MEDISEP Scheme: For government workers and retirees, there is a health insurance programme called the Kerala MEDISEP Scheme. Previously, the Kerala government was advised to develop a health insurance policy for employees and pensioners by the 10th Pay Revision Commission. Based on it, the Finance Minister declared the programme in the 2017–2018 budget speech, though he did not refer to it by its official name, the insurance programme.
One of the best insurance schemes the state has ever seen, this state programme is only available to citizens of Kerala and will help almost 30 lakh people there. In this post, information on this Kerala MEDISEP Scheme will be provided. The post will also discuss the MEDISEP Scheme’s purpose, benefits, eligibility, required paperwork, and registration process.
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MEDISEP Scheme 2023: Kerala’s Health Insurance Scheme
Medical Insurance for State Employees and Pensioners is the full name of the MEDISEP Scheme, which is run by the Keralan government’s Department of Finance. The chief minister of Kerala state introduced this insurance programme on July 1st, 2022, despite the fact that it had been alluded to in the announcement of the 2017 and 2018 budgets. The following are the main components of this plan:
- MEDICSEP Health Insurance Scheme is a state programme that is only available to state employees and retired pensioners in the State of Kerala.
- A total of 30 million residents of the state will benefit from this programme over its three-year run.
- This programme covers Rs 3 Lakh each year.
- 1920 diseases are covered by this programme.
- In order to be eligible for this programme, a patient must have spent at least 24 hours in the hospital.
- The relevant authorities compile a list of hospitals that have signed up for the programme.
- Total financial assistance coverage before and after hospitalisation is 15 days.
- To register and for further information, go to www.medisep.kerala.gov.in.
- The MEDISEP application deadline is December 31, 2022.
Kerala MEDISEP Scheme Objectives
The MEDISEP program’s goal is to provide all retirees and active employees of the State Government of Kerala, as well as the High Court of Kerala, who are currently covered under the current Kerala Government Servants Medical Attendant Rules [1960], with comprehensive medical insurance protection.
Kerala MEDISEP Scheme Highlights
| Name of the scheme | Kerala MEDISEP Scheme |
| launched by | Chief Minister Pinarayi Vijayan said |
| Year | 2023 |
| State | Kerala |
| Beneficiaries | Pensioners and employees |
| Official Website | medisep.kerala.gov.in |
MEDISEP Scheme Benefits for 2023
- The following benefits are provided to qualified residents of Kerala under the Medisep scheme:
- 30 million people will gain access to this three-year initiative through the basic package (BBP). Every year, it will provide 300,000 rupees.
- The MEDISEP programme covers a total of 1920 medical treatments and surgical procedures. Though there will be 1823 processes in the BBP package.
- The category of “general surgery” under the BBP, general surgery therapy packages, contains the most treatment possibilities (197). There are 168 packages in the cardiology category. Orthopaedics has 144 packages, dental surgery has 147, and surgical oncology has 156. 111 are for plastic surgery.
- The programme covers expenses associated with hospitals, including lodging, meals, prescription medicine charges, staff and doctor fees, and medical costs.
- MEDISEP has a distinct bundle for catastrophic and transplant surgeries.
Other Benefits of the MEDISEP Scheme
The MEDISEP scheme offers a cashless option for the services indicated. When a hospital is referred to as a “cashless facility,” it means that the insurance company will pay the hospital directly for the services provided in accordance with the list.
However, coverage will be offered even if it is performed in a facility that is not on the panel in the event of an accident or any other kind of unanticipated medical emergency that is covered by the approved list of treatments and procedures.
The plan will pay for the above expenses for the 15 days before and following hospitalisation.
If the mother of a newborn kid is covered by the MEDISEP programme, then any infants with structural or functional disabilities are covered under this programme until the program’s allotted time has passed.
The base plan of the programme will pay up to Rs 1.5 lakh for “unspecified operations.”
BBF Plan
- Catastrophic secondary and tertiary benefits would be a part of the system’s basic benefits package. routine care procedures, emergency and trauma care surgeries, and care therapies.
- Additionally, the proposal offers additional coverage for certain treatments for severe illnesses, like organ transplant operations. Additionally, any pre-existing conditions that the recipients may have will be covered. On the other hand, outpatient therapy will not be covered by the MEDISEP plan.
- The initial set of benefits consists of 1823 procedures.
BBP’s Confirmed Amount
First and foremost, BBP offers beneficiaries a 3 lakh rupee annual coverage. Additionally, a different mechanism called MEDICSEP, which is described in more detail in the sentence after this one, permits an increase in coverage of Rs. 6 lakh.
BBP essentially consists of two parts. One is fixed and holds 1.5 lakh, and the other, known as a floater system, is mobile.
If the floater system is not used in the recipient’s current year, it will be carried over to the following year and will total 4.5 lakh for the beneficiary in that year. If it is not used, it will therefore accumulate over three years and, in the last few years, might reach 6 lakh rupees.
Therefore, the BBP only includes the lodging fee, implant cost, and treatment cost as its advantages.
Then there is the cost of the procedure, which includes the price of the major procedures and pharmaceuticals as well as the price of the pre-hospital admission medical advice and treatment, the price of the doctor’s services, nursing costs, post-discharge prescriptions, and post-hospitalization reviews.
The price of the implants will be decided by Nppa.
The basic benefit package includes coverage for lodging expenses as well. These expenses are regulated, with general rooms costing up to Rs. 1000 and semi-private rooms costing up to Rs. 1500. These rates are the maximum fees that the insurance will cover.
Costly procedures covered by the BBP
The majority of the packages or operations for the cardio sector are covered by this plan, and the most expensive treatments—ranging from 1 lakh to 2 lakh rupees—are also for cardio surgery.
Aortic stenting is a costly procedure for which the BBP also pays up to 5.78 lacs, after which the patient is responsible for the balance.
A common procedure, intracranial balloon angioplasty with stenting, has a ceiling of Rs 2.03 lakh.
Catastrophic Package Costing
- The cost of the catastrophic package includes all associated costs, including those for the procedure, the implant, lodging, and research.
- Each individual package will have a single cost.
- For example, liver transplants are allowed to cost a maximum of Rs. 18 lakh. A kidney transplant costs three lakh rupees in India. A heart-lung transplant will set you back 20 lakh rupees. An Indian cochlear implant costs 6.39 lakh rupees. A hip replacement will cost you 400,000 rupees in total. Additionally, the price of an auditory brainstem implant is 18.24 lakh rupees.
- The package will also cover any necessary medical or surgical implications, and participating hospitals have been instructed not to bill the beneficiary for any additional costs that may arise as a result of these consequences.
- The insurance industry has set up a reserve fund with a minimum value of Rs 35 crore exclusively for the treatment of severe illnesses.
Contribution to the Plans
- As a result, the beneficiary is expected to contribute Rs. 500 per month from their pay as a government employee and their yearly Rs. 6000 gross pension entitlement.
- The supplementary government will annually offer beneficiaries a policy worth 4,800 rupees (GST included).
- The additional funds it has received from the insured will be used to make up any gap if the insurance company finds that the Rs 35 crore it has set aside for catastrophic illness is insufficient.
Who will profit from this?
- All state government employees who are currently employed and who are working in accordance with the act of 1960, as well as all retired individuals who are receiving pensions, shall benefit, in accordance with the MEDISEP Scheme’s conditions.
- Additionally, there are service personnel who work in assisted schools, colleges, and both the teaching and non-teaching sectors.
- On the list of recipients are the university staff members who have received grants from the state government and local self-government organisations.
- There are also employees of the Kerala High Court included.
- Beneficiaries of this programme include the retired teaching and non-teaching employees of aided schools, colleges, and universities who have all received funds from the State Government and LSGls.
- Pensioners who were hired directly and family pensioners will also benefit from this strategy.
- Additional family members, children, and spouses of teaching and non-teaching staff at aided schools and colleges will also be included on the list of beneficiaries, and participation in the programme is required for all of the aforementioned defined categories.
- Their children will also be listed as beneficiaries if both parents are on the scheme’s beneficiary list.
Who will not benefit from this?
- There is still a list of demographic groups in Kerala that are not included in this programme.
- The Kerala State Electricity Board (KSEB), the Kerala State Road Transport Corporation (KSRTC), and the Kerala Water Authority (KWA) are autonomous organisations, cooperative institutions, and boards whose employees and retirees are not eligible. The State Information Commission and the Human Rights Commission’s pensioners and employees were not permitted to take part in the insurance programme either.
What happens if a worker decides not to take part?
- Employees who are currently getting benefits from the plan but nevertheless decide they do not want to continue may disregard the remaining payments if no claims were filed while they were employed. However, if claims were submitted by the office under the programmes, then he or she would be responsible for making the monthly premium contribution in accordance with the package the beneficiary selected.
When an Employee Is Suspended, What Happens?
The premium for the term of suspension will be deducted from the employee’s monthly salary if they are currently on suspension.
MEDISEP Scheme Eligibility Requirements for 2023.
The following crucial detail must be noticed in order to qualify for the MEDICEP programme:
- The hospital must accept the beneficiaries for a whole day or a complete 24 hours.
- 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.
Required Documents
- Identity Card
- Aadhar card
- Mobile Number
- Email ID
Registration for the Kerala MEDISEP Scheme 2023.
- The home page of the MEDICEP scheme will be visible after you open the official website for it.
- From here, navigate to the webpage’s registration option.
- The page will change to a new one.
- Complete the application form with the necessary details.
- Please turn in any necessary paperwork for uploading.
- Verify that all of the data is accurate before selecting the submit option.
- If you go about it this way, joining the programme will be simpler for you.
Login Process
- You can either get in touch with the administrators or visit the official website directly at medisep.kerala.gov.in to register or log in for the programme.
- The login option is located on the MEDISEP homepage; point your cursor there and choose the department to which you belong.
- You will be taken to another page after selecting the department where you will be prompted for your name and password in order to capture them.
- They must be typed in before clicking the “login” button.
- Your log-in process is finished.
How to Download a Medical ID Card Online
- Please click here to go to the online home page of the MEDISEP Scheme to get started.
- The website’s home page will then immediately load on the screen for you.
- The next step is to click the “Download Medcard” link on the website.
- The new login page will then appear in its entirety on the screen.
- Enter your login information, including your employee ID/PEN/PPONo, beneficiary type, and MEDICSEP ID.
- Click the sign-in button now.
- The MED CARD will then be shown after that.
- To download it to your device, select the download option.
Know Your Status
- Please click here to go to the online home of the MEDISEP Scheme to get started.
- The website’s home page will then immediately load on the screen for you.
- The next step is to click the “Status” link on the webpage.
- The new page will then be shown in its entirety on the screen.
- Enter the Emp ID/PEN/PPONO, Date Of Birth, after choosing the category.
- Click the search option now.
- The current status will be shown.
- To download it, select the print option from the menu.
View Medisep Hospital List
- Please click here to go to the online home of the MEDISEP Scheme to get started.
- The website’s home page will then immediately load on the screen for you.
- Choose “Hospital” on the webpage to continue.
- The complete new page will then be seen on the screen.
- Choose the district and the state.
- Click the search option now.
- On the screen will be a list of hospitals organised by district.
Kerala MEDISEP Scheme View Nodal Officers
- Please click here to go to the online home of the MEDISEP Scheme to get started.
- The website’s home page will then immediately load on the screen for you.
- To continue, click the “Nodal Officers” link on the webpage.
- The new page will then be shown in its entirety on the screen.
- The page will include information on the nodal officers per department.
- The Nodal Officer list for any department can be downloaded to your device by selecting the “download now” option.
MEDISEP Grievance System
- Go to the official MEDISEP website first.
- The website’s home page will then immediately load on the screen for you.
- From here, select the “Grievance” link on the website to continue.
- Click File Grievance, then Login/Submit.
- A login form is displayed.
- Type in the medisep ID.
- Press Sign In.
- You may now voice your complaint here.