MEDISEP: Medical Insurance Scheme for Kerala Government Employees and Pensioners
GOVERNMENT OF KERALA
Finance Department – Medical Insurance Scheme for State Government Employees and Pensioners – MEDISEP – Grievance Redressal Mechanism – Orders issued.
FINANCE (HEALTH INSURANCE) DEPARTMENT
1) G. O.(P) No.54/2017/F in Dated 24/04/2017.
2) G. O.(P) No. 01/2022/Fin Dated 01/01/2022.
3) G.O.(P) No. 70/2022/Fin Dated 23/06/2022.
Government have accorded sanction for the implementation of Medical Insurance Scheme for the State Government Employees, Pensioners/Family pensioners and their eligible family members based on the recommendation of the Tenth Pay Revision Commission vide the Government Order read 1st above. Later, it was decided to extend the scheme to employees and pensioners of Universities which receive Grant-in-Aid from State Government and Local Self Government Institutions and directly recruited personal staff of Chief Minister, Ministers, Leader of opposition, Chief Whip, Speaker, Deputy Speaker, Chairmen of Financial Committees and Personal staff pensioners and family pensioners with a provision to avail cashless medical assistance through an insurance company selected by competitive bidding process. Vide Government Order read 2nd above, Government have issued in principle approval for the implementation of the scheme through the Oriental Insurance Company Limited. Now, Government have issued sanction for the commencement of MEDISEP scheme through the Oriental Insurance Company Limited w.el 01/07/2022 vide the Government Order read 3rd above and was ordered therein that the detailed procedure for Grievance Redressal Mechanism will be issued separately.
Government have examined the matter in detail and are pleased to accord sanction for the implementation of the following Grievance Redressal Mechanism designed for MEDISEP, with the intention of timely redressal of disputes if any, which may arise between the stakeholders viz. Insurer & Beneficiary, Insurer & Empanelled hospital, Beneficiary & Empanelled hospital during the policy plan period in connection with the validity, interpretation, implementation or alleged breach of any provision of the scheme.
GRIEVANCE REDRESSAL THROUGH THE INSURER (OICL)
The grievance/complaint should be filed within 30 days of obtaining discharge from the hospital.
24*7 hours Call Centre having active IVRS (Interactive Voice Response System) will be opened and operated by the designated Third Party Administrators (TPAs) of the Insurer for grievance redressal. The toll-free number printed on the Medisep ID card of the beneficiaries shall be used for accessing the Call Centre. Through the system, the aggrieved can raise a ticket for voice complaints and the call centre executives will contact the aggrieved and initiate appropriate action for complaint resolution. If the aggrieved is not satisfied, he/she can request the call centre executives to escalate the complaint to the grievance redressal mechanism of the Insurer. Ticket IDs will be generated for such complaints and their status will be updated in the MEDISEP portal.