MEDISEP Application Form in Malayalam
Kerala Government facilitating the cashless treatment for government employees and pensioners and scheme can be availed by the employee by filing the MEDISEP Application Form that can be download from the link given at the bottom of this page. The employees are eligible for medical reimbursement for both outpatient and inpatient medical care from government hospitals and empanelled private hospitals.
MEDISEP (Medical Insurance Scheme for State Employees and Pensioners) is an Comprehensive health insurance coverage of up to Rs 3 lakh would be provided under the scheme every year. A higher amount is allowed in case of grave ailments. Cashless facility will be available in hospitals as per the scheme. Up to Rs 1.5 lakh from the unclaimed amount during the first year can be carried forward to the next year. Insurance coverage will be provided for hospitalisation of more than 24 hours.
MEDISEP Scheme Eligibility Criteria
- All serving employees of State Government including teaching and non-teaching staff of Aided Schools and Colleges by remitting prescribed premium.
- Part time Contingent employees/pensioners and part time teachers/pensioners subject to remittance of prescribed premium.
- Their dependents, spouse/partner, children who have not attained the age of 25 and
- Children of any age who are facing physical or mental disability are eligible.
- Dependant parents of the employee
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
The scheme envisages cashless treatment facility to beneficiaries through an insurance company and a network of empanelled hospitals for the benefit package given below.
- Basic Benefit Package – The Insurer shall pay all expenses (as per package costs specified) incurred in course of medical treatment availed by the beneficiaries in empanelled hospitals (24 hours admission clause) for the medical, surgical and day care procedures as enlisted in Annexure 1.
- Additional Benefit Package: The Insurance coverage given over and above the basic coverage for catastrophic illnesses specified enlisted in Annexure 2.
- Coverage of Pre-existing diseases: All diseases under the Scheme shall be covered from day one and there shall not be any waiting period.
- Pre &Post hospitalization benefit: Benefits up to 15 days Pre-Hospitalization & up to 15 days Post Hospitalization respectively which would cover all expenses related to treatment of the sickness for which hospitalization was done. The beneficiary shall avail this benefit on cashless basis in empanelled hospitals.
- New-born child/children to an insured mother would be covered from day one up to the expiry of the current policy plan period. However, next year the child/children could be covered as a regular member of the family. All Congenital diseases of newborn child/children shall be covered under the scheme.
- The insurance coverage shall start from day one and continue till the expiry of the policy plan period.
- ‘Unspecified Procedures’ should be covered under Basic Benefit package based on the pre-authorization process initiated by insurance company and authority, which will be limited to Rs.1.5 lakhs per annum during the block period of three years. New diseases like COVID-19 will also be covered based on the regulatory provisions issued by IRDAI from time to time.
MEDISEP Application Form
You can download the MEDISEP Application Form PDF using the link given below.