After evaluating the overall functionality of the Megha Health Insurance Scheme, the State government has decided to implement a restructured scheme in convergence with Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) managed and administered by the National Health Authority, Government of India
The scheme will be known as the Megha Health Insurance Scheme Phase 5 (MHIS-5) and will provide an insurance cover of Rs 5,30,000 for all eligible beneficiaries on a family floater basis to beneficiary family units through a network of empanelled hospitals. The estimated number of beneficiary family units is 7,26,530.
The Health Department through the State Nodal Agency has recently invited competitive quotations from insurance companies which fulfill the eligibility criteria as laid down in the tender documents for the implementation of MHIS-5 and PMJAY in all districts of the State. The contract with the selected insurance company is expected to be signed on August 3.
MHIS-5 is intended to benefit all persons that are residents in all the districts of the State including all families belonging to the SECC category of families but not including families that include one or more members that are government servants. However, any member of a government servant family who is not eligible for any reimbursement benefits should be provided with the benefit coverage under MHIS 5.
The beneficiaries shall be registered by the insurer based on the information available within the beneficiary database provided by the State Nodal Agency and at a period as specified by the agency.
Coverage for meeting expenses of hospitalisation for medical or surgical procedures included maternity and new-born benefits, selected outpatient procedures, surgical day care procedures, outpatient diagnostic services or any other treatment classified as Health Benefit Package given under Schedule 3 of the insurance contract for up to Rs 5,30,000 per family per policy year subject to limits in any of the empanelled health care providers across India. The benefit to the family will be available on a floater basis meaning benefits can be availed individually or collectively by members of the family per policy year.
It may be mentioned that the Meghalaya government had implemented the MHIS Phase 1 to 3 in convergence with the erstwhile Rashtriya Swasthya Bima Yojana.
The State government had also implemented the MHIS-4 in convergence with the PMJAY providing an insurance cover of Rs 5 lakh per household belonging to identified SECC category of families along with already enrolled RSBY beneficiary families not existing in the SECC database. The scheme was provided on a family floater basis to beneficiaries’ family units through a network of empanelled healthcare providers.
