The 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 information regarding this insurance scheme. Additionally, the article will cover the aim, benefits, eligibility, documents needed, and sign up process with regard to this MEDISEP Scheme Kerala.
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MEDISEP Scheme 2022: 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, 2022. 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.
- Total 15 days of coverage with financial aid before and after hospitalization.
- For registering and all details, visit www.medisep.kerala.gov.in.
- Last date to apply for MEDISEP is December 31, 2022.
Kerala MEDISEP Scheme 2022 Overview
|Name of the scheme||MEDISEP Scheme Kerala|
|launched by||Chief Minister Pinarayi Vijayan said|
|Beneficiaries||Pensioners and employees|
Kerala MEDISEP Scheme Objectives
The objective of the MEDISEP programme 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 .
MEDISEP Scheme 2022 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 in MEDISEP Scheme
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.
- 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, 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 cardiosurgery, 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.
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.
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 non teaching 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 non teaching 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 recruited staff pensioners and family pensioners.
- Additional family members, children, and spouses of the teaching and non teaching 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.
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 who 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 2022 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.
MEDISEP Scheme 2022 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 2022 Registration 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.
- 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 by clicking here.
- 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/PPONo
- Now click on the sign in option.
- After that, the MEDCARD will be displayed.
- Click on the download option to get it 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.