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.
The following eligibility criteria applies to Megha Health Insurance Scheme:
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 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:
|Benefits offered||Extent of coverage|
|Hospitalisation benefits||Rs.2.8 lakh (family floater cover for 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.
Some of the notable features of Megha Health Insurance can be listed as follows:
The following exclusions apply to Megha Health Insurance Scheme:
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.
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