IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT THE HONOURABLE MR. JUSTICE D. K. SINGH THURSDAY, THE

16TH DAY OF JANUARY 2025 / 26TH POUSHA, 1946 WP(C) NO. 91 OF 2023 PETITIONER:

P.A. GANGADHARAN AGED 70 YEARS S/O. AYYAPPANKUTTY, PALLATHUKUDI, CHULLI PARAMBIL, METHALA P.O., PERUMBAVOOR, PIN. THE SECRETARY, KERALA STATE PENSIONER’S SANGH, KUNNATHUNAD TALUK SAMITHY, PERUMBAVUR, ERNAKULAM., PIN - 683545 BY ADVS. B.PRAMOD BIJU VIGNESWAR ASWATHI SURESH AYYAPPADAS V RESPONDENT/S:

1 THE STATE OF KERALA, REPRESENTED BY ITS SECRETARY TO GOVERNMENT FINANCE (HEALTH INSURANCE) DEPARTMENT, SECRETARIAT, THIRUVANANTHAPURAM, PIN - 695001 2 ORIENTAL INSURANCE COMPANY

2ND FLOOR, MAHATMA GANDHI ROAD, REVIPURAM, PERUMANOOR, ERNAKULAM, REPRESENTED BY ITS MANAGER., PIN - 682036

3 VIDAL HELATH INSURANCE TPA LTD MAHATMA GANDHI ROAD, VYTTILA, ERNAKULAM, KERALA, REPRESENTED BY ITS MANAGER., PIN - 682001

4 M/S FAMILY HEALTH PLAN INSURANCE LTD WARRIAM ROAD, PALLIMUKKU, ERNKAULAM, REPRESENTED BY ITS MANAGER., PIN - 682016 BY ADVS.

K.S.SANTHI, SC, ORIENTAL INSURANCE COMPANY LTD.

GEORGE A.CHERIAN JACOB MATHEW KAITHALIL(K/000596/1989)

GEORGE CHERIAN (SR.)(G-81)

SRI.P.K. BABU -SPL.GP THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION ON

16.01.2025, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:

JUDGMENT

The petitioner is a retired employee from the General Education Department of the Government of Kerala. The petitioner also claims to be the Secretary of the Kunnathunadu Taluk unit of Kerala Pensioners’ Sangh, which is an association of persons who have retired from the different departments of the Government of Kerala. The petitioner has approached this Court in the present Writ Petition for modification of the ‘Medical Insurance Scheme for State Government Employees’ (MEDISEP), which has been rolled out by the State Government for providing the medical reimbursement to the employees undergoing treatment in hospitals. Most of the prayers are in the realm of the policy decision and this Court has no jurisdiction to lay down the policy decision. If the policy of the Government is not violative of the fundamental rights of the citizen, the policy decision cannot be interfered with.

2. The MEDISEP scheme is a welfare scheme in favour of the employees for reimbursing the medical expenses by the respective departments for the treatment undertaken by the employees including the retired employees, who are covered by the said scheme. The term of the scheme will expire in July 2025. At this stage, there is no question of any direction to the State Government even otherwise to modify the scheme as prayed for in this writ petition.

3. In the counter affidavit filed on behalf of the State, it has been stated that the benefit package of the MEDISEP scheme was finalised by the expert committee constituted by the Department of Finance for revision of packages and costing. As per the scheme, the insurer is required to reimburse the empanelled health care provider as per the package cost specified in the Government Order, G.O.(P) No.70/2022/FIN dated 23.06.2023. There is no instruction from the MEDISEP authorities or from the Government permitting to reduce the claim from the amount mentioned in the package. Therefore, I do not find that the apprehension of the petitioner has any basis in view of the specific stand taken by the Government that no such direction has been issued to reduce the amount mentioned in the packages. It is further stated that the scheme started functioning from 01.07.2022 and till 06.01.2023, 4,75,212 claims were approved under the scheme and an amount of Rs.10,65,38,71,698/- was utilised for such cases under the scheme. The said MEDISEP scheme has been implemented through Oriental Insurance Company Limited (OICL) for a block period of three years and the treatment packages have already been fixed. A contract in this connection has been signed between the OICL and the Government of Kerala, and there is no question of modifying the contract either by the G