Meghalaya Health Insurance Scheme

The Government of Meghalaya developed a universal health insurance scheme for the state by improvising 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 hospitalisation 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.

Objectives to the Scheme:

  • One of the primary objectives of the MHIS is to create a practical and sustainable universal healthcare scheme for the residents of the state.
  • The scheme aims to enhance the benefits of the scheme through more efficient hospital networks, administration, enrollment, and utilisation of the scheme.
  • The MHIS strives to adhere to the highest quality standards in terms of maintaining the database of those enrolled to the scheme.
  • The government aims to keep the out-of-pocket expenditure of the residents to the minimum and does so by constantly monitoring the cost of the packages offered.
  • Coverage is adequately provided after taking into account the incidence rate of diseases and ailments that are prevalent in the state.
  • Furthermore, the scheme aims at improving the overall quality of service and facilities provided to patients.
  • Lastly, the MHIS aims to strengthen the voice of its residents and to empower them to actively seek treatment for their ailments.

Features and Benefits:

Since its initial launch in 2012, the MHIS has undergone regular changes with regard to the package rates and the treatments covered in the scheme. The following are some of the features and benefits of the scheme:

  • The MHIS-III provides the beneficiaries of the scheme a coverage of Rs.2.80 lakh on a floater basis for a family of 5 members.
  • A beneficiary of the MHIS can avail a maximum coverage of Rs.2.5 lakh in a single instance for medical treatments.
  • Beneficiaries of the scheme can avail services from hospitals empanelled in the scheme. These include both government-run and private hospitals.
  • At the time of enrollment, beneficiaries of the scheme are required to pay an enrollment fee of Rs.50.
  • The enrolment process is carried out by the insurance provider and beneficiaries are notified of the schedule ahead of time.
  • Beneficiaries receive smart cards once the enrolment process is complete.
  • For medical treatments that are not specifically covered by the scheme, the empanelled hospital will have to obtain manual approval from the insurance provider.
  • The scheme also permits beneficiaries to avail services from empanelled hospitals outside Meghalaya.

The most recent is the 4th phase of the scheme which will be integrated with the Pradhan Mantri Rashtriya Swasthya Suraksha Mission. The government of Meghalaya is yet to roll out the latest version of the scheme. It is scheduled to be in effect before the end of 2018 and will provide beneficiaries with coverage up to Rs.5 lakh.

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