Kerala MEDISEP Scheme: Health Insurance Coverage, Card Download & Hospital List

Medical Insurance for State Employees and Pensioners Scheme (MEDISEP) is a cashless health insurance scheme implemented by the Finance (Health Insurance) Department, Government of Kerala, providing eligible State Government employees, pensioners, and their dependents with up to Rs. 5 lakh annual family floater coverage. Under MEDISEP Phase-II, effective from 1 February 2026, beneficiaries can avail cashless treatment for more than 2,516 medical procedures at empanelled hospitals across the network. Eligible beneficiaries can check their status and download their MEDISEP ID Card through medisep.kerala.gov.in using their PEN or PPO number.

Introduction of Kerala MEDISEP: A Brief Insight

A medical emergency can arrive without warning, but the financial burden that follows often worries families even more. Before the launch of MEDISEP, Kerala Government employees and pensioners had to bear hospital expenses themselves and then wait for reimbursement through a lengthy administrative process. For costly treatments, arranging money in advance was often a major challenge. To address this issue and ensure timely access to healthcare, the Government of Kerala introduced MEDISEP (Medical Insurance for State Employees and Pensioners Scheme) on 1 July 2022, bringing a cashless health insurance system for government employees, pensioners, and their eligible dependents.

The scheme is implemented by the Finance (Health Insurance) Department, Government of Kerala in partnership with Oriental Insurance Company Ltd.. Its primary objective is to provide comprehensive health protection and reduce the financial stress associated with hospitalization by offering cashless treatment at empanelled hospitals.

Under the upgraded MEDISEP Phase-II, which came into effect on 1 February 2026, beneficiaries receive a family floater health cover of Rs. 5 lakh per year. The scheme covers more than 2,516 medical procedures across 41 specialties, including major surgeries, day-care procedures, and several advanced treatments. In addition to the regular insurance cover, a dedicated Rs. 40 crore catastrophic illness corpus has been created to support high-cost treatments such as organ transplants and other critical medical procedures.

One of the most beneficiary-friendly features of the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP) is that pre-existing diseases are covered from the very first day. Beneficiaries do not have to wait through any exclusion period to access treatment for existing medical conditions. The scheme also provides coverage for pre-hospitalization and post-hospitalization expenses, maternity benefits, newborn coverage, and emergency reimbursement in specified situations.

Instead of paying large hospital bills and seeking reimbursement later, beneficiaries can simply visit an empanelled hospital, present their QR Code-enabled MEDISEP ID Card, and avail eligible treatment on a cashless basis. The hospital directly coordinates with the insurer for approval and claim settlement, making the process significantly easier for patients and their families.

Coverage under MEDISEP is compulsory for most eligible categories, including Kerala State Government employees, pensioners, aided school and college staff, university employees receiving State grants, Local Self-Government Institution employees, and their eligible family members. The annual premium, currently fixed at Rs. 8,244 for the first policy year, is automatically deducted from salary or pension, eliminating the need for separate premium payments.

Beneficiaries can check their enrollment status, download their MEDISEP ID Card, search empanelled hospitals, and access claim-related services through the official portal at medisep.kerala.gov.in. For assistance regarding enrollment, treatment, claims, or grievances, the scheme also provides a dedicated toll-free helpline at 1800-425-1857.

Beneficiaries not covered under MEDISEP can also check their eligibility under the Central Government’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), offering similar cashless hospitalisation coverage of up to Rs. 5 lakh for eligible families. Senior citizens aged 70 and above can additionally explore the Ayushman Vay Vandana Card Scheme, which provides dedicated elderly health cover regardless of family income. Kerala residents outside the government sector can also look at the Oommen Chandy Health Insurance Scheme, which extends comprehensive medical coverage to below-poverty-line families across the state.

State government employees, pensioners, and anyone looking for more health, welfare, and insurance schemes available under the Kerala Government can explore all available programmes on our Kerala Government Welfare Schemes page.

Benefits Provided to Eligible Beneficiaries

The Finance (Health Insurance) Department of Kerala in partnership with Oriental Insurance Company Ltd., provides comprehensive health insurance coverage to beneficiaries under the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP) Phase-II.

Basic Health Insurance Coverage

• Rs. 5 lakh annual health insurance coverage on a family floater basis
• Coverage for more than 2,516 medical procedures across 41 medical specialties
• Includes hospitalization, surgical treatment, medical management, and approved day-care procedures
• Total Knee Replacement (TKR) and Total Hip Replacement (THR) are covered under the standard package itself

Additional Protection for Catastrophic Illnesses

• A dedicated Rs. 40 crore corpus fund has been created for catastrophic and high-cost treatments during the two-year policy period
• Covers major procedures such as organ transplantation and other critical medical interventions
• Catastrophic illness packages are fully inclusive, covering procedure charges, implants, room rent, investigations, and related treatment expenses
• Hospitals cannot collect additional charges from beneficiaries for approved catastrophic treatment packages, even if the hospital stay extends due to complications

Coverage for Pre-Existing Diseases

• All eligible beneficiaries receive coverage for pre-existing diseases from Day One
• No waiting period applies for any pre-existing medical condition under MEDISEP

Pre- and Post-Hospitalization Benefits

• Expenses incurred up to 3 days before hospitalization are covered
• Expenses incurred up to 5 days after discharge are also covered

Maternity and Newborn Benefits

• A newborn baby receives automatic coverage under MEDISEP from the date of birth up to 90 days
• After 90 days, the child can be added formally as a dependent beneficiary
• Maternity benefits for both normal delivery and caesarean delivery are available
• Coverage is limited to a maximum of two living children

Cashless Treatment Facility

• Cashless treatment is available at empanelled government and private hospitals across India
• Beneficiaries only need to present their QR-code-enabled MEDISEP ID Card at the hospital’s insurance help desk
• Eligible treatments can be availed without making upfront payments, subject to authorization

Emergency Reimbursement Facility

• Reimbursement is available for emergency treatment received at non-empanelled hospitals
• Applicable for emergencies such as cardiac arrest, stroke, and road traffic accidents
• Claims must be submitted through the MEDISEP Portal within 30 days from the date of discharge

Room Rent Coverage Limits

Fast Claim and Authorization Processing

• Normal pre-authorization requests are processed within 12 working hours
• Emergency pre-authorization requests are processed within 1 working hour
• If no decision is communicated within 12 working hours, the request is treated as deemed authorized
• Final claim approval is generally completed within 10 hours after submission of all required documents

Enhanced Package Rates Under MEDISEP Phase-II

• Package rates are based on the Health Benefit Package (HBP) 2022 Tier-I city rates
• Higher reimbursement rates have been introduced compared to the earlier phase
• Package enhancement ranges from approximately 15% for non-NABH hospitals to 50% for fully NABH-accredited hospitals
• This ensures better coverage and access to treatment at higher-quality healthcare facilities

Eligibility Conditions Required to be Fulfilled

The Finance (Health Insurance) Department, Government of Kerala, has prescribed the following eligibility conditions for the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP):

Compulsory Coverage Categories

• All serving State Government employees (including employees of the High Court of Kerala) covered under the Kerala Government Servants’ Medical Attendance Rules, 1960 (KGSMA Rules)
• Part-time contingent employees and part-time teachers
• Teaching and non-teaching staff of aided schools and aided colleges, along with their eligible family members
• Pensioners, their spouses, and family pensioners
• Employees and pensioners of Universities receiving Grant-in-Aid from the Government of Kerala
• Employees and pensioners of Local Self-Government Institutions (LSGIs)
• Directly recruited personal staff of the Chief Minister, Ministers, Leader of Opposition, Chief Whip, Speaker, Deputy Speaker, Chairmen of Financial Committees, and their pensioners/family pensioners

Optional Coverage Under MEDISEP

• All India Service (AIS) officers serving under the Government of Kerala can join MEDISEP on an optional basis

Eligible Family Members for Serving Employees

Under the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP), a serving employee can include the following dependents:

• Legally wedded spouse, provided the spouse is not already covered independently as a government employee or pensioner
• Dependent biological or adopted children up to employment, marriage, or 25 years of age, whichever occurs earlier
• Differently-abled dependent children with a valid disability certificate – no upper age limit applies
• Dependent parents

Eligible Family Members for Pensioners

Pensioners covered under MEDISEP can include the following family members:

• Legally wedded spouse, if not independently covered under the scheme
• Differently-abled dependent children with a valid disability certificate, without any age restriction

Who Is Not Eligible

• Employees who proceeded on Leave Without Allowance (LWA) before the commencement of MEDISEP and have not rejoined service or paid the applicable premium for the current enrollment cycle
• Persons seeking fresh enrollment after the notified enrollment period, except newly appointed employees and newly sanctioned pensioners

Coverage for PSU and Cooperative Sector Employees

MEDISEP Phase-II provides a provision for employees and pensioners of Public Sector Undertakings (PSUs), Boards, Corporations, Autonomous Bodies, Statutory Bodies, and Cooperative Institutions that do not receive benefits under the Employees’ State Insurance (ESI) Scheme.

Such institutions can seek inclusion in the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP) by approaching the insurer directly and submitting the required employee data along with the applicable premium contribution.

Note: MEDISEP does not prescribe any general age limit for beneficiaries. The only age-related restriction applies to dependent children, who remain eligible up to 25 years of age unless they are differently abled, in which case coverage can continue without any age limit upon submission of a valid disability certificate.

Documents Required to be Attached

MEDISEP is largely a database-driven scheme, so most beneficiaries are enrolled automatically through their PEN or PPO records. However, certain documents and details may be required for identity verification, family member inclusion, cashless treatment, and reimbursement claims.

For Enrollment and MEDISEP ID Card

• Permanent Employee Number (PEN) – for serving government employees
• Pension Payment Order (PPO) Number – for pensioners and family pensioners
• Date of Birth – for beneficiary verification and ID card download
• Aadhaar Card of the beneficiary and enrolled dependents

For Adding Family Members

• Marriage Certificate – for adding a spouse (within 60 days of marriage)
• Birth Certificate – for adding a newborn child (within 90 days of birth)
• Disability Certificate – for differently-abled dependent children seeking coverage without age limits

For Availing Cashless Treatment

• MEDISEP Health Card (QR-code enabled)
• Valid Photo Identity Proof

For Emergency Reimbursement Claims

• Discharge Summary clearly mentioning the emergency condition
• Original Hospital Bills, pharmacy invoices, and diagnostic reports
• Claim Application submitted through the MEDISEP Portal within 30 days from the date of discharge

Important: Reimbursement is permitted only in specified emergency situations such as cardiac arrest, stroke, and road traffic accidents treated in non-empanelled hospitals, subject to scheme guidelines and claim approval.

How Beneficiaries Can Apply to Avail the Benefit of the Scheme

If you’re covered under the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP), you don’t need to submit a fresh application every time you need treatment. Once your enrollment is active, you can use your MEDISEP card to avail cashless treatment at empanelled hospitals. The process is simple, and the steps below explain everything in an easy-to-understand manner.

Step 1: Check Whether You Are Covered Under MEDISEP

Step 1: Open the official MEDISEP portal at medisep.kerala.gov.in.

Step 2: Click on the “Status” option available on the homepage.

Step 3: Select whether you are a serving employee or a pensioner.

Step 4: Enter your PEN (Permanent Employee Number) or PPO (Pension Payment Order) Number, along with your Date of Birth.

Step 5: The system will show your enrollment status under the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP).

Step 2: Download Your MEDISEP ID Card

Step 6: After confirming your status, locate the “Med Card” option on the portal.

Step 7: Log in using your MEDISEP ID as the User ID and your PEN/PPO/Employee ID as the password.

Step 8: Download your QR Code-based MEDISEP ID Card.

Step 9: Save a copy on your mobile phone and keep a printed copy at home. This card is required whenever you visit a hospital under the scheme.

Step 3: Add Your Family Members (If Required)

Step 10: If you get married after joining MEDISEP, add your spouse’s details through the portal within 60 days of marriage.

Step 11: If a child is born, add the newborn’s details within 90 days of birth.

Step 12: If you have a differently-abled dependent child, upload the required disability certificate so that coverage can continue without age restrictions.

Step 13: Verify all details carefully before submission to avoid future claim-related issues.

Step 4: Use Cashless Treatment at an Empanelled Hospital

Step 14: When hospitalization is required, choose a hospital empanelled under the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP).

Step 15: Visit the hospital and inform the insurance help desk that you are a MEDISEP beneficiary.

Step 16: Show your MEDISEP ID Card and a valid photo identity proof.

Step 17: The hospital will verify your details and submit an online pre-authorization request to the insurance company.

Step 18: In normal cases, approval is generally processed within 12 working hours. In emergencies, approval is usually processed within 1 working hour.

Step 19: Once approval is received, treatment begins and eligible expenses are settled directly between the hospital and the insurer.

Step 20: You do not have to pay hospital charges covered under the approved MEDISEP package, making the treatment completely cashless.

Step 5: What to Do During an Emergency at a Non-Empanelled Hospital

Step 21: In emergencies such as cardiac arrest, stroke, or road accidents, seek treatment immediately, even if the nearest hospital is not empanelled under MEDISEP.

Step 22: After discharge, collect all important documents, including the discharge summary, diagnostic reports, pharmacy bills, and original itemized hospital bills.

Step 23: Visit the MEDISEP portal and submit a reimbursement claim online.

Step 24: Upload all required documents and ensure the claim is filed within 30 days from the date of discharge.

Step 25: After verification, the admissible claim amount will be processed as per MEDISEP rules.

Important: Beneficiaries do not need to pay premiums separately every month, as the contribution is automatically deducted from the salary or pension. Always keep your MEDISEP ID Card, Aadhaar details, and dependent information updated. If you face any difficulty regarding enrollment, cashless treatment, claim settlement, or hospital services, you may approach the District Level Grievance Redressal Committee (DGRC) and, if necessary, escalate the matter to the State Level Grievance Redressal Committee (SGRC).

Important Links Available of the Scheme

• MEDISEP Official Portal, Government of Kerala
• Find Your Empanelled Hospital MEDISEP Network Search
• MEDISEP Emergency Reimbursement Claim Page
• MEDISEP Official Government Orders and Circulars
• MEDISEP Terms and Conditions

Contact Details in Case of Help Needed

• Nodal Department: Finance (Health Insurance) Department, Government of Kerala
• Implementing Insurer: Oriental Insurance Company Ltd.
• Toll-Free Helpline: 1800-425-1857 (10:15 AM to 5:15 PM)
• Phone: 0471-2517486
• Email: info.medisep@kerala.gov.in
• Office: Finance (Health Insurance) Department, Government Secretariat, Thiruvananthapuram – 695001

Frequently Asked Questions (FAQs)

Q. What is MEDISEP?

Ans. MEDISEP, short for Medical Insurance for State Employees and Pensioners Scheme, is a cashless health insurance scheme launched by the Government of Kerala. It provides eligible beneficiaries and their dependents with access to cashless hospitalization and medical treatment at empanelled hospitals across the state and outside Kerala.

Q. Who can avail benefits under the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP)?

Ans. Serving State Government employees, pensioners, family pensioners, aided school and college employees, university employees receiving State grants, Local Self-Government Institution employees, and their eligible dependents are covered under MEDISEP. AIS officers serving in Kerala may join on an optional basis.

Q. How much health insurance coverage is available under MEDISEP?

Ans. Under MEDISEP Phase-II, beneficiaries receive a family floater health insurance cover of Rs. 5 lakh per year. In addition, catastrophic illness treatments are supported through a separate corpus fund for high-cost procedures.

Q. What is the premium amount under MEDISEP?

Ans. The annual premium for the first policy year is Rs. 8,244. The contribution is automatically deducted from the beneficiary’s salary or pension, so no separate payment process is required.

Q. Are pre-existing diseases covered under MEDISEP?

Ans. Yes. One of the biggest advantages of the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP) is that all pre-existing diseases are covered from Day 1, without any waiting period.

Q. Does MEDISEP cover OPD or outpatient treatment?

Ans. No. MEDISEP mainly covers hospitalization and inpatient treatment. Routine outpatient consultations and OPD expenses are not covered under the scheme.

Q. Can beneficiaries receive treatment at private hospitals?

Ans. Yes. Cashless treatment is available at both empanelled government and private hospitals that are part of the MEDISEP network.

Q. Can treatment be taken at a non-empanelled hospital?

Ans. Yes, but only in specified emergencies such as cardiac arrest, stroke, or road accidents. In such cases, reimbursement can be claimed through the MEDISEP portal within the prescribed time limit.

Q. Is there any additional support for organ transplants and other high-cost treatments?

Ans. Yes. MEDISEP Phase-II includes support from a dedicated Rs. 40 crore catastrophic illness corpus fund, which helps cover eligible high-cost treatments such as organ transplants and other serious medical procedures.

Q. How can I download my MEDISEP ID Card?

Ans. Visit the official MEDISEP portal, verify your status using your PEN/PPO Number and Date of Birth, and then download your QR Code-enabled MEDISEP ID Card through the Med Card section.

Q. Are family members covered under the Medical Insurance for State Employees and Pensioners Scheme (MEDISEP)?

Ans. Yes. Eligible family members such as spouse, dependent children, differently-abled children, and eligible dependent parents can be covered under MEDISEP, subject to the scheme guidelines.

Q. Are newborn children covered under MEDISEP?

Ans. Yes. A newborn baby receives automatic coverage under MEDISEP from birth up to 90 days. Thereafter, the child should be formally added to the beneficiary database for continued coverage.

Q. Is there any restriction on maternity benefits?

Ans. Yes. Maternity benefits, including normal delivery and caesarean section, are available under MEDISEP, but the benefit is limited to two living children.

Q. How much time does it take for cashless treatment approval?

Ans. Normally, pre-authorization requests are processed within 12 working hours. Emergency requests are usually approved within 1 working hour. If no decision is communicated within the prescribed period, the request may be treated as deemed approved as per scheme provisions.

Q. What should I do if my claim is rejected or delayed?

Ans. Beneficiaries can first approach the District Level Grievance Redressal Committee (DGRC). If the issue remains unresolved, an appeal can be filed before the State Level Grievance Redressal Committee (SGRC).

Q. How can I contact MEDISEP for assistance?

Ans. Beneficiaries can call the MEDISEP toll-free helpline at 1800-425-1857, send an email to info.medisep@kerala.gov.in, or visit the official portal for support related to enrollment, claims, hospitals, and grievance redressal.

Tabassum

Tabassum is a government schemes researcher and writer with 5 years of experience tracking Central and State welfare scheme programmes across India. She has covered 500+ schemes spanning agriculture, women welfare, education, and housing, helping lakhs of beneficiaries understand their entitlements in simple language.