Status Check, Procedures, Facilities

Organisation : Government of Kerala
Facility Name : Medical Insurance Scheme
Applicable For : Employees & Pensioners
Applicable State/UT : Kerala
Website : https://medisep.kerala.gov.in/

What is Kerala Medical Insurance Scheme?

The Medical Insurance Scheme is intended to provide comprehensive health insurance coverage to all serving employees of the State Government including the High Court of Kerala who are covered under the existing Kerala Government Servants Medical Attendant Rules [KGSMA Rules, 1960] and pensioners.

Related / Similar Facility : KSVC Kerala Veterinary Certificate Registration

This also includes newly recruited employees and their family, part time contingent employees, part time teachers, teaching, non-teaching staff of aided schools and colleges and their family and pensioners and their spouses and family pensioners on compulsory basis, and all Civil Service officers serving under the Government of Kerala on optional basis.

Medical Insurance For State Employees And Pensioners:
Employees:
All serving employees of State Government including teaching and non teaching staff of Aided Schools and Colleges, employees of LSG Institutions and Universities in the State.

Pensioners:
All State pensioners including Family/Part time/Exgratia pensioners, pensioners of LSG Institutions and Universities in the State.

Dependants :
Dependants of employees and pensioners.

Eligibility of Kerala Medical Insurance Scheme

Eligibility of Beneficiaries:
i) All serving employees of State Government including teaching and non-teaching staff of Aided Schools and Colleges by remitting prescribed premium. In addition to the above mentioned categories, employees of the universities which receive Grant-in-Aid from the State Government and Local Self Government Institutions and the directly recruited personal staff of the Chief Minister, Ministers, Leader of Opposition and Chief Whip, Speaker, Deputy Speaker and the Chairmen of the Financial Committees shall also be considered as beneficiary for this scheme.

ii) Newly appointed employees who joined service during the policy period of three years shall join the scheme by remitting the premium from the month of joining and can avail Rupees Two Lakh per annum as Basic Sum Insured.

iii) Part time Contingent employees/pensioners and part time teachers/pensioners subject to remittance of prescribed premium. The part-time contingent pensioners/family pensioners and Exgratia Pensioners/family pensioners should execute an authorisation for deducting the prescribed monthly premium from their monthly pension.

iv) All service pensioners including teaching and nonteaching staff of aided schools and colleges by deduction of entitled medical allowance. In addition to the above mentioned categories pensioners of the universities which receive Grantin- Aid from the State Government and Local Self Government Institutions and the directly recruited personal staff pensioners/family pensioners shall also be considered as beneficiary for this scheme.

How To Apply For Kerala Medical Insurance Scheme?

Enrolment of Beneficiary

i) The Kerala Medical Insurance Scheme beneficiaries must mandatorily fulfil their enrolment procedure as prescribed by Government within the duration of enrolment Period.
ii) Enrolment of such beneficiaries shall not be allowed after the expiry of the enrolment period.
iii) In case of pensioners the prescribed enrolment procedure shall be followed as specified by Government from time to time.
iv) The database of beneficiaries will be maintained by the State Nodal Cell and will be shared with the selected insurer for initiating the enrolment process. The enrolment of the beneficiaries and issuance of ID cards would be undertaken by the insurer.
v) The date of expiry of policy shall be co-terminus for all the beneficiaries.
vi) Insured will have the option to change the details regarding dependant beneficiary.
vii) Every employee/pensioner will be notified regarding enrolment with Permanent Employee Numbers/Pension Payment Order Number.
viii) The empanelled Hospitals/Nursing Homes/Day Care Clinics and the beneficiaries shall have the access to the dedicated website to see their relevant information.

Family Enrolment

The Kerala Medical Insurance Scheme shall cover a family and dependants as follows.

A. In the case of an insured employee:
(i) legal spouse of the employee (who do not have the eligibility to enrol in this scheme).
ii) minor or adopted child/children dependant upon the insured, till they get employed, married or attained the age of 25 years whichever is earlier.
(iii) Physically challenged/mentally challenged child/children of the employee without any age restriction.(certificate should be produced as specified in the scheme).
iv) dependant parents of the employee.

B. In the case of insured pensioner:
Spouse (who do not have the eligibility to enrol in this scheme) and physically challenged/mentally challenged child/children of the pensioner without any age restriction. (certificate should be produced as specified in the scheme).

C. In the case of insured family pensioner:
Physically challenged/mentally challenged child/children of the pensioner without any age restriction. (certificate should be produced as specified in the scheme)

Addition & Deletion of Family Members

The Kerala Medical Insurance Scheme shall cover a family and dependants as follows.

A. In the case of an insured employee:
(i) legal spouse of the employee (who do not have the eligibility to enrol in this scheme).
(ii) minor or adopted child/children dependant upon the insured, till they get employed, married or attained the age of 25 years whichever is earlier.
(iii) Physically challenged/mentally challenged child/children of the employee without any age restriction.(certificate should be produced as specified in the scheme).
(iv) dependant parents of the employee.

B. In the case of insured pensioner:
Spouse (who do not have the eligibility to enrol in this scheme) and physically challenged/mentally challenged child/children of the pensioner without any age restriction. (certificate should be produced as specified in the scheme).

C. In the case of insured family pensioner:
Physically challenged/mentally challenged child/children of the pensioner without any age restriction. (certificate should be produced as specified in the scheme)

Helpline

Toll Free Number: 1800 – 425 – 1857
Time: (10.15 AM to 5.15 PM)