Medisep: Premium Rs 6000, and health insurance cover of Rs 3 lakh

Thiruvananthapuram: The annual premium for Medisep, the health insurance scheme for government employees, teachers and pensioners, would be raised from Rs 3,000 to Rs 6,000. The annual insurance coverage would also be increased from Rs 2 lakh to Rs 3 lakh.

The finance department has invited tenders to implement the scheme from January 1 that will benefit nearly 11 lakh people.

In the initial phase, most hospitals refused to cooperate with the scheme due to the low treatment rates fixed by the government. Due to this, the contract awarded to Reliance was cancelled last year. To ensure the hospitals' support, the treatment expenses for each disease has been increased in the new tender.

The room rent has also been increased. Now, the beneficiary can claim Rs 1,000 for general ward, Rs 1,500 for semi-private ward and Rs 2,000 for private ward. If the treatment expense is more than the fixed rate, then the patients will have to pay on their own. The insurance cover has been extended to include 1,920 ailments instead of 1,823.

The maximum treatment rate that can be claimed for severe illnesses and transplant surgeries has also been fixed. The insurance company has to allocate Rs 35 crore for this. The government would pay the contract amount in four instalments. Government hospitals, private hospitals and institutions such as RCC would be included.

The patient should not be charged more than the price fixed by the National Pharmaceutical Pricing Authority for medicines.

The proposal is to levy the premium in monthly instalments of Rs 500, instead of one-time payment of Rs 6,000. The monthly medical allowance of Rs 300 given to pensioners would be levied. Talks will be held with the respective associations on levying the remaining Rs 200 from the pension amount.

In the first phase, the scheme is for three years. And Rs 3 lakh can be reimbursed or availed as cashless treatment for each year.

If unutilised, up to Rs 1.5 lakh in each year would be added to the insurance amount for next year. For example: if only Rs 1 lakh was claimed in the first year, then Rs 1.5 lakh from the remaining Rs 2 lakh would be added to the next year's amount of Rs 3 lakh. Like this, even in the second year, Rs 1.5 lakh can be carried over.

Major treatment expenses

* Liver transplant: Rs 18 lakh

* Bone marrow transplant: Rs 9.46 lakh

* Cochlear implantation: Rs 6.39 lakh

* Kidney transplant: Rs 3 lakh

* Knee replacement: Rs 3 lakh

* Hip replacement: Rs 4 lakh

* Brain surgery: Rs 18.24 lakh

* Heart, lungs transplant: Rs 15 lakh

Who all are part of the scheme?

* Government employees, pensioners, their dependents and family pensioners

* A spouse not eligible to be part of Medisep; a daughter whose age is less than 25

* Physically- or mentally-challenged children, irrespective of their age

Insurance for...

* Hospitalisation for more than 24 hours

* 1920 ailments, including the diseases that were afflicted earlier

* Expenses for 15 days prior to the treatment

* Expenses for 15 days after getting discharged from hospital