SHILLONG: The new conditions set by the Health Department on the Megha Health Insurance Scheme (MHIS) has exposed glaring loopholes in the hurriedly-announced programme by the Congress Government just before the Assembly elections, ostensibly aimed at wooing voters.
The beneficiaries are unhappy over the new rules as they feel that they have been cheated by the Government for not making clear the various aspects of the scheme at the time of registration.
Moreover, there is nothing called a Megha Health Insurance Scheme since the smart card issued by the health department clearly mentions the name of the scheme as Rashtriya Swasthya Bima Yojana (RSBY), a Centrally-sponsored scheme, and the State Government has just used a fresh nomenclature only to take credit, the beneficiaries alleged.
As per the new guidelines which are being publicized by the Government through advertisements in the media – the data for the scheme has been compiled by using the 2007 electoral rolls since the beneficiary list was prepared was prepared prior to the current electoral roll (2013), certain names may be excluded in this phase of enrolment.
The announcement also states that next year the latest database will be taken into consideration and new beneficiaries will be added to the current list.
The detail on the total insurance cover was provided in the announcement stating that the upper limit is Rs 1.6 lakh and under cover A – Rs 30,000 is RSBY cover, Cover B – Rs 30,000 is for replenishment cover for RSBY, Cover C – Rs 30,000 for additional treatment only and Cover D – Rs 70,000 for critical care. The advertisement also states that the scheme is valid only for patients admitted into the general ward and anyone admitted to private ward will need to pay the excess out of their own pockets.
“In case of admission to private hospitals, beneficiaries will pay the amount exceeding the pre-approved package rates and in case of critical care, prior pre-authorization from the insurance company (ICICI Lombard) will need to be sort by the concerned hospital,” the advertisement added.
However, the beneficiaries argued that they were not made aware of the new guidelines since the department and the authorities, at the time of registration, had claimed that the upper limit for treatment is Rs 1.6 lakh without highlighting any further conditions. Moreover, the beneficiaries also claimed that they came to know about the rules only when they were admitted in hospitals and had to pay extra money from their pockets after the reimbursement was denied by the insurance company.