Health insurance not optional for Kerala employees and pensioners

All serving employees of the State Government and pensioners should mandatorily avail ‘Medisep’ and the demand to make the health insurance scheme optional cannot be allowed, said Finance Minister K N Balagopal.

Such options are not provided anywhere in the country. Take the case of the Central Government Health Scheme, ESI ( Employees State Insurance), or the schemes of the Tamil Nadu and Karnataka governments. All those who are included under the scope of such schemes are its members. Only if all joined the initiative, the scheme be extended to them at a low premium, the minister said.

Under the health insurance schemes of governments, no coverage is provided for Ayurveda, Homoeopathy, or Unani. This is because it is difficult to define definite packages.

While Medisep consists of 1,920 packages and covers 12 serious illnesses, the Ayushman Bharat scheme of the Central Government has only 1,670 packages. The Centre, Tamil Nadu, and Karnataka have an average of 1,000 packages and they don’t provide coverage for grave diseases.

The State Government scheme has a corpus fund of Rs 35 crore for the treatment of fatal diseases, including organ transplantation. However, the same was fully utilized in the first nine months of starting the scheme. The government itself has set aside a corpus fund of Rs 28 from each premium payment to ensure continued treatment. The same will be used as and when the corpus fund of the insurance company gets fully spent. It has also been decided to allocate an amount, fixing the maximum limit at Rs 3 crore a month, with the stipulation that they should only do treatments such as knee and hip replacement surgeries in government hospitals. Besides, the insurance company has been asked to assess the utilization of the Rs 3 crore fund and initiate follow-up measures.

Many hospitals raise complaints that Medisep is offering fewer packages while implementing health schemes for Central government employees who have far fewer packages, the minister said. Also, the insurance company has been directed to hold talks with any hospital that charges rates higher than those of the package and take the necessary measures.

There are complaints that treatments are not being provided at certain departments of some of the empaneled hospitals. He added that the insurance company has also been asked to look into the matter and also empanel more hospitals.

A sum of Rs 195.26 crore was given through the earlier reimbursement scheme during the period of 2018–22. However, a total of 2,21,871 claims worth Rs 576.94 crore have been received under the Medisep scheme in just eight months, the minister said, adding that the amount is being disbursed quickly.