THIRUVANANTHAPURAM: Over 100 hospitals, including specialty hospitals in both the government and private sector, have agreed to join Medisep, the cashless health insurance scheme for government employees and pensioners. The empanelling process is on and more hospitals will be added to the list in a few weeks, according to the finance department.
The project launch is unlikely to meet the original March deadline and is now expected in the first quarter of the new fiscal. The government is awaiting the list of empanelled hospitals from Oriental General Insurance company, the insurance provider which won the tender for the project. After scrutinising the list, the government may direct the agency to add more hospitals to ensure that the beneficiaries spread across the state have easy access to treatment.
The empanelling is conducted by two third-party administrators appointed by the insurance provider - Vidal Health Insurance TPA and Family Health Plan Insurance TPA. Once the process is completed, the government will ink a three-year contract with Oriental for scheme implementation. Oriental had recently conducted a demo of the claims management software for officers in charge of Medisep. The software provides separate access windows to customers, hospitals, Finance Department, Oriental and third-party administrators.
The database of beneficiaries is almost ready and it will be handed over to the insurance providers after the contract is signed. Medisep is perhaps the largest insurance programme to come up in the government sector. It will cover about 11.30 lakh beneficiaries, including employees and pensioners, and their dependents which will total around 17.77 lakh.
Employees and pensioners will have to pay Rs 500 as a monthly premium. It is designed as a comprehensive scheme covering 2,000 medical procedures. 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 per cent GST to Oriental Insurance Company. The excess amount collected will be used for reimbursement to the insurance company when it spends in excess of the Rs 35 crore corpus fund kept for catastrophic illnesses.
The policy cover
The policy cover is for three years on a floater basis. Each year the beneficiary will be entitled to Rs 1.5 lakh fixed coverage and Rs 1.5 lakh floater. The floater can be taken together as Rs 1.5 lakh or Rs 3 lakh or Rs 4.5 lakh in the first to third years depending on the necessity and utilisation. In addition to these, beneficiaries with catastrophic illnesses will be given assistance from the Rs 35 crore corpus fund to be maintained by the insurance company.
Rs 6,000 is the annual premium collected by the government from a beneficiary as against the actual payment of Rs 4,800 plus 18 per cent GST to Oriental Insurance Company.