Megha Health Insurance Scheme (MHIS)

• Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
• 10,000+ hospitals for cashless treatment
• Claim up to Rs. 55,000 deduction under section 80D**

Megha Health Insurance Scheme is a universal health insurance scheme introduced by the government of Meghalaya. As a universal health insurance scheme, this plan focuses on providing free health insurance benefits for the poorest sections of the society. This plan can be taken by anyone living in Meghalaya except for state and central government employees. This scheme follows the framework of the central government’s Rashtriya Swasthya Bima Yojana (RSBY), which was designed to provide health insurance coverage for underprivileged people.

Eligibility for Megha Health Insurance Scheme

The following eligibility criteria applies to Megha Health Insurance Scheme:

• This coverage 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 this cover.
• Up to 5 members of a family can be enrolled in this cover on a family floater basis.

Enrollment Process

The enrollment process for Megha Health Insurance Scheme is simple. Since the scheme is mainly intended for the poorest 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 be announced for each village well in advance. Enrollment centers will be set up in each village on a specific date.
• The enrollment center will collect the beneficiary’s fingerprints, photography, identity proof, etc.
• A smart card that contains all the collected information will be printed 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 Megha Health Insurance 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 empanelled hospitals.

The cashless treatment benefit is based on the predetermined package rates for specific health conditions. Information regarding the package rates, empanelled hospitals, claim status, etc. can be accessed 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:

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 Megha Health Insurance Scheme

Some of the notable features of Megha Health Insurance can be listed as follows:

• As noted, this scheme functions on the RSBY framework. Beneficiaries will get the RSBY smart card, and this coverage offers additional benefits over the existing benefits offered by RSBY.
• 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 empanelled outside the state of Meghalaya for the benefit of this policy members.
• Coverage is available for admission in general ward, intensive care unit, or private ward. However, beneficiaries must pay a little extra for private ward admission.
• More than one family members can receive treatment under this scheme at the same time.

Exclusions of Megha Health Insurance Scheme

The following exclusions apply to Megha Health Insurance Scheme:

• Self-inflicted injuries or attempted suicide
• Congenital external diseases
• Any kinds of cosmetic or aesthetic treatments
• Conditions that do not require hospitalisation
• Any illnesses caused due to drugs or alcohol
• Fertility related treatments or sterilization
• Injuries or illnesses caused by war or nuclear activity

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 hospitalisation, the beneficiary must provide the smart card to the officer at the MHIS counter. The officer will verify the details and approve the admission request. Following the treatment, the empanelled hospital will send the bill to the insurance company. The smart card must also be produced during the time of discharge.