Govt to educate people on health scheme
SHILLONG: Health Minister AL Hek informed that there is a total registration of 54 per cent of Megha Health Insurance Scheme-IV in the state.
He was replying to a call attention motion moved by Congress MLA Mayralborn Syiem during the Autumn session of the Meghalaya Legislative Assembly on Wednesday.
Syiem urged the health minister to give wide publicity of the scheme to the public.
Hek informed that the Megha Health Insurance Scheme Phase IV is functioning in convergence with the Central Scheme Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) and therefore new guidelines have been integrated in the scheme.
Under the scheme, portability of patients is permitted across states which means if a hospital is empanelled under the scheme in Meghalaya, that hospital will need to provide its services to any eligible beneficiary from any state.
Similarly, for Meghalaya, the beneficiaries can utilize the scheme in any hospital empanelled under PMJAY.
On account of the new guidelines of PMJAY, the state government had anticipated that some issues may arise, therefore through the State Nodal Agency- MHIS, a letter was sent to the Central government in September 2018 seeking permission to empanel a few hospitals outside the state, specifically for beneficiaries of Meghalaya.
Access to hospitals
However, in its response to the state government, the National Health Authority permitted Meghalaya to empanel hospitals in states not implementing PMJAY (like West Bengal) since PMJAY guidelines permit states to empanel hospitals only in their own state.
Hek said the benefits of the new guidelines are that during previous phases of MHIS implementation, beneficiaries could access only a few hospitals outside the state.
Hek said that currently beneficiaries can access hospitals across the country. In Assam alone beneficiaries can access over 170 empanelled hospitals.
In fact, during MHIS III, beneficiaries from Meghalaya accessed only 9 hospitals in Assam, but in MHIS IV, beneficiaries have utilized the scheme in 21 hospitals (as per August 30, 2019 report), which are located across Assam and not just in Guwahati. Meghalaya beneficiaries have also utilized the scheme in Tata Memorial Hospital & Research Centre – Mumbai, AIIMS – Patna, Park Hospital – Gurugram among others.
As done in all previous phases, MHIS IV also follows the same guidelines, whereby beneficiaries are benefitted from the scheme as per package rates/list and Insurance Company settles claims as per the claims raised for each beneficiary.
Under MHIS IV, no delay in claims settlement has been observed and the insurance company is regularly paying the hospitals as per the timelines.
As on August 30, 2019, 41728 claims amounting to Rs 30 crore has been raised with 33,535 claims amounting to more than Rs 22 crore have been paid.
The State Nodal Agency – MHIS is in continuous communication and coordination with the National Health Authority and State Health Agencies of the different states, so that beneficiaries do not face any issues while utilizing the scheme outside the state.
Hek said efforts will also be taken to inform and educate the public in Meghalaya about the scheme’s guidelines, package list under the scheme, as well as the empanelled hospitals.