THIRUVANANTHAPURAM: The Medical Insurance Scheme for State Employees and Pensioners (Medisep) special fund for catastrophic illnesses has run into a bizarre crisis. The fund is fast drying up due to the unusually high number of people availing aid for knee joint replacement, which is normally an elective surgery, forcing the government to impose restrictions.
The fund with a corpus of Rs 35 crore was set apart for severe illnesses that require prolonged treatment and expensive procedures like kidney and liver transplantations, cardiac surgery, bone marrow transplantation, etc. besides knee joint and hip replacements.
As per Oriental Insurance, the insurance provider for the scheme covering 29.91 lakh government employees and pensioners, Rs 30.22 crore from the fund was spent to settle 1575 claims on knee joint replacement. Rs 2.02 crore was spent on 114 claims for hip replacement and Rs 3.69 crore for 39 liver transplantation cases. Worried over the disproportionate distribution, the government issued an order last week restricting knee joint and hip replacement surgeries to government hospitals. It also limited the monthly spending from the fund to Rs 3 crore.
“Most of the settled claims for these procedures were from private hospitals. Disproportionate spending will affect people with other serious illnesses that require costly procedures like renal and liver transplantations, cardiac surgery, or bone marrow transplantation,” said a finance department officer.
The government order on 30 March said the corpus fund for catastrophic packages would be replenished with the excess money collected from beneficiaries. The annual premium collected by the government from a beneficiary is Rs 6000 as against the actual payment of Rs 4800 plus 18 pc GST to the Oriental Insurance Company. “The balance amount was kept by the government to replenish the corpus for the catastrophic package. But it occurred much earlier than our expectation,” said a source.