The state government’s plan to introduce the Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) has entered the final stage with the state cabinet clearing the proposal. Close to 12 lakh people are expected to benefit from the scheme, to be implemented by Reliance General Insurance
Thiruvananthapuram: With the state cabinet on Friday approving the Medical Insurance Scheme for State Employees and Pensioners (MEDISEP), nearly 12 lakh persons along with their families would to get health insurance cover of up to Rs 6 lakh for three years in the state.
The beneficiaries include state government employees including High Court staff for whom Kerala Government Services Medical Attendant Rules are applicable, part time contingency employees, teaching and non-teaching staff of aided education sector, part-time teachers, staff of local bodies and universities, members of personal staff, pensioners and family pension scheme members in all these categories.
As per rules the dependents of these categories will also benefit from the insurance cover.
According to finance department, the health insurance cover will be provided under the following three categories:
Basic insurance: As per the scheme, each family will get a health insurance cover of Rs 2 lakh annually during the insurance period. This coverage is for three years.
Additional coverage: For organ transplantation, each family will get a maximum of Rs 6 lakh during the three year period. This will be over and above the coverage of Rs 2 lakh per year for each family.
Serious ailments: In case the additional coverage of Rs 6 lakh is not sufficient for treatment of serious ailments then Rs 3 lakh each will be made available to the family during the period of the scheme. A corpus fund Rs 25 crore will be constituted by the company for this purpose. The additional assistance to the beneficiaries would be provided from the corpus fund.
Reliance General Insurance company which quoted the lowest annual premium amount of Rs 2992.48 including GST, was selected for implementing MEDISEP. The company was finalised after seeking expression of interest from companies which were recognised by the Insurance Regulatory and Development Authority. On the basis of the expression of interest received, the government had floated e-tender and finalised RGIC.
A premium of Rs 250 each will be deducted from the salaries of different categories of employees every month. For pensioners, the premium amount will be deducted from their medical allowance of Rs 300. The premium amount will be paid to the company by the government in three installments.
The government has clarified that the existing medical reimbursement scheme for outpatient services will continue.
According to the details given by the government, the children of the employees would be given health cover under the scheme till the age of 25 or if they get married or get employment, whichever happens first. There will be no age limit for differently-abled children.
The insurance cover can be availed for treatment in government and private hospitals with minimum bed strength of 50 and four to five doctors. The LDF government had made the announcement in 2018 budget that it will introduce a comprehensive health insurance scheme.
The health insurance is part of the government's plan for providing comprehensive health care facilities to the people of the state including specialty treatment. Officials said the facilities in government hospitals had been increased significantly by adding super specialty services in general, taluk, district hospitals. Cancer care facilities have been introduced in many of the district hospitals.
Finance minister Dr T.M. Thomas Isaac said by implementing the insurance scheme, the government had fulfilled a major promise.
What does it offer
- Basic insurance: Each family will get a health insurance cover of Rs 2 lakh annually for three years.
- For organ transplantation: Each family will get a maximum of Rs 6 lakh during the three year period.
- Serious ailments: If additional coverage of Rs 6 lakh is not sufficient, then Rs 3 lakh each will be made available in case of serious ailments
