directly in recruiting staff pensioners and family pensioners.
- Additional family members, children, and spouses of the teaching and nonteaching personnel of aided schools and colleges will also be on the list of beneficiaries, plus It’s mandatory for all of the above categories that are defined to participate in the scheme.
- If both parents are on the beneficiary list of the scheme, then their children will also be included on the beneficiary list.
MEDISEP Scheme: Who will not be Benefitted?
In the state of Kerala, there is still a list of categories of people who will not be eligible for this scheme. Employees and retirees of independent organizations, cooperative institutions, and boards, such as the Kerala State Electricity Board (KSEB), the Kerala State Road Transport Corporation (KSRTC), and the Kerala Water Authority (KWA), would not be eligible. Employees and retirees of the State Information Commission and the Human Rights Commission were not allowed to participate in the insurance scheme either.
What if an Employee Decides not to Participate?
If an employee is receiving the benefits of the scheme but still does not want to continue, then he or she can ignore the remaining benefits if no claims were made while in office. But if claims were made by the office under the schemes, then he or she will have to pay the premium monthly contribution according to the package beneficiary opted for.
What Happens if an Employee is Suspended?
If an employee is currently on suspension, the premium for the time period will be taken away from their monthly allowance.
MEDISEP Scheme 2024 Eligibility Criteria
In order to be a beneficiary of the MEDICEP scheme, the following important point must be noted down:
- Beneficiaries must be admitted to the hospital for a full day or for a full 24 hours.
Documents Needed
- The important documents needed for the scheme are first The identity card of the person
- Aadhar card
- Mobile number
- Email ID
Kerala MEDISEP Scheme 2024Registration Process
- Open the official website of the MEDICEP scheme and the home page will be displayed in front of you
- Proceed from here by going to the register option on the webpage.
- There will be a transition to a new page.
- Fill out the application form with the relevant information.
- Please submit any pertinent papers that need to be uploaded.
- Make sure that all of the information is correct, and then choose the submit option.
- You will have an easier time signing up for the program if you do it this way.
MEDISEP Scheme Login Process
- In order to register or sign in for the scheme, you can either contact the officials or directly visit the online website link, which is medisep.kerala.gov.in.
- On the homepage of MEDISEP there is a login option, move the cursor towards it and select the department to which you belong.
- After choosing the department, it will take you to another page that will ask you to give your name and password and capture them.
- You have to type them in and click on the “login” button.
- Hence your log-in procedure is completed.
Steps to Download MEDCard Online
- To begin, please visit the MEDISEP Scheme’s online abode.
- The screen will then load the website’s homepage for you automatically.
- Proceed from here by selecting the “Download Medcard” option on the webpage.
- The screen will then display a fresh login page in its entirety.
- Enter the login details like beneficiary type and MEDICSEP ID, and Employee ID/PEN/PPO No
- Now click on the sign-in option.
- After that, the MED CARD will be displayed.
- Click on the download option to get it downloaded to your device.
MEDISEP Scheme: Know Your Status
- To begin, please visit the MEDISEP Scheme’s online abode
- The screen will then load the website’s homepage for you automatically.
- Proceed from here by selecting the “Status” option on the webpage.
- The screen will then display a fresh page in its entirety.
- Select the category and enter Emp ID/PEN/PPONO, Date Of Birth.
- Now click on the search option.
- The status will be displayed.
- Click on the print option to get it downloaded.
View Medisep Hospital List
- To begin, please visit the MEDISEP Scheme’s online abode.
- The screen will then load the website’s homepage for you automatically.
- Proceed from here by selecting the “Hospital” option on the webpage.
- The screen will then display a new page in its entirety.
- Select the state and district.
- Now click on the search option.
- The district-wise list of hospitals will be displayed on the screen.
View Nodal Officers
- To begin, please visit the MEDISEP Scheme’s online abode.
- The screen will then load the website’s homepage for you automatically.
- Proceed from here by selecting the “Nodal Officers” option on the webpage.
- The screen will then display a fresh page in its entirety.
- The page will have details of department-wise nodal officers.
- Click on the download now option to get any department’s Nodal Officer list downloaded to your device.
MEDISEP Grievance System
- First, visit MEDISEP’s official website.
- The screen will then load the website’s homepage for you automatically.
- Proceed from here by selecting the “Grievance” option on the webpage.
- Click Grievance Filing and Login/Submit.
- A login form appears.
- Enter the medisep id.
- Click Sign In.
- You may complain here now.