Medisep Phase II to Begin from February 1 with Enhanced Coverage and Benefits

Thiruvananthapuram: The Kerala government has announced the launch of the second phase of the Medisep medical insurance scheme for government employees, pensioners, and their dependants, with effect from February 1. Under Phase II, the basic insurance coverage has been increased from Rs 3 lakh to Rs 5 lakh, offering wider financial protection against rising healthcare costs.

The decision to roll out the revamped phase was taken after collecting feedback from employees, pensioners, and service organisations, followed by a detailed review study. An expert committee led by former Additional Finance Secretary Dr Sriram Venkitaraman was constituted to assess shortcomings in the first phase and recommend improvements, many of which have been incorporated into Phase II.

The monthly premium has been fixed at Rs 687, amounting to an annual contribution of Rs 8,244. Although the insurance company had proposed a higher premium of Rs 810, the state government waived GST and capped the amount at Rs 687, citing its commitment to supporting employees. The scheme will be implemented by Oriental Insurance Company and will remain in force for two years.

There is no age limit for enrolment. Beneficiaries include serving government employees, service and family pensioners, employees and pensioners of universities and local self-government institutions, and their dependants. The scheme covers nearly 3.3 million beneficiaries across the state.

Treatment packages under Phase II will be aligned with the nationally recognised Health Benefit Package 2022, allowing beneficiaries access to a wider network of hospitals across the country. Cashless inpatient treatment will be available at empanelled hospitals for all recognised treatment categories.

The total number of treatment packages has been increased from 1,920 to 2,516, with package rates seeing a five percent hike. The daily room rent limit has been raised to Rs 5,000, while pay wards in government hospitals will be eligible for room charges up to Rs 2,000 per day. Separate allocations will be provided for high-cost medicines and diagnostic tests, which will be reimbursed in addition to the base package amount.

A major enhancement under Phase II is the extension of knee and hip replacement surgeries to private hospitals. In the first phase, these procedures were restricted to government hospitals. Coverage for ten critical and organ transplant surgeries will continue, with the insurance company earmarking Rs 40 crore over two years for this purpose.

Patients requiring continuous treatments such as dialysis and chemotherapy will benefit from a one-time registration system on the insurance portal, ensuring uninterrupted free treatment. Ten additional treatment categories have also been brought under the reimbursement facility.

Although premier institutions such as the Sree Chitra Tirunal Institute for Medical Sciences and Research and JIPMER have not been empanelled, treatment expenses incurred at these hospitals will be eligible for reimbursement. In emergency situations such as road accidents, heart attacks, and strokes, beneficiaries may seek treatment at non-empanelled hospitals, with expenses reimbursed by the insurer.

The scheme will feature a 24-hour call centre and a three-tier grievance redressal mechanism, with representatives from the Private Hospital Association and the Indian Medical Association included in the system. Details of treatment packages and empanelled hospitals will be published on the official Medisep website.

The first phase of Medisep officially concluded on June 30 but was extended until January to ensure continuity of coverage until the launch of Phase II.