MEDISEP Application Form - Summary
Kerala Government is making cashless treatment available for government employees and pensioners through the MEDISEP Application Form. This form can be downloaded from the link provided at the bottom of this page. Eligible employees can receive medical reimbursement for both outpatient and inpatient care from government hospitals and empanelled private hospitals.
What is MEDISEP?
MEDISEP (Medical Insurance Scheme for State Employees and Pensioners) offers comprehensive health insurance coverage of up to Rs 3 lakh each year. In cases of serious illnesses, a higher amount can be claimed. The scheme provides a cashless facility at hospitals. Unclaimed amounts up to Rs 1.5 lakh from the first year can be carried forward to the next year. Hospitalisation of more than 24 hours is covered under this insurance.
MEDISEP Scheme Eligibility Criteria
- All serving employees of the State Government, including teaching and non-teaching staff of Aided Schools and Colleges, by paying the required premium.
- Part-time contingent employees/pensioners and part-time teachers/pensioners, provided they remit the prescribed premium.
- Dependents such as spouse/partner and children who haven’t turned 25.
- Children of any age facing physical or mental disability are eligible.
- Dependent parents of the employee are also covered.
Major Treatment Expenses – MEDISEP
- Liver transplant: Rs 18 lakh
- Bone marrow transplant: Rs 9.46 lakh
- Cochlear implantation: Rs 6.39 lakh
- Kidney transplant: Rs 3 lakh
- Knee replacement: Rs 3 lakh
- Hip replacement: Rs 4 lakh
- Brain surgery: Rs 18.24 lakh
- Heart, lungs transplant: Rs 15 lakh
MEDISEP Benefit Package
This scheme provides cashless treatment facilities through an insurance company and a network of empanelled hospitals, along with the benefit package listed below:
- Basic Benefit Package: The insurer will cover all expenses for medical treatment availed by beneficiaries in empanelled hospitals (24 hours admission clause) for medical, surgical, and day care procedures as specified in Annexure 1.
- Additional Benefit Package: Insurance coverage is provided beyond the basic plan for catastrophic illnesses listed in Annexure 2.
- Coverage of Pre-existing Diseases: All diseases under the scheme are covered from day one, with no waiting period.
- Pre & Post Hospitalization Benefit: Coverage of expenses up to 15 days prior and 15 days after hospitalization for the sickness treated. This can be availed on a cashless basis in empanelled hospitals.
- The newborn child/children to an insured mother are covered from day one until the policy ends. The child/children can be included as regular family members in the following year. All congenital diseases of newborns are covered under the scheme.
- Insurance coverage starts from day one and continues until the end of the policy period.
- ‘Unspecified Procedures’ are covered under the Basic Benefit package, based on pre-authorization processes and are limited to Rs 1.5 lakh per annum in a block period of three years. New diseases like COVID-19 will also be covered following regulations from IRDAI.
Download the MEDISEP Application Form
You can easily download the MEDISEP Application Form PDF using the link below.