Health Insurance Scheme In Meghalaya 2024 | Rashtriya Swasthya Bima Yojana (RSBY)

The government of Meghalaya developed a universal health insurance scheme for the state by improving on the structural framework of the Rashtriya Swasthya Bima Yojana (RSBY). The scheme provides coverage to all residents of the state apart from those who are employed by the state and central governments. The scheme was launched in 2012 with the aim of providing financial assistance for hospitalization to residents of the state.

 When the scheme was launched in 2012 it provided a health cover of RS 1.60 lakh to a family of 5 on a floater basis. To avail the services of the scheme, the beneficiaries were required to pay an enrollment fee of RS 31. Since 2012 a number of improvements and amendments have been made to the scheme to further enhance the coverage that the beneficiaries receive.

Eligibility Criteria For Meghalaya Health Insurance Scheme:

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The following eligibility criteria applies to Megha Health Insurance Scheme :-

• This Scheme is available for people who are residents of Meghalaya.
• The beneficiary list was prepared by using the 2016 electoral roll as the source material. Only those who are in the electoral roll can avail this cover.
• Central and state government employees are not covered in this scheme.
• There is no age limit for availing cover.
• Up to 5 members of a family can enroll in this cover on a family floater basis.

How To Enroll for The Scheme:

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The enrollment process for Megha Health Insurance Scheme is simple. Since the scheme is mainly intended for the protest section of the society, the enrollment process is mostly physical and involves the collection of biometric data and identity proofs. The process is given as follows-

• The insurance company will be provided with the list of eligible subscribers under this policy cover.
• The insurer will coordinate with the district level officials to come up with an enrollment schedule for various villages in a district.
• The enrollment date will announce for each village well in advance. Enrollment centers will set up in each village on a specific date.
• The enrollment center will collect the beneficiaries fingerprints, photograph, identity proof, etc.
• A smart card that contains all the collected information will print and provided to the beneficiary in the enrollment center.
• The scheme is currently in its phase iii of enrollment. To enroll in this scheme, the beneficiary must pay RS 50 towards enrollment fee. 

Benefits of the Scheme:

The Megha Health Insurance Scheme provides cashless treatment benefits for enrolled members. The premium charges applicable for the cover is paid by the government. During the time of treatment, the subscribed members must produce their smart card to avail cashless treatment in empaneled hospitals.

The cashless treatment benefit is based on the predetermined package rates for specific health conditions. Information regarding the package rates, empaneled hospital, claim status  etc. can  access from the scheme’s official website. The scheme is currently in Phase III of its enrollment. The benefit offered following the phase iii revision can be given as follows:-

Benefits Offered                                                        Extent of Coverage

Hospitalization benefits                                            RS 2.8 lakh (family floater cover up to 5 members)

Day Care Treatment                                                  Available for specific treatments

Senior citizen cover                                                  Additional coverage for RS 30,000

Coverage for pre-existing diseases                            Available

This coverage is valid for a period of one year. After one year, the policyholder must renew the smart card by paying the required enrollment fee. For the current phase of implementation, the government has chosen New India Assurance as the insurer after a bidding process.

Key Features of the Scheme:

• The maximum benefit a person can avail at one single time is RS 2.5 lakh for critical care and tertiary care treatments.
• Certain hospitals are also empaneled outside the state of Meghalaya for the benefits of this policy members.
• Coverage is available for admission in general ward, Intensive Care Unit, or private ward, however, beneficiaries must pay a little amount if admission for  private ward.
• More than one family members can receive treatment under this scheme at the same time.

Claim Process:

Since there are no reimbursement claims involved in the process between the beneficiary and the insurer, the claim process is straightforward. During the time of hospitalization, the beneficiary must provide the smart card to the officer at the MHIS counter. The officier will verify the details and approve the admission request. The smart card must also be produced during the time of discharge.

MORE INFORMATION YOU CAN VISIT THIS OFFICIAL WEBSITE

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