CM Vijayan comes out with 2nd phase of insurance scheme for state govt employees, pensioners

Thiruvananthapuram, Aug 6 Ahead of the forthcoming crucial elections -- local body (December) and Assembly (April/May 2026) -- the Pinarayi Vijayan-led Kerala government on Wednesday approved the second phase of the Medisep medical insurance scheme for state government employees and pensioners.

There are about one million families which will now avail this new facility.

The scheme will see significant enhancements in insurance coverage and treatment options.

Under the new phase, basic insurance coverage will be raised from Rs 3 lakh to Rs 5 lakh.

Over 2,100 treatment procedures across 41 specialty categories will now be included under the base treatment package.

Two high-cost procedures — Cardiac Resynchronisation Therapy (CRT with Defibrillator – Rs 6 lakh) and ICD Dual Chamber Implantation (Rs 5 lakh) — previously excluded in Phase 1, will now be included in the additional package.

Surgeries such as knee and hip replacements will also become part of the base benefit package.

The scheme will now include 10 critical illness and organ transplant packages, for which the insurance company must earmark a corpus fund of Rs 40 crore for two years.

Room rent will be covered up to Rs 5,000 per day, which is 1 per cent of the base insurance coverage, and up to Rs 2,000 per day in government hospitals.

Additionally, employees and pensioners from public sector undertakings, boards, corporations, self-governing institutions, and the cooperative sector who are not covered under ESI will now be included in Medisep Phase 2 in-principle.

The policy term will now be two years, down from three.

Premium and package rates will be revised in the second year.

Only public sector insurance companies with technical qualifications from Phase 1 will be allowed to participate in the tendering process for Phase 2.

The number of emergency treatments eligible for reimbursement from non-empanelled hospitals will be increased from 3 to 13, adding 10 new procedures beyond heart attack, stroke, and road accidents.

Daycare procedures requiring continuous treatment, such as dialysis and chemotherapy, will be allowed one-time registration on the insurance portal.

Combined approval for both surgical and medical packages will also be introduced.

Pre and post-hospitalisation expenses will now be covered for 3 and 5 days, respectively.

A three-tier grievance redressal mechanism will be established at district, state, and appellate levels.

To ensure faster access to beneficiary data, QR codes will be added to Medisep cards.

Strict action will be taken against hospitals that deviate from the contract.

The insurance company will frame an SOP (Standard Operating Procedure) for this purpose.

To curb overbilling and exploitation in private hospitals, the Clinical Establishment Authority's services will also be leveraged.

Incidentally as of July 1st 2025, over 10.5 lakhs claims was processed totaling Rs 1,911 crore.

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