Medisep, first announced in the State Budget of 2017-18 and slated to become one of the largest social insurance schemes ever, is finally getting off the ground.
The scheme, which envisages comprehensive health insurance coverage to approximately five lakh serving employees of the State government who are covered under the existing Kerala Government Servants Medical Attendant Rules and another five lakh pensioners, will be launched by Chief Minister Pinarayi Vijayan on July 1.
In effect, the scheme will benefit 30 lakh individual beneficiaries, including newly recruited employees and their family; part time contingent employees; part time teachers; teaching and non-teaching staff of aided schools and colleges and their family; pensioners and their spouses; family pensioners on compulsory basis; and all Civil Services officers.
It envisages cashless treatment facility to beneficiaries through an insurance company and a network of empaneled hospitals for a basic benefit package of ₹3 lakh per annum for the policy period of three years. The package covers medical, surgical and day care procedures.
In addition to the basic package, catastrophic illnesses will be covered for super-specialty and transplant surgeries (up to ₹18 lakh for liver transplant). The basic benefit package consists of 1,920 surgical and medical procedures. The scheme will also cover all pre-existing diseases of the beneficiaries from the inception of the scheme. However, outpatient treatment will not be covered under the scheme.
The basic benefit package has been envisaged in such a way that ₹1.5 lakh would be on “floater” basis. If unused, this amount can be carried forward to the next year’s insurance cover.
Oriental insurance company has won the tender for running the scheme.
Medisep, which was to be launched in 2020-21, was delayed because of the disinterest shown by private hospitals, with major corporate hospitals refusing to be empaneled. The scheme was then re-tendered with revised package rates and the government has decided that it will go ahead with the rollout of the scheme, even if some private hospitals chose to stay away.
However, with a huge base volume of 30 lakh beneficiaries, it is reckoned that not many private hospitals can afford to ignore the scheme for long.
