Rashtriya Swasthya Bima Yojana + Universal Health Insurance Scheme

 
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meghalaya.gov.in
 
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Frequently Asked Questions

1. What is MHIS?

MHIS has been introduced as a health insurance by the Government of Meghalaya, following the framework of RSBY. It is called Megha Health Insurance Scheme (Rashtriya Swaythiya Bima Yojana + Universal Health Insurance Scheme).

2. Why is the card RSBY?

Since MHIS uses the existing RSBY framework for the implementation of the scheme, the RSBY card is being used. MHIS is an additional cover using RSBY as a base which provides seamless all India health insurance cover of the basic RSBY cover to beneficiaries using the technology platform and card of RSBY while at the same time providing the MHIS related additional benefits on the same card.

3. Who are entitled to the scheme?

All the citizens of the state of Meghalaya are entitled excluding State and Central Government employees.

4. How many members are entitled for the scheme?

A maximum of five (5) members of the family are entitled to the Megha Health Insurance Scheme.

5. How much does the MHIS beneficiary have to pay to avail the scheme?

MHIS beneficiary will have to pay only ` 30 at the time of enrolment.

6. Who pays the premium to the insurance company?

The premium will be paid by the Government and not the beneficiary.

7. What is the source for the data of beneficiary list?

The data has been compiled by using the 2013 electoral roll.

8. Why are some people not included in the data?

Since the beneficiary list was prepared prior to the current electoral roll, certain names may be excluded. Next year, the latest database will be taken into consideration, and new beneficiaries will be added to the current list.

9. What is the enrollment process?

An electronic list of eligible households is provided to the insurer, using a pre-specified data format. An enrollment schedule for each village along with dates is prepared by the insurance company with the help of the district level officials. The date and location of the enrollment in the village is publicized in advance. Mobile enrollment stations are set up at local centres in each village. These stations are equipped by the insurer with the hardware required to collect biometric information (fingerprints) and photographs of the members of the household covered and a printer to print smart cards with a photo. The smart card, along with an information pamphlet, describing the scheme and the list of hospitals, is provided on the spot once the beneficiary has paid the 31 rupee fee and the concerned Government Officer has authenticated the smart card. The cards shall be handed over in a plastic cover.

10. What is the insurance cover for the scheme?

Megha Health Insurance Scheme covers hospitalization expenses up to `2,00,000 for a family of five on a floater basis.

11. What is meant by floater basis?

Floater basis means that the total amount can be used by one person or jointly with other members of the family.

12. What is meant by hospitalization?

Hospitalisation means admission to hospital for 24 hours or more. MHIS applies to such hospitalization. However, it includes such day care treatments entailing less than 24 hours that are in the specified list.

13. What is the maximum amount a beneficiary can avail at one point of time?

A single beneficiary can avail a maximum of about `170000 at one point of time.

14. What are package rates?

Packages Rates are pre approved rates that are available for specified surgical and medical procedures. The link for package rates is MHIS-%20Package-%20rates.pdf

15. What about procedures not specified in the package rates.

For unspecified procedures, the concerned hospitals will need to seek manual approval from the insurance company.

16. What is not covered under MHIS?

MHIS does not cover OPD expenses or expenses in hospitals which does not lead to hospitalization.

17. What is excluded under the scheme?

There are certain common exclusions under the scheme, which are as follows -
1. Conditions that do not require hospitalization
2. Congenital external diseases
3. Drug and Alcohol Induced illness
4. Sterilization and Fertility related procedures
5. Vaccination
6. War, Nuclear invasion
7. Suicide
8. Naturopathy,Unani, Siddha, Ayurveda

18. Which hospitals are under the scheme?

All public hospitals and health centres of the state and a few private hospitals are empanelled under MHIS. The list of hospitals can be seen here - http://meghealth.gov.in/mhis/hospitals.html

19. Is the scheme valid for admission in Private Hospitals?

The scheme is valid for hospitalization in empanelled private hospitals in the state of Meghalaya as well as outside the state

20. What is the purpose of empanelling certain hospitals outside Meghalaya?

Hospitals have been empanelled outside Meghalaya, to be able to provide critical and cancer treatment facilities to the residents of Meghalaya. To see the list please visit Hospital/Empanelled_Hospital_outside_Meghalaya.pdf

21. Why is there an out of pocket expense with regards to Private Hospitals?

In certain private hospitals, the cost of certain procedures is more than the specified rates. In those cases, the beneficiary will have to pay the exceeding amount from their own pockets.

22. Is the scheme entitled only for admission to General Ward?

Under MHIS, the beneficiary can be admitted to General Ward, Private Ward or ICU. In case of hospitalization in Private Ward, patients will have to pay the excess amount out of their own pockets.

23. How to use the smart card in empanelled hospital?

The card needs to be handed over to the officer in-charge in the MHIS counter present in the hospital on the day of admission.

24. Can more than one member be admitted/treated under one smart card at the same time?

Yes, more than one member of a family can be treated at the same time. In case all members require hospitalization at the same time, they can all utilize the card and avail the scheme.

 FOR FURTHER INFORMATION ON THE FUNCTIONING OF THE SCHEME KINDLY VISIT http://rsby.gov.in/faq_scheme.aspx