by Medisep 2026, the second phase of Kerala’s Medical Insurance for State Employees and Pensioners, has raised the health cover to ₹5 lakh and added hundreds of new treatment packages. Phase 2 started on 1 February 2026 and covers around 32 lakh people, including government employees, pensioners and their dependants. Here is everything you need to know about the cover, premium, hospitals, card download and how to make a claim.
Medisep 2026 Phase 2 at a Glance
| Feature | Phase 1 | Phase 2 (Medisep 2026) |
|---|---|---|
| Start date | July 2022 | 1 February 2026 |
| Basic cover | ₹3 lakh | ₹5 lakh |
| Monthly premium | ₹500 | ₹687 (₹8,224 a year) |
| Treatment packages | 1,920 | 2,516 |
| Room rent limit | ₹2,000 | Up to ₹5,000 |
| Insurer | Oriental Insurance | Oriental Insurance |
| Age limit | None | None |
Who Is Covered Under Medisep 2026?
- Kerala state government employees
- Service pensioners and family pensioners
- Employees and pensioners of universities and local self-government institutions covered by the scheme
- Eligible dependants such as spouse, children and dependent parents, as per scheme rules
There is no age limit and no medical check-up, so existing illnesses are covered from day one.
Key Benefits in Medisep Phase 2
1. Higher ₹5 lakh cover
The basic cover has been increased from ₹3 lakh to ₹5 lakh, and medical and surgical packages can be claimed at the same time during one admission.
2. Cashless treatment in all empanelled hospitals
Every empanelled hospital must provide cashless treatment across all available departments. More private hospitals are being added to the network.
3. Knee and hip replacement in private hospitals
Joint replacement surgery, earlier limited to government hospitals, can now be done in empanelled private hospitals too.
4. Emergency care in non-empanelled hospitals
For accidents, heart attacks, strokes and ten other emergencies, treatment at a non-empanelled hospital is covered and the insurer pays the hospital directly.
5. Better room rent
Room rent up to ₹5,000 a day is allowed. Pay wards in government hospitals are covered up to ₹2,000. Any extra amount is paid by the patient.
6. One-time registration for day care
Patients who need regular dialysis or chemotherapy register once, instead of getting fresh approval every visit.
7. Catastrophic cover continues
Additional cover for organ transplants and other very serious procedures continues in Phase 2. Treatment at SCTIMST Thiruvananthapuram and JIPMER is reimbursable.
How to Download the Medisep Card
- Visit the official portal medisep.kerala.gov.in.
- Choose the option to download or view the Medisep ID card.
- Enter your Medisep ID, or your PEN (employee) / PPO (pensioner) number, as asked.
- Verify with the OTP sent to your registered mobile number.
- Download the card as a PDF and save it on your phone.
Your drawing and disbursing officer (DDO) or treasury can help if your details are missing or wrong.
How to Use Medisep for Cashless Treatment
- Check that the hospital is empanelled under Medisep 2026.
- Show your Medisep ID card and a photo ID at the hospital’s Medisep help desk.
- The hospital sends a pre-authorisation request to the insurer.
- Once approved, treatment is cashless within the package limits.
- At discharge, sign the final bill. Pay only for items not covered, such as extra room rent.
How to Raise a Complaint
If a hospital refuses cashless treatment or asks for extra money for covered packages, contact the Medisep grievance cell through the portal or the district-level grievance committee. Keep copies of bills, discharge summary and the pre-authorisation status.
Medisep vs Ayushman Bharat
Medisep is only for state employees and pensioners and is funded by their premium. Low-income families who are not government employees can check eligibility for Ayushman Bharat (Karunya Arogya Suraksha Padhathi), which offers up to ₹5 lakh per family in Kerala.
Medisep 2026: How the Premium Is Paid
Members do not pay the Medisep 2026 premium separately. The monthly amount of ₹687 is deducted from salary for employees and from pension for pensioners through the treasury or the drawing and disbursing officer. Over a year this comes to ₹8,224 per member, and it covers the member and eligible dependants together. Check your pay slip or pension statement to confirm the deduction; if it is missing, inform your DDO or treasury officer, because a missing deduction can create problems during claims.
Who Counts as a Dependant?
Dependants under Medisep 2026 are defined by the scheme rules. In general, they include the spouse, children who meet the age and dependency conditions, and parents who are fully dependent on the member. Details such as the age limit for children and income limits for parents are set in the government order, so verify your family list on the Medisep portal. Add or correct dependants through your DDO as early as possible; adding a family member in the middle of a hospital stay can delay approval.
Step-by-Step: Using Medisep 2026 at a Hospital
- Before admission: Confirm on the Medisep portal or with the hospital’s insurance desk that the hospital and the department are empanelled.
- At admission: Show the Medisep ID card and a photo ID. The help desk registers the patient and raises a pre-authorisation request.
- During treatment: The insurer reviews the request. For planned surgery, approval may come before the procedure; in emergencies, treatment starts first and approval follows.
- At discharge: Check the final bill. Covered package costs are settled directly between the hospital and the insurer. You pay only for non-covered items like room upgrades beyond the limit.
- After discharge: Keep copies of the discharge summary and bills for your records.
Documents to Keep Ready
- Medisep ID card (digital or printed)
- Photo ID such as Aadhaar or service ID
- PEN number (employees) or PPO number (pensioners)
- Doctor’s referral or prescription for planned admissions
- Previous medical records for chronic conditions
- For dependants, proof of relationship if asked
What Medisep 2026 Usually Does Not Cover
Like most group health schemes, Medisep 2026 focuses on in-patient treatment. Outpatient consultations, routine medicines bought outside, cosmetic procedures, and treatments not included in the package list are generally not covered. Room charges above the ₹5,000 limit are paid by the patient. Always ask the hospital help desk whether a planned procedure is part of the Medisep 2026 package list before admission.
Phase 1 Experience and What Changed
During the first phase, members often complained about limited private hospitals, low room rent limits and refusals of cashless treatment. Medisep 2026 tries to fix these issues: every empanelled hospital must offer cashless care across all its departments, room rent support is higher, joint replacements are allowed in private hospitals, and there is a clear emergency route for non-empanelled hospitals. The number of packages has also gone up from 1,920 to 2,516.
Important Dates for Medisep 2026
- Phase 1 period: July 2022 to January 2026
- Phase 2 start: 1 February 2026 (one month after the planned 1 January date)
- Premium deduction: Monthly, through salary or pension
- Hospital list updates: Ongoing as more hospitals are empanelled
Raising a Grievance Under Medisep 2026
If a hospital denies cashless treatment, charges extra for covered packages or delays approval, members can raise a grievance. Start with the Medisep help desk in the hospital and note the request number. If unresolved, file a complaint through the Medisep portal or the district grievance redressal committee. Keep copies of bills, the pre-authorisation status and any written refusal. Complaints with clear documents are resolved faster.
Tips to Get the Most From Medisep 2026
- Save the Medisep 2026 card on your phone and print one copy for elders.
- Check the empanelled hospital list near your home and workplace in advance.
- Ask for the package name and amount before planned surgeries.
- Use the day-care one-time registration for dialysis or chemotherapy.
- Report errors in family details to your DDO immediately.
Medisep 2026 for Pensioners
Pensioners get the same ₹5 lakh benefits under Medisep 2026, with the premium deducted from monthly pension. As there is no age limit, elderly members can get treatment for age-related illnesses such as heart disease, cataract, joint problems and kidney disease within package limits. Family pensioners are also covered. Pensioners who face issues with their ID card should contact the treasury where they draw pension.
How to Find Empanelled Hospitals
The Medisep portal publishes the list of empanelled hospitals, district by district. Search by district and specialty to see which hospitals near you accept the scheme. Because new hospitals are being added under Phase 2, check the list again before any planned treatment, even if you looked a few months ago. Large private hospitals usually have a dedicated insurance or Medisep desk near the admission counter; call them in advance to confirm the package and the documents they need.
Emergency Treatment: What to Do
In a real emergency, save life first. Take the patient to the nearest hospital that can handle the case. For accidents, heart attacks, strokes and the other listed emergencies, treatment at a non-empanelled hospital is covered, and the insurer is expected to pay the hospital directly. Inform the hospital that the patient is a Medisep member as soon as possible and share the ID card. Family members should also inform the Medisep help desk or insurer helpline listed on the portal. Keep every bill, test report and the discharge summary.
Day-Care Treatments and Chronic Illness
Patients with kidney failure, cancer or other long-term illnesses often need repeated hospital visits. Under Phase 2, day-care procedures such as dialysis and chemotherapy need only one registration, after which repeat sessions continue without fresh approval each time. This saves time for patients and families. Ask the hospital to register the treatment plan at the first visit.
Catastrophic Illness Cover
Some treatments are very expensive, such as organ transplants and certain complex surgeries. The scheme keeps a separate catastrophic cover for a list of such procedures, over and above the basic ₹5 lakh. The exact list and limits are notified by the government. If a doctor advises one of these treatments, ask the hospital’s insurance desk to check eligibility under catastrophic cover before admission.
Real-Life Example
Consider a retired teacher in Kozhikode who needs a knee replacement. In Phase 1, this surgery was covered only in government hospitals, which had long waiting lists. Under Medisep 2026, she can choose an empanelled private hospital. The hospital raises a pre-authorisation for the knee replacement package, the insurer approves it, and the surgery is done without paying the package cost. She pays only if she chooses a room above the ₹5,000 limit or buys items not in the package.
Medisep and Other Insurance
Some members also have private health insurance. You can use Medisep first and keep the private policy for costs that Medisep does not cover, subject to the private insurer’s rules. Families of non-government workers should look at central and state schemes; for example, PM Jeevan Jyoti Bima Yojana and PM Suraksha Bima Yojana give low-cost life and accident cover through bank accounts.
Common Problems and Quick Fixes
| Problem | What to do |
|---|---|
| ID card not downloading | Check PEN/PPO number; contact DDO or treasury |
| Dependant missing in card | Submit details with proof to DDO for update |
| Hospital refuses cashless | Ask for written reason; file grievance on portal |
| Extra charges for covered package | Keep bill; complain to grievance committee |
| Premium not deducted | Inform DDO/treasury immediately |
Final Word
Medisep 2026 is a big improvement for Kerala’s employees and pensioners: higher cover, more packages, better room rent and stronger emergency support. Spend ten minutes today downloading your card, checking dependants and noting the nearest empanelled hospitals. That small preparation can save a lot of stress when someone in the family needs care under Medisep 2026.
Who Manages the Scheme?
The scheme is run by the Finance Department of the Government of Kerala, with Oriental Insurance as the insurer for Phase 2. The Finance Department sets premium, packages and rules through government orders, while the insurer processes pre-authorisations and payments to hospitals. District-level committees handle grievances. Knowing who does what helps you go to the right office: the DDO or treasury for card and deduction issues, the hospital desk and insurer for claims, and the grievance committee for disputes.
New Employees and Recently Retired Members
Employees who joined service recently are added to the scheme through their office, and their premium deduction begins from salary. Their Medisep ID is generated after the details are uploaded. New retirees continue as pensioners; their record moves from the salary side to the pension side, and the deduction shifts to the monthly pension. In both cases, there can be a short gap while records update, so check the portal a month or two after joining or retiring and inform the DDO or treasury if your card is not active.
Why the Premium Went Up
The premium rose from ₹500 to ₹687 a month because the cover increased from ₹3 lakh to ₹5 lakh, the room rent limit went up, packages increased by almost 600, and private hospital coverage widened. The earlier proposed figure was ₹810, so the final amount is lower than first announced. For a family that needs even one major surgery in five years, the added cover usually outweighs the higher premium.
Checklist for Members
- Card downloaded and saved
- Dependants verified on the portal
- Monthly deduction visible in pay slip or pension statement
- Nearest empanelled hospitals noted
- Grievance route understood
Medisep 2026 for Families Living Away From Kerala
Some dependants, such as children studying outside the state, may need treatment far from home. The scheme mainly works through hospitals empanelled in Kerala, plus a few reimbursable institutions like SCTIMST in Thiruvananthapuram and JIPMER in Puducherry. For treatment outside this network, especially planned procedures, coverage may not apply, so check the rules before admission. In a true emergency outside the network, keep every document and contact the insurer at once to understand what can be reimbursed under the emergency provisions.
Keep Your Information Current
Change of mobile number, address, marriage, birth of a child or the death of a dependant should be updated in your records through the DDO or treasury. Outdated information is the most common cause of claim delays. A quick yearly review of your Medisep profile is a simple habit that saves trouble later.
Finally, remember that the scheme is meant to reduce the financial burden of hospital care, not replace preventive health. Regular check-ups, timely treatment of chronic illnesses and healthy habits remain the best protection for every family. Use the cover wisely, keep records safe, and help colleagues who are not yet familiar with the new rules.
Frequently Asked Questions
What is the Medisep premium in 2026?
The Phase 2 premium is ₹687 per month, or ₹8,224 per year, deducted from salary or pension.
How much is the Medisep cover in Phase 2?
Medisep 2026 gives a basic cover of ₹5 lakh, plus extra catastrophic cover for serious procedures.
When did Medisep Phase 2 start?
Medisep Phase 2 started on 1 February 2026.
Is there an age limit for Medisep?
No. Members and dependants of any age are covered, including those with existing illnesses.
Can I get treatment in a non-empanelled hospital?
Only in listed emergencies such as accidents, heart attacks and strokes. Planned treatment should be in empanelled hospitals.
Disclaimer: Details are based on official information reported for Medisep Phase 2. Check the Medisep portal or your DDO for the latest hospital list and rules.
