THIRUVANANTHAPURAM: Uncertainty prevails over the future of Medisep, the health insurance scheme for government employees and pensioners, as the expert committee appointed by the state government to recommend revisions is yet to submit its report.
The Oriental Insurance is the insurance provider and, under the present scheme, the annual premium for a beneficiary is Rs 5,664, including 18% GST. The government makes an advance payment of the premium amount to Oriental Insurance in four instalments a year. The government will retrieve this amount from the salary or pension of beneficiaries in 12 instalments.
Earlier, the insurance provider had asked the government to hike the premium. This demand and the criticism by employees’ organisations prompted the government to appoint an expert committee to submit recommendations on revamping the scheme. The major criticism by employees was that prominent hospitals are not partnering with the scheme. Lack of standard treatment packages and inclusion of impractical rates were also raised.
The agreement with the Oriental insurance ends on June 30, 2025, and the government will have to decide on a premium hike to renew it.
Started in July 2022, the scheme has 30.92 lakh beneficiaries. Of the 11.43 lakh direct beneficiaries, 5.53 lakh are government employees and 5.90 lakh are pensioners. Besides 19.48 lakh dependants of employees and pensioners are also part of the scheme. As many as 628 hospitals are partnering with the scheme. Of them, 471 are private hospitals and 145 are government hospitals. Until March, 9.49 lakh claims worth `1,849.89 crore were approved.
Meanwhile, Finance Minister K N Balagopal said the government wants to continue the programme. “We are waiting for the expert committee report. It will have recommendations on different aspects like premium, bidding etc,” he said.