THIRUVANANTHAPURAM: Medisep, the new health insurance scheme for state government employees and pensioners, will come into effect on July 1. A three-year scheme, the ‘Medical Insurance Scheme for State Employees and Pensioners’ (Medisep) will cover nearly 1,920 medical procedures.
The deduction of monthly premium of Rs 500 will begin with the salary of employees for the month of June and payment for pensioners in July. The hospital network would include over 200 private hospitals and government hospitals of the rank of taluk hospital and above.
Nearly 11 lakh beneficiaries and their dependents (about 18 lakh) have enrolled in the scheme. The beneficiaries are state government employees, pensioners, family pensioners and their eligible family members. Employees and pensioners of universities, local selfgovernment institutions, directly recruited personal staff of chief minister, ministers, leader of opposition, chief whip, speaker, deputy speaker, chairpersons of financial committees, personal staff pensioners and family pensioners are also covered under the scheme.
Each year, the beneficiary would be entitled for Rs 1.5 lakh fixed coverage and Rs 1.5 lakh floater. The floater can be taken together as Rs 1.5 lakh or Rs 3 lakh or Rs 4.5 lakh in the first to third years, depending on the necessity and utilisation. Besides, beneficiaries with catastrophic illnesses will be given assistance from the `35-crore corpus fund to be maintained by the insurance company.
The government will make advance payment of premium to Oriental Insurance Company Ltd through which the scheme is implemented. The annual premium paid by the government to the insurance provider is Rs 4,800 plus 18% GST per beneficiary.
However, the government will collect Rs 6,000 as annual premium from each beneficiary and the excess amount collected will be used for reimbursement to the insurance company when it spends in excess of the Rs 35 crore corpus fund kept for catastrophic illnesses. The two third-party administrators of the scheme are Vidal Health Insurance TPA and Family Health Plan Insurance TPA. Government orders on the list of hospitals and procedures are expected shortly.
Monthly premium D500
Beneficiary entitled for yearly fixed coverage of Rs 1.5 lakh and Rs 1.5 lakh floater
11 lakh beneficiaries and 18 lakh dependents enrolled in scheme
1,920 medical procedures covered
Network includes over 200 private and government hospitals
Rs 35 crore corpus fund for catastrophic illnesses
- Treatment cost
- Doctor/attendant fees
- Room rent
- Diagnostic charge
- Food expenses