Meghalaya Health Insurance Scheme (MHIS)

The MHIS full form is Megha Health Insurance Scheme and was initiated in 2012 and spearheaded by the Government of Meghalaya through the State Nodal Agency. Implementation commenced in tandem with the Rashtriya Swasthya Bima Yojana (RSBY) in 2013.

Initially, the insurance coverage stood at ₹1.6 lakhs for all state citizens except state and central government employees. Recognising the limitations of the RSBY, which primarily covered secondary care and surgical packages, the comprehensive MHIS introduced critical care, oncology, and other vital tertiary care packages.

Since its inception, the Meghalaya health insurance coverage has progressively expanded to ₹2.0 Lakhs in MHIS II, ₹2.8 Lakhs in MHIS III (with an additional ₹30,000 senior citizen cover for enrolled senior citizens), and further to ₹5 Lakhs in MHIS IV, eventually reaching ₹5.3 Lakhs in MHIS V.

This growth isn't solely confined to increased financial coverage but also encompasses the broadening of the scheme's scope, achieved through persistent governmental interventions to address implementation challenges.

Notably, the Megha Health Insurance Scheme, Shillong, Meghalaya, has been integrated with the Pradhan Mantri Jan Arogya Yojana since its fourth phase (2019), ushering in operational changes that have notably enhanced service delivery over recent years.

Over the years, numerous improvements and amendments have been introduced to the scheme, aimed at augmenting the breadth and quality of coverage afforded to beneficiaries.

Enhancing the network of hospitals, as well as improving implementation, administration, enrollment, and utilisation of scheme benefits.

• Vigilantly monitoring cost packages to minimise out-of-pocket expenses.

• Enhancing overall service quality, including patient care facilities.

• Empowering citizens and influencing health-seeking behaviours through strengthened citizen voice.

• Establishing a sustainable and viable universal health insurance scheme for Meghalaya residents.

• Maintaining a high-quality database of the state's population.

• Providing sufficient coverage based on regional disease prevalence and the need for tertiary care procedures.

• Implementing robust quality control, monitoring, and fraud prevention mechanisms.

Since its inception in 2012, the MHIS has consistently undergone revisions concerning package rates and covered treatments. Here are some key features and advantages of the scheme:

• Each beneficiary can receive a maximum coverage of ₹5.3lakh per family on a floater basis.

• Upon enrollment, beneficiaries are required to pay an enrollment fee of ₹30.

• Upon completion of the enrollment process, beneficiaries are issued smart cards.

• The Meghalaya health insurance also allows beneficiaries to avail of services from empanelled hospitals located outside Meghalaya.

• MHIS-III offers beneficiaries a floater coverage of Rs.2.80 (and an additional ₹30,000 senior citizen cover for enrolled senior citizens) lakh for a family of five members.

• Beneficiaries have access to services from both government and private hospitals enlisted in the scheme.

• The enrollment procedure is facilitated by the insurance provider, with beneficiaries informed of the schedule beforehand.

• For medical treatments not explicitly covered by the scheme, the empanelled hospital must obtain manual approval from the insurance provider.

Every Indian citizen hailing from Meghalaya is eligible to enrol in MHIS, except for individuals employed by central and state government entities.

• Newborns are covered from birth until the policy's expiration for the respective year.

• Special provisions are made for the coverage of cardiac and diabetic patients.

• Secondary care includes coverage for pre- and post-hospitalisation expenses up to one day before admission and up to five days following discharge from the hospital.

• Pre-existing conditions are covered from the onset of the policy.

• Pregnant women receive coverage for both antenatal and postnatal care.

Exclusions of Meghalaya Health Insurance Scheme (MHIS)

• Expenses incurred at hospitals or nursing homes primarily for evaluation or diagnostic purposes during hospitalisation, and expenses for vitamins and tonics, unless deemed essential for treatment by the attending physician.

• Assisted reproductive techniques or infertility-related procedures not listed in the National Health Benefit Package.

• Surgeries for ageing-related cosmetic procedures, laser tattoo removal, augmentation surgeries, and purely cosmetic procedures such as fat grafting, neck lift, and aesthetic rhinoplasty.

• Persistent vegetative state, where patients are completely unresponsive to stimuli and display no higher brain function, sustained solely by medical intervention.

• Conditions that do not require hospitalisation and can be managed through outpatient care.

• Dental treatments or surgeries for corrective, prosthetic, or cosmetic purposes, including tooth cavity fillings, root canals, periodontal diseases, and dental implants. Exceptions apply for trauma or injury-related treatments, bone treatment for neoplasia, tumours, or cysts requiring hospitalisation.
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• Vaccination and immunisation.

• Circumcision for children under two years old, unless necessary for treating a non-excluded disease or due to an accident.

You are required to provide specific documents to verify your personal and family details. The necessary documents personal details verification include:

• Aadhaar card

• MGNREGA job card

• Voter ID

• Birth certificate

• Ration card

• Any other Government certificate or ID card with a photo

• Similarly, to verify family details, you must provide any of the following documents:

• 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

Here's a step-by-step guide to registering for the MHIS card:

Step 01: Visit your nearest empanelled hospital or district kiosk.

Step 02: Present the required document for personal identification.

Step 03: If you're adding family members, provide documents to prove your relationship with them.

Step 04: Pay the registration fee.

Step 05: Once the officials have completed the authentication process, your MHIS card will be issued.

While the Meghalaya Health Insurance Scheme (MHIS) undeniably stands as a remarkable initiative, offering invaluable support and coverage to the people of Meghalaya, it is prudent to complement it with an additional health insurance policy.

Investing in a comprehensive mediclaim policy ensures coverage for exclusions not covered by MHIS and provides enhanced protection for unforeseen medical expenses. With Tata AIG, individuals can choose from a wide array of individual and family floater medical insurance plans, each designed to offer extensive benefits tailored to their specific requirements.

Our diverse range of insurance plans extends to critical illness insurance, elder care, and parental insurance, ensuring that there is a suitable option for every individual's unique needs. When considering the purchase of a health insurance policy, it is imperative to evaluate the coverage and premium offered meticulously.

Tata AIG’s cashless medical insurance facility ensures policyholders can access a variety of medical services at their preferred hospitals without incurring out-of-pocket expenses, providing peace of mind and financial security in times of need.

The Meghalaya Health Insurance Scheme (MHIS) stands as a vital lifeline for the residents of Meghalaya, offering comprehensive healthcare coverage and financial protection against medical expenses.

As the scheme continues to evolve and adapt to the changing healthcare landscape, its enduring commitment to improving healthcare outcomes and fostering a healthier future for all remains persistent.