Kerala MEDISEP Scheme

Scheme Introduction: A Brief Overview

The Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) is a health insurance scheme of the Government of Kerala that provides medical coverage to eligible State Government employees, pensioners and their eligible family members. The scheme is mainly designed to reduce the financial burden of hospitalisation and major medical treatment by providing cashless treatment at MEDISEP empanelled government and private hospitals, subject to the approved treatment packages and scheme conditions.

The scheme is administered by the Finance Department, Government of Kerala, with The Oriental Insurance Company Limited as the insurance company. Overall, MEDISEP provides eligible employees, pensioners and their eligible family members with financial protection against covered hospitalisation and treatment expenses under the scheme's approved packages and conditions.

MEDISEP Phase I became operational on 1 July 2022. The scheme has now entered Phase II (MEDISEP 2.0) from 1 February 2026, bringing higher coverage and a wider range of treatments. Under Phase II, thebasic annual coverage has increased from ₹3 lakh to ₹5 lakh, while the number of treatment packages has increased from 1,920 to 2,516.

The scheme covers a wide range of medical and surgical treatments, along with expenses included in the approved treatment packages. These may include medicines, doctor and attendant charges, room charges, diagnostic services, implants and dietary charges, as applicable to the covered package. Pre-existing diseases are covered from the beginning of the insurance coverage without a waiting period. Eligible pre- and post-hospitalisation expenses are also covered for the prescribed period.

In addition to cashless treatment at empanelled hospitals, Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) has provisions for reimbursement of specified accident and emergency treatments received at non-empanelled hospitals, subject to the applicable rules. The June 2026 Government circular further provides an online reimbursement mechanism for specified emergency cases.

Apart from MEDISEP, the Government of Kerala also runs other health-related schemes such as the Sruthitharangam Scheme and the Oommen Chandy Health Insurance Scheme, which provide healthcare support to eligible beneficiaries under their respective guidelines. You can learn more about these schemes through the detailed guides linked below.

Scheme Benefits

MEDISEP Phase II provides enhanced medical insurance coverage compared with the first phase. The major benefits available under the scheme are given below.

• Annual health insurance coverage of up to ₹5 lakh under the basic benefit package, subject to the applicable scheme conditions.
• 2,516 treatment packages are included in Phase II, covering various medical and surgical procedures.
• Eligible beneficiaries can receive cashless treatment at MEDISEP empanelled hospitals for covered procedures.
• The private hospital room-rent ceiling has been increased to ₹5,000 per day under Phase II.
• A room-rent ceiling of ₹2,000 per day is applicable to pay wards in Government hospitals under the revised package provisions.
• Knee and hip replacement surgeries performed in eligible private hospitals can be covered under the revised Phase-II provisions.
• Medical and surgical packages can be combined where permitted under the applicable MEDISEP package rules.
• Specified regular treatments such as dialysis and chemotherapy have a one-time registration facility to simplify repeated treatment procedures.
• Specified emergency treatments received at non-empanelled hospitals may qualify for reimbursement under the Government's Phase-II emergency reimbursement guidelines.
• The scheme provides coverage for eligible family members and dependants according to the prescribed MEDISEP conditions.

Additional Coverage for Catastrophic Illnesses

MEDISEP provides additional coverage over and above the Basic Benefit Package for specified catastrophic illnesses and major procedures. The insurer is required to provide a separate corpus of at least ₹35 crore for three years for the additional catastrophic coverage.

Some of the procedures and package ceilings listed in the Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) Additional Benefit Package are:

These catastrophic package rates include procedure charges, implant costs, room charges and investigation costs. Expenses above the approved package ceiling are to be borne by the beneficiary.

Eligibility Requirements

Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) is intended for specified categories of Kerala Government employees, pensioners and their eligible family members. The following categories are covered subject to the conditions prescribed under the scheme.

• Serving employees of the Kerala State Government who fall under the applicable Government medical attendance rules.
• Eligible employees of the High Court of Kerala.
• Part-time contingent employees and part-time teachers covered under the scheme.
• Teaching and non-teaching staff of eligible Government-aided schools and colleges.
• Eligible employees and pensioners of universities receiving State Government grant-in-aid, subject to the applicable conditions.
• Eligible employees and pensioners of Local Self Government Institutions, as provided under the scheme.
• State Government pensioners and eligible family pensioners.
• Eligible spouses and other family members/dependants of covered employees and pensioners.
• Dependent children can be covered subject to the prescribed conditions. A dependent child generally remains eligible until employment, marriage or attaining 25 years of age, whichever occurs earlier.
• Differently abled dependent children can be covered without an age restriction, subject to the prescribed eligibility and supporting certification.
• Dependent parents can be included where they satisfy the conditions specified under the MEDISEP rules.
• All India Service officers serving under the Government of Kerala may be covered on an optional basis as provided under the scheme.

Eligibility for employees of specific boards, corporations, public sector undertakings, autonomous or statutory bodies and cooperative institutions is subject to the applicable MEDISEP provisions and the institution's participation in the scheme. Such employees should verify their eligibility through their concerned organisation or the MEDISEP portal.

Required Documents

The documents and details required may vary depending on whether the beneficiary is an employee, pensioner or family member. Generally, the following documents and details should be kept ready for MEDISEP-related services.

• MEDISEP ID card or MEDISEP ID, where already issued.
• Employee ID/PEN number for serving employees.
• PPO number or pension-related identification details for pensioners and family pensioners.
• Details of eligible family members/dependants to be included in the MEDISEP profile.
• Proof of relationship for eligible dependants, wherever applicable.
• Disability certificate for differently abled dependent children, where applicable.
• Hospital records, prescriptions, discharge summary, bills and other treatment documents for an eligible reimbursement claim.
• Bank account details where required for reimbursement processing.

How to Check MEDISEP Status and Download the Card

Eligible employees and pensioners can get their MEDISEP ID after their details are registered in the MEDISEP system through the concerned department or Treasury. Follow these steps to access your MEDISEP ID

Step 1: Check MEDISEP Status

• Visit the official MEDISEP website and open the "Status" section. This option can also be used to find your MEDISEP ID if you do not know it.
• Select your category:
  • Employee – if you are a serving employee
  • Pensioner – if you are retired
• Enter the required details:
  • Employee: Employee ID, PEN Number, Date of Birth and Treasury
  • Pensioner: PPO Number, Date of Birth and Treasury
• Click Submit. Your MEDISEP details, including your MEDISEP ID, name, mobile number, status and amount paid, will be displayed.

Step 2: Download the MEDISEP Card

• Once you have your MEDISEP ID, go to the "MEDCARD" section on the MEDISEP website.
• Select "Beneficiary" as the account type and enter:
  • MEDISEP ID
  • PEN Number for employees
  • PPO Number for pensioners
• Click Sign In.
• After logging in, you can view your MEDISEP details and download the MEDISEP Card.

Steps to Apply

MEDISEP is not a general public insurance scheme for which every resident can submit a fresh application. Eligible employees and pensioners are covered through the prescribed departmental, DDO or Treasury process. Beneficiaries can use the MEDISEP portal to check their details and access available online services.

• Firts you need to visit the official MEDISEP portal.
• Use the available login or status facility to check your MEDISEP details.
• Verify important information such as employee ID/PEN, PPO number, date of birth and family/dependant details.
• If there is an error in employee details, approach the concerned DDO or departmental authority for correction.
• Pensioners and family pensioners should approach the concerned Treasury Office for applicable corrections or updates.
• After the details are verified, download the MEDISEP ID card from the portal when available.
• For covered treatment, visit a MEDISEP empanelled hospital and present the MEDISEP ID/card at the designated MEDISEP or insurance desk.
• The hospital will verify the beneficiary details and process eligible treatment under the applicable MEDISEP package.
• For eligible emergency treatment at a non-empanelled hospital, follow the separate online reimbursement procedure prescribed under the Phase-II guidelines.
• Submit the emergency reimbursement claim and required documents through the MEDISEP portal within the prescribed time limit.

Emergency Reimbursement Under Phase II

MEDISEP Phase II provides a specific reimbursement mechanism for certain emergency treatments taken at non-empanelled hospitals. This facility is governed by the conditions prescribed by the Government and should not be treated as general reimbursement for every treatment taken at a non-empanelled hospital.

Relevant Links

• MEDISEP Official Portal – Government of Kerala
• MEDISEP Empanelled Hospital List
• Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) Reimbursement
• MEDISEP Circulars and Government Orders
• Kerala Government Document Portal
• Kerala MEDISEP Phase II – Emergency Treatment & Reimbursement Guidelines, June 2026
• Kerala Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) Phase II Guidelines – January 2026.
• Kerala Medical Insurance Scheme for State Employees and Pensioners (MEDISEP) Scheme Manual

Contact Information

• Department: Finance Department, Government of Kerala (MEDISEP)
• MEDISEP Helpline: 18004251857, 18004250237
• Email: [email protected]
• Address: Finance Department, Government Secretariat, Thiruvananthapuram, Kerala