Medisep is a unique and comprehensive social insurance scheme like no other and one that is going to be a model for the rest of the country. However, there seemed to be an organised attempt by some hospitals and lobbies to scuttle the scheme, said Finance Minister, K. N. Balagopal, in the Assembly on Wednesday.
“There are teething troubles that need to be settled and efforts are on to empanel more hospitals so that the scheme is more meaningful. Some hospitals were deliberately staying away from the scheme and if this attitude continued, they would have to be named and exposed,” he added.
He was replying to a calling attention motion by Ramesh Chennithala on Medisep, the health insurance scheme for Government employees and pensioners. Mr. Chennithala claimed that the medical reimbursement scheme that was earlier in place without any cost limits had been “upset” by the implementation of Medisep and that the Government had brought in the scheme without doing any homework.
Mr. Balagopal, in his reply, said that the medical reimbursement for outpatient procedures, interest-free medical advance and the medical advance that was given to pensioners had been retained even after the implementation of Medisep.
He pointed out that a government employee over 50 years of age will have to pay an annual premium of at least ₹25,000 to join any health insurance scheme. There was no insurance scheme which offered such comprehensive coverage, with a government guarantee and all pre-existing illnesses covered, for an annual premium of just ₹6,000. Some 35 lakh individuals, including pensioners, were benefitting from the scheme.
The Government has also created a corpus fund of ₹35 crore, from which the treatment cost for 12 serious illnesses and organ transplants will be met.
Mr. Balagopal said that the scheme has been implemented after several rounds of discussions with all employee organisations and there was wide acceptance of the scheme. The scheme covered 1,920 procedures. So far, only 396 hospitals, including 143 government hospitals, have been empanelled. However, emergency medical care can be sought under Medisep from even hospitals which are not empanelled. A three-tier grievance redressal mechanism has also been set up
He pointed out that any employee who has tried to claim medical reimbursement would be well aware of the cumbersome procedures and the red tapes involved in getting a reimbursement. In contrast, Medisep is a cashless insurance scheme, which is fully digitally managed. In the first few weeks itself, 902 claims worth ₹1.89 crores had been settled under Medisep
He sought the cooperation of the Opposition and all stakeholders to improve the scheme. Social pressure is what is needed to make more hospitals join the scheme. The Government has already initiated several meetings to get more hospitals empanelled, Mr. Balagopal said.
