Demands for lower MEDISEP premiums are unrealistic. That is what experts are saying now. The scheme covers government employees and pensioners in Kerala. Insurers are facing huge losses on this plan.
The claims ratio hit 120% in the 2023-24 financial year. This means for every ₹100 collected, insurers pay out ₹120. This is a big problem. No insurer can survive such losses.
MEDISEP’s Current Financial Challenge
The MEDISEP scheme covers about 10 lakh people. These are Kerala government employees and pensioners. Each person pays ₹500 per month. This means ₹6,000 per year. This premium amount has been fixed since 2022.
The current insurer is Oriental Insurance Company (OIC). OIC has lost a lot of money. Claims reached ₹1,050 crore in 2023-24. But OIC only collected ₹875 crore in premiums. That is a shortfall of ₹175 crore.
“The current premium is very low,” said a former insurance managing director. Experts agree. The scheme covers treatments up to ₹3 lakh annually. Organ transplants get up to ₹15 lakh. These are big benefits for a low premium. This makes it hard for insurers to profit. For general information on health insurance, you can visit the IRDAI website.
Future of the MEDISEP Scheme
OIC’s contract ends very soon. It finishes on June 30, 2024. The Kerala government is looking for a new insurer. They started a tender process. But few companies may bid if the premium stays low.
Insurers in other states are also facing issues. Some are pulling out of similar government schemes. Others are raising premiums. This happens because of big losses. Rajasthan is one such example.
Pensioners and unions want a lower premium. They ask the government to pay some of it. But experts say the government already pays a service charge. A premium hike might be more likely than a cut.
What Experts Suggest for MEDISEP
Experts offer solutions for the current problem. They say the government should pay part of the premium. This would make the scheme sustainable. Some other states do this already.
* Karnataka’s government pays 50% of the premium.
* Tamil Nadu also shares the cost.
This helps insurers manage the high claims. It also keeps premiums affordable for beneficiaries. Will the Kerala government consider this? Only time will tell. For more about Kerala state initiatives, check the official Kerala Government portal. The goal is to keep health coverage for all. But it must be fair for insurers too.
