SHILLONG, Sep 9: The state government has extended the policy coverage of Megha Health Insurance Scheme (MHIS) Phase VI by one year from September 1 to August 31, 2025, with a sum of Rs 5.3 lakh insured per household.
“All eligible beneficiaries in Meghalaya, excluding state and central government employees, can avail the benefits in all empanelled hospitals under the scheme,” Ram Kumar, CEO of MHIS, said on Monday.
He also said that the State Nodal Agency-MHIS (SNA-MHIS) had received a letter from the private hospitals in August wherein they expressed their concerns on the implementation of Megha Health Insurance Scheme Pradhan Mantri Jan Arogya Yojana at the hospitals.
According to him, they expressed various concerns regarding processing and settlement of claims. He said similar concerns were previously brought to the attention of SNA-MHIS by the private hospitals. These concerns were addressed during the State Grievance Redressal Committee meeting held on August 7, he added.
Kumar further stated that steps were taken to resolve the issues. He said despite these efforts, certain challenges remained due to issues related to the technological platforms used for claims processing and payments.
He mentioned that the private hospitals had subsequently expressed their grievances through a letter written to Chief Minister Conrad K Sangma.
“Following the letter received on September 2, the SNA-MHIS immediately convened a meeting with private hospitals to address the concerns. During this meeting, the hospitals informed SNA-MHIS that they would temporarily suspend cashless services for MHIS-PMJAY patients until the issues were fully resolved,” he said.
He said consequent to the September 2 meeting, the private hospitals had on September 3 informed SNA-MHIS through a letter that they are willing to extend cashless benefits to MHIS-PMJAY patients but the issues highlighted in the letter should be addressed at the earliest.
To address the issues raised by the private hospitals, Kumar said he, along with a team from SNA-MHIS, held discussions with officials from the National Health Authority in New Delhi.
The team from SNA-MHIS and officials from the insurance company were stationed in the national capital for four days to resolve the pending issues, he said.
“As per the reports of the insurance company, a total claims settlement of Rs 3.59 crore has been made from September 2 to 9,” Kumar said.
He added that altogether 1,89,018 cases were raised under MHIS VI from September 1, 2023 to August 31, 2024. He said 1,55,211 (82%) of them were approved while the remaining are pending.
According to him, the pending cases are for both public and private hospitals and these should be cleared within the next two weeks.
To ensure continued progress, he said he is conducting weekly reviews with the insurance company to follow up on the unresolved matters. He added that Health Minister Ampareen Lyngdoh is constantly monitoring the issue for timely resolution.
“Officials of the National Health Authority have also assured of daily monitoring until this is sorted out,” he further said.
