Success-Stories-on-Health-Sector

mEgHalaYa
mEgHa HEaltH insuranCE sCHEmE
ProblEm statEmEnt
Out of pocket expenditure in Meghalaya is very
high. The project aims to decrease the out of pocket
expenditure by households on health care.
ProgrammE DEsCriPtion
Megha Health Insurance Scheme (MHIS) was launched
in 2012. it provides coverage to all the households in the
State for hospitalisation up to Rs. 1,60,000 on a family
floater basis. Five members per household are covered,
and each household pays Rs. 31 as registration fee for
enrolment. There is no age limit and pre-existing diseases
are also covered. State and Central government employees
are excluded. Each enrolled household receives a unique
digital identity card – MHIS smart card to avail of the
benefits at both public and private empanelled hospitals
for 1288 procedures (including cancer/critical care).
Around 170 hospitals (in the State) and 13 super-specialty
hospitals (outside the State) are empanelled. The premium
on behalf of the enrolled household is funded by the State
government. The programme is implemented by the State
nodal agency through a private insurance company,
selected through a competitive bidding process. in the
empanelled public hospital, 30% of the reimbursements
received is paid as an incentive to doctors and staff and
the rest is utilised for infrastructural development. a
grievance redressal mechanism has also been set up at the
district level and above.
sCalabilitY
The total number of packages to increase to 1704
procedures, specially to include OPD benefits, criticalcare
surgical benefits and follow-up care for critical
illnesses.
ConClusions/lEssons lEarnt
In 2013, approximately 2 lakh households (46% of
total households) in the State have been enrolled and
32000 beneficiaries have availed of the benefits. From
the reimbursements received by public hospitals
the scheme has helped improve the public health
facilities in the State through purchase of medical
equipment, patient beds, generators and other
infrastructure. a planned enrolment route map for
enrolment is yet to be developed to increase enrolments.
activities to generate awareness to be held for
beneficiaries.
rEFErEnCE
http://www.meghealth.gov.in/mhis/welcome.html
Contact
Chief Executive Officer
State Nodal Agency -Megha Health Insurance Scheme,
Department of Health and Family Welfare,
government of Meghalaya
Email: rsbymegh@gmail.com
165