THIRUVANANTHAPURAM: Medisep, the cashless health insurance scheme for state government employees and pensioners launched on July 1, benefitted nearly 12,000 persons until Sunday. Together these claims were worth around Rs 40 crore. The flagship programme of the Pinarayi Vijayan government, implemented through the Oriental Insurance Company, covers 11 lakh employees and pensioners and their 23 lakh dependents. About 400 hospitals, including 143 government hospitals, have partnered with it. Another 54 hospitals will join shortly. Top procedures availed of by the beneficiaries during the first 38 days were cataract surgery (1,355) followed by haemodialysis (1,342).
Close to hundred persons got assistance from the special fund for catastrophic illnesses. This fund can be availed of when the patient’s treatment expense exceeds the annual ceiling. It helped two persons undergo liver transplant surgery at a cost of Rs 16 lakh each. Others included two persons who underwent renal transplantation, one bone marrow transplant, 10 total hip replacement and 78 knee joint replacement.
The Medisep, launched on July 1, covers 1920 treatments and surgical procedures. A noted feature is the coverage for pre-existing diseases. The policy cover is for three years on floater basis. Each year the beneficiary is entitled to Rs 1.5 lakh fixed coverage and Rs 1.5 lakh floater. Unutilised floater benefit will be carried over to the next year. Thus, a person who has not availed of floater in the first year will have an eligibility for Rs 4.5 lakh next year. In addition to these, beneficiaries with catastrophic illnesses will be given assistance from the Rs 35 crore corpus fund maintained by the insurance company.
The annual premium collected by the government from a beneficiary is Rs 6,000 as against the actual payment of Rs 4,800 plus 18 pc GST to the Oriental Insurance Company. The excess amount collected is used for reimbursement to the insurance company when it spends in excess of the Rs 35 crore corpus fund for catastrophic illnesses.
Sources said efforts are on to empanel more hospitals. Several leading private hospitals are yet to join the scheme. Also, the government has asked beneficiaries to download their Medisep ID card and ensure that the names and details are correct. Corrections have to be made with the help of DODs or treasury officers before August 25.