MHIS- Meghalaya Health Insurance Scheme

Megha Health Insurance Scheme, Meghalya - Key Exclusions

Meghalaya, located in northeastern India, is known for its indigenous communities and rich cultural heritage. Meghalaya is also called the “Scotland of the East” for its pleasant climate and hills.

However, like many regions in India, Meghalaya faces significant challenges in healthcare delivery due to its hilly terrain, dispersed population, and socio-economic disparities. To tackle these challenges, the state government of Meghalaya has introduced the Meghalaya Health Insurance Scheme. Let's explore the details of the Meghalaya health insurance scheme.

What is the Meghalaya Health Insurance Scheme, or MHIS?

The Megha Health Insurance Scheme (MHIS) was launched in 2012 by the Government of Meghalaya through the State Nodal Agency. In 2013, the implementation of MHIS was combined with Rashtriya Swasthya Bima Yojana (RSBY).

Previously, insurance coverage was up to ₹1.6 lakh for all residents of Meghalaya, except government employees. Primarily, RSBY provides coverage with secondary care and surgical packages with certain limitations. To fill this gap, the state government has launched a comprehensive MHIS introducing tertiary care packages including critical care, oncology, and others.

Since its commencement, the Meghalaya health insurance coverage has increased its worth up to ₹2.0 Lakhs in MHIS II, ₹2.8 Lakhs in MHIS III (for enrolled senior citizens, an extra cover up to ₹30,000), and further to ₹5 Lakhs in MHIS IV, eventually reaching ₹5.3 Lakhs in MHIS V.

This monetary enhancement is not only limited to financial coverage but also widens the scope of the scheme, achieved through ongoing government efforts to address implementation challenges. In 2019, the Megha Health Insurance Scheme, Shillong, Meghalaya, was linked with the Pradhan Mantri Jan Aarogya Yojana, initiating operational changes that have significantly improved service delivery in recent years.

In recent years, numerous amendments and modifications have been introduced to the scheme, aimed at boosting the quality of coverage afforded to beneficiaries.

What are the Key Objectives of Megha Health Insurance Scheme?

Enhancing hospital networks and improving implementation, administration, enrolment, and the reach of scheme benefits.

To minimise out-of-pocket expenses for residents of Meghalaya when accessing healthcare services

• To enhance overall service quality, including patient care
• To empower citizens and influence health-seeking behaviours
• To establish a sustainable and viable universal health insurance scheme for the people of Meghalaya
• To maintain a high-quality database of the state's population
• To provide adequate health care coverage based on the need for tertiary care procedures and regional disease prevalence
• To implement robust quality control and fraud prevention mechanisms

Key Features of Meghalaya Health Insurance Scheme (MHIS)

Since its commencement in 2012, the MHIS has consistently undergone amendments related to package rates and treatment coverage. The following are some key features and potential benefits of this scheme:

• Maximum coverage of ₹5.3 lakh per family on a floater basis can be received by each beneficiary.
• Enrolled candidates are required to pay a minimal fee of ₹30 upon enrollment.
• Once the enrollment process is done, beneficiaries are issued smart cards.
• The MHIS also allows eligible citizens to avail of services from tied-up hospitals located outside Meghalaya.
• A floater coverage of Rs. 2.80 lakh (and an additional ₹30,000 senior citizen cover for enrolled senior citizens) can be obtained for a family of five members under MHIS-III.
• Beneficiaries can get services from both government and private hospitals outlined in the scheme.  
• The insurance provider will facilitate your enrollment procedure by informing the beneficiaries before scheduling it.
• The enlisted hospital must obtain manual approval from the insurance provider for medical treatments not directly covered by the scheme.

Required Documents for Meghalaya Health Insurance Scheme

To verify the personal and family details, candidates are required to provide specific documents. The necessary documents for verification include:

• Birth certificate
• Ration card
• Aadhaar card
• MGNREGA job card
• Voter ID
• Any other Government certificate or ID card with a photo

Additionally, you must provide one of the following documents to verify your family details:

• RSBY/MHIS Card for the RSBY/MHIS category
• Headman’s certificate
• Ration card
• PM’s letter (only for the SECC beneficiary category)
• Any other government document listing all family members.

For the addition of a member, the following documents are required:

• Adoption certificate
• Ration card
• Headsman’s certificate
• Birth certificate
• Marriage certificate

Eligibility Criteria of MHIS

Every Indian citizen who is a resident of Meghalaya is eligible to enrol in the Megha Health Insurance Scheme, except for individuals employed by the central and state governments.

Inclusions & Exclusions of Meghalaya Health Insurance Scheme

• The newborn baby is covered from birth until the policy's expiration for the specific year.
• For the coverage of cardiac and diabetic patients, special provisions are applicable.
• Coverage includes 1 day of pre-hospitalisation care and up to 5 days of post-hospitalisation care from the hospital, which are included under secondary care.
• Pre-existing conditions are covered from day one without any waiting period.
• Pregnant women obtain health coverage for both antenatal and postnatal care.

Key Exclusions:

• Expenses for vitamins and tonics, unless deemed essential for treatment authorised by the physician. Expenses incurred for evaluation or diagnostic purposes during hospitalisation.
• Infertility-related treatments that are not listed in the National Health Benefit Package.
• Surgeries for cosmetic procedures such as laser tattoo removal, augmentation surgeries, purely cosmetic procedures, and aesthetic rhinoplasty.
• Conditions manageable through outpatient care that do not require hospitalisation are excluded.
• Vaccination and immunisation.
• Circumcision for children under two years old, unless necessary for treating a non-excluded disease or due to an accident.
• Dental treatments or surgeries for corrective, prosthetic, or cosmetic purposes, including tooth cavity fillings, dental implants, root canals, and periodontal diseases. Except for trauma or injury-related treatments, bone treatment for neoplasia, tumours, or cysts requires hospitalisation.

Importance of a Comprehensive Health Insurance Plan

While the government-sponsored health insurance scheme- the MHIS undoubtedly stands as a remarkable initiative by the Meghalaya government, offering comprehensive healthcare support and coverage for the people hailing from Meghalaya, it is wise to complement it with a private comprehensive healthcare plan. Investing in a private comprehensive health policy ensures coverage for healthcare services excluded under MHIS and offers adequate protection from unforeseen medical circumstances. With Star Health insurance, people can select from a wide range of health insurance plans as its plan is specifically crafted to offer extensive health coverage to meet the individual's personalised medical needs.

Star Health’s extensive insurance plans extend to comprehensive plans like critical illness insurance, senior citizen plan, and family floater plan, ensuring that there is a suitable option for every individual's unique needs. However, it is imperative to evaluate the coverage and premiums offered by a particular health policy when considering buying a health insurance policy.

Final Thoughts!

The Megha Health Insurance Scheme proved to be a vital lifeline for the households of Meghalaya as it offers comprehensive healthcare coverage and a financial cushion against unexpected medical expenses.

As the scheme persistently undergoes amendments and modifications to fit the changing healthcare landscape, demonstrating its enduring commitment to improving healthcare facilities and building a healthier future for the residents of Meghalaya.