What are the Details of CM Vijayan's 2nd Phase of Insurance Scheme for State Employees and Pensioners?
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Synopsis
The Kerala government has launched the second phase of the Medisep medical insurance scheme, aimed at enhancing coverage for state employees and pensioners. With improvements such as increased coverage limits, expanded treatment options, and a focus on critical illnesses, this initiative reflects the government's commitment to public welfare in a politically significant period.
Key Takeaways
- Coverage increase: Basic insurance coverage raised to Rs 5 lakh.
- Expanded procedures: Over 2,100 treatment procedures included.
- Critical illness coverage: 10 critical illness packages added.
- Emergency treatments: Eligible procedures increased from 3 to 13.
- Room rent coverage: Up to Rs 5,000 per day covered.
Thiruvananthapuram, Aug 6 (NationPress) In anticipation of the upcoming significant elections -- local body (December) and Assembly (April/May 2026) -- the government of Kerala, led by Pinarayi Vijayan, has on Wednesday sanctioned the second phase of the Medisep medical insurance scheme for state government employees and pensioners.
Approximately one million families will now benefit from this enhanced facility.
This phase introduces substantial improvements in insurance coverage and treatment alternatives.
The basic insurance coverage will increase from Rs 3 lakh to Rs 5 lakh.
More than 2,100 treatment procedures across 41 specialty categories will be added to the base treatment package.
Previously excluded high-cost procedures like Cardiac Resynchronisation Therapy (CRT with Defibrillator – Rs 6 lakh) and ICD Dual Chamber Implantation (Rs 5 lakh) will now be incorporated in the additional package.
Surgeries such as knee and hip replacements will also be included in the base benefit package.
The scheme will now offer 10 critical illness and organ transplant packages, with the insurance company required to set aside a corpus fund of Rs 40 crore for two years.
Room rent coverage will rise to Rs 5,000 per day, representing 1 percent of the base insurance coverage, and Rs 2,000 per day in government hospitals.
Moreover, employees and pensioners from public sector undertakings, boards, corporations, self-governing institutions, and the cooperative sector not under ESI will now be included in Medisep Phase 2.
The policy term is now reduced to two years from three.
Premium and package rates will see adjustments in the second year.
Only public sector insurance firms with technical qualifications from Phase 1 will be permitted to participate in the tendering process for Phase 2.
The number of emergency treatments eligible for reimbursement from non-empanelled hospitals will rise from 3 to 13, introducing 10 new procedures beyond heart attacks, strokes, and road accidents.
Daycare procedures necessitating continuous treatment, such as dialysis and chemotherapy, will allow for one-time registration on the insurance portal.
Combined approval for both surgical and medical packages will also be initiated.
Pre and post-hospitalization costs will now be covered for 3 and 5 days, respectively.
A three-tier grievance redressal system will be implemented at district, state, and appellate levels.
To facilitate quicker access to beneficiary data, QR codes will be added to Medisep cards.
Strict measures will be enforced against hospitals breaching contract terms.
The insurance company will establish a Standard Operating Procedure (SOP) for this purpose.
To prevent overbilling and exploitation in private hospitals, the Clinical Establishment Authority's services will be utilized.
As of July 1st, 2025, over 10.5 lakh claims have been processed, totaling Rs 1,911 crore.
Point of View
The introduction of the second phase of the Medisep insurance scheme is a significant move by the Kerala government, demonstrating a proactive approach to healthcare in the state. Amidst upcoming elections, this initiative is likely to resonate positively with state employees and pensioners, highlighting the government's commitment to their welfare. It sets a precedent for other states to consider similar measures that prioritize the health and well-being of their public servants.
NationPress
19/08/2025
Frequently Asked Questions
What is the Medisep insurance scheme?
The Medisep insurance scheme is a medical insurance initiative launched by the Kerala government to provide health coverage for state government employees and pensioners.
What are the new features of the second phase?
The second phase includes increased insurance coverage, additional treatment procedures, and the inclusion of critical illness and organ transplant packages.
How much will the basic insurance coverage increase?
The basic insurance coverage will rise from Rs 3 lakh to Rs 5 lakh in the second phase.
Who will benefit from this scheme?
Approximately one million families of state government employees and pensioners will benefit from the enhanced Medisep scheme.
What is the policy term for the new phase?
The policy term for the second phase has been reduced to two years from the previous three-year term.
