The MEDISEP program's objective is to offer complete medical insurance coverage to all active and retired state government employees in Kerala. Read this blog to know more about the scheme
The Department of Finance, Government of Kerala, implements the MEDISEP Kerala Scheme, which stands for Medical Insurance for State Employees and Pensioners. Although this plan was included in the budget announcements for 2017 and 2018, the Kerala ‘s chief minister introduced it on July 1st, 2022.
The following are the scheme’s essential points:
- MEDISEP Kerala Health Insurance Scheme is available only to government employees and retired pensioners in Kerala.
- This insurance covers ₹3 lakhs per year.
- This plan covers 1920 diseases and their treatment.
- This programme is only available to persons who have been hospitalised for at least 24 hours.
- The relevant authorities compile a list of hospitals that have registered under the system.
- Before and after hospitalisation, there is a total of 15 days of coverage with financial assistance.
- Visit www.medisep.kerala.gov.in for further information and to register.
- The application deadline for MEDISEP is 31 December 2022.
- An Overview of MEDISEP Scheme 2022
- The MEDISEP Scheme Kerala was launched by the Chief Minister Pinarayi Vijayan in 2022 whose beneficiaries are the government employees and pensioners. The official website for this scheme is medisep.kerala.gov.in.
Objectives of the MEDISEP Kerala Scheme
The MEDISEP Kerala programme’s goal is to provide comprehensive medical insurance coverage to all retirees and active workers of the State Government of Kerala plus the High Court of Kerala, who are currently covered under the Kerala Government Servants Medical Attendant Rules of 1960.
Advantages of the MEDISEP Kerala Scheme
- The aforementioned benefits are provided to qualified Kerala residents under the MEDISEP kerala scheme:
- This three-year initiative will assist 30 million individuals under the basic package (BBP). It will pay ₹300,000 per year.
- The MEDISEP programme covers a total of 1920 treatments and surgical procedures. Despite the fact that the BBP bundle will include 1823 processes.
- The category of “general surgery” has the most treatment possibilities under the BBP, general surgical therapy packages (197). Cardiology is comprised of 168 packages. There are 156 packages in surgical oncology, 144 in orthopaedics, and 147 in dental surgery. There are 111 in plastic surgery.
- Lodging, food, prescription medicine prices, doctor and staff costs, and medical expenditures are all covered by the programme.
New Hospitals which are added to the list of ‘MEDISEP’ kerala Scheme
Recently, this MEDISEP Kerala Programme, notably the MEDISEP Insurance health policy, expanded its hospital roster. There are 31 new hospitals in all. The whole list will be published by the Kerala Department of Finance and Oriental Insurance. On 1 July 2022, 246 hospitals joined the initiative, with 31 of them being private hospitals. KIMSHEALTH of Trivandrum and Thiruvananthapuram has joined the insurance. Initially, KIMSHEALTH will perform transplant procedures in collaboration with MEDISEP. If hospitals on this list do not follow with the MEDISEP plan, the government will remove financing, preventing them from functioning efficiently.
What is the progress rate of this Scheme in the State?
Details regarding each facility’s treatments and fees, as well as other relevant information, are shown on the online portal. So far, 23,207 persons have accessed the state insurance facilities. They acquired insurance coverage for 66 crores. For 21,380 claims, private hospitals were reimbursed with ₹59 crore. ₹3 crore was given to government hospitals (1,684 claims). 143 patients have received ₹3.53 crore in funding for organ transplant operation.
More hospitals to be included in this Scheme
Despite strong efforts to undermine Medisep, this cashless health insurance programme for state government employees and pensioners, efforts to recruit new institutions are underway. A few hospitals were purposefully ignoring the insurance scheme, and the government expected to expose them shortly. So yet, just 396 institutions, which includes 143 government hospitals, have been accredited. Since Medisep’s debut on July 1, 2022, 902 individuals have benefited from it. A net of ₹1.89 crore has been shelled out to resolve claims. The Minister also announced that claims for 1,500 beneficiaries were being processed.
Strict steps will be taken against hospitals who refuse to participate in the Medisep Scheme
1. Hospitals that would try to disrupt the government’s Medical Insurance for State Employees and Pensioners (Medisep) system will suffer harsh penalties, according to a high-level seminar held here. After learning that some impanelled hospitals were violating their contracts with the government, the conference convened by Finance Minister K N Balagopal determined to take firm action. Complaints about certain hospitals refusing to deliver care in line with the accord, billing increased rates, and altering their views after the agreement was signed were also brought up during the conference. The minister asked the insurance company to contact these hospitals and stated that Kerala government would intervene if the situation persisted.
2. The Finance Department has also enquired into potential penalties for irresponsible hospitals. Veena George, the minister of health, informed the gathering that the necessary processes had been put in place for the smooth adoption of Medisep at government hospitals. The secretaries of the departments of finance and health also attended the session. It was designed to cover over 1,920 medical services under the Medisep programme, which entered into effect on 1st July,2022.
Government Hospitals that are Uncooperative
1. According to concerns, several government-run hospitals have been criticised for reportedly refusing to engage with Medisep. The advantages of the government insurance scheme have not been available at the Medical College Hospital in Thiruvananthapuram.
2. Many medical college personnel and retirees continued to pay exorbitant fees for treatment at super-speciality clinics. Patients were reportedly sent home since Medisep advantages were no longer accessible.
3. Because many private hospitals in Thiruvananthapuram have refused to work with the government to manage the plan, Medisep members in the city must rely increasingly on the medical college. The insurance business has provided the software and expertise required for the implementation of Medisep to workers at government-run hospitals. A number of district hospitals have also yet to enrol in the federal programme. Under the Medisep initiative, medical colleges in Kottayam and Kozhikode give treatment.
Initial Issues faced by the MEDISEP Kerala Scheme
1. In Thiruvananthapuram, Minister Balagopal termed the difficulties at Medisep-approved hospitals as “initial hiccoughs.” He was reacting to Ramesh Chennithala’s motion in the State Assembly to call attention to something. The minister went on to state that a three-tier dispute settlement mechanism has been developed to investigate the issues that employees and retirees have when using the Medisep programme. He noted that the insurance endeavour includes many employees, both current and former than the continuing reimbursement scheme.
2. Furthermore, the deferred payment for hospital costs will be maintained. Other plans for health insurance would demand yearly premium payments of ₹10,000 to ₹12,000, which would surpass ₹25,000 for persons over the age of 50, but Medisep would only need ₹6,000.
Conclusion
In all, the benefits provided by this Scheme is a big talk but it would have been much better if it was available for all the people of Kerala state. Get in touch with Vakilsearch for any further details. We have the best legal staff to get all your problems and queries solved.
