THIRUVANANTHAPURAM: The Cabinet meeting on Wednesday approved the second phase of the Medisep insurance scheme for government employees and pensioners. Basic insurance coverage will be enhanced from the present Rs 3 lakh to Rs 5 lakh. Employees of public sector enterprises will also be brought under the scheme's coverage, said an official statement.
The basic treatment package will include 2100 procedures for 41 speciality treatments. Cardiac Resynchronisation Therapy (CRT with Defibrillator- Rs 6 lakh, ICD Dual Chamber - Rs 5 lakh) will be included in the additional package. Knee replacement and hip surgery will be included in the basic benefit package.
The new scheme will cover ten types of serious illnesses/ organ transplant treatment packages. To meet this, the insurance company will be asked to set apart a corpus fund of Rs 40 crore for two years.
Upto 1 pc of the basic insurance coverage, Rs 5000, will be granted as room rent. Upto Rs 2000 will be granted for pay ward room rent in government hospitals. The Cabinet gave in-principle approval to include non-ESI staffers and pensioners in public sector enterprises, boards, corporations, autonomous institutions and cooperatives. The policy period will be enhanced from the present two years to three years. Premium and package rates will be increased in the second year.
Public sector insurance companies which qualified in the technical bid during the first phase of tendering will only be allowed to participate in the tender process for the second phase. Three more treatments - heart attack, stroke and road accident - will be considered for reimbursement.
A one-time registration system will be introduced in the insurance portal for the benefit of persons requiring continuous treatment under daycare procedures for dialysis and chemotherapy. Pre-hospitalisation expenses will be covered for three days, and post-hospitalisation expenses for five days.
A three-level complaint redressal mechanism - district level, state level and appellate authority - will be started. QR code will be introduced in the beneficiaries' identity cards. The selected insurance company will be asked to prepare an SOP that provides for strict action against hospitals violating the agreement.