MEGHA HEALTH INSURANCE SCHEME

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FAQ

MHIS has been introduced as a health insurance scheme by the Government of Meghalaya, following the framework of RSBY in the year 2012. It is now being implemented in convergence with Ayuhsman Bharat Pradhan Mantri Jan Arogya Yojana. It is called Megha Health Insurance Scheme (AB-PMJAY + Universal Health Insurance Scheme).

AB-PMJAY is the initiative of the Government of India to ensure that poor and vulnerable sections of society are provided health care. It is called the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana, this initiative is part of the Government’s vision to ensure that its citizens – especially the poor and vulnerable groups have universal access to good quality hospital services without anyone having to face financial hardship as a consequence of using health services. More details are available at www.pmjay.gov.in

All the citizens of the state of Meghalaya are entitled, excluding State and Central Government employees who are entitled under the State/Central reimbursement policy.

There is no restriction on the family size under the scheme.

There is no age limit under the scheme.

Individual E-Cards will be given to all Beneficiaries at the time of Registration.
A fee of ₹ 30 will be charged to each MHIS beneficiary, whereas SECC & RSBY beneficiaries do not need to pay the fee.

The data has been compiled by using the Socio-Economic Caste Census data of 2011 and the Electoral list of 2016.

The Scheme provides insurance cover of up to Rs 5,30,000 per family on a floater basis.

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

A beneficiary can walk into any District Kiosk and empanelled Hospital Registration Centres to register themselves under the scheme. They must provide a valid government issued Photo Identity Card for personal registration. To add members under the family, the beneficiary must provide supporting documents as proof of relation between members of the family such as Marriage Certificate, Birth Certificate, Ration Card or Headman/Village Certificate.

Upon completion of registration, the beneficiary will be handed an individual PMJAY/MHIS card.

After registration a paper ID card will be issued to all beneficiaries. The card will include the individual’s details such as photo, name, age, gender, bar code and the unique PMJAY/MHIS ID number.

Any one of the documents in each section are required during the Registration Drive:
Personal Details Family Details Add Member (If Required)
  1. Voter Id
  2. Aadhaar Card
  3. Birth Certificate
  4. MGNREGA Job Card 
  5. Ration Card 
  6. Other Government ID/Certificate with Photo
  1. Ration Card
  2. RSBY/MHIS Card for RSBY/MHIS category
  3. PM’s Letter for SECC Beneficiary Category (once received)
  4. Other Government Documents which lists all members of Family
  5. Headman’s Certificate
  1. Adoption Certificate
  2. Birth Certificate
  3. Marriage Certificate
  4. Ration Card
  5. Headman’s Certificate

Beneficiaries can register themselves at District Kiosk Centres and State Kiosk all year round. The list of Kiosks is indicated below:

SL No District Location
1 EAST GARO HILLS WILLIAMNAGAR CIVIL HOSPITAL
2 EAST JAINTIA HILLS DM&HO OFFICE KHLIEHRIAT
3 EAST KHASI HILLS CIVIL HOSPITAL SHILLONG
4 NORTH GARO HILLS RESUBELPARA CHC
5 RI BHOI DM&HO NONGPOH
6 SOUTH GARO HILLS BAGHMARA CIVIL HOSPITAL
7 SOUTH WEST GARO HILLS AMPATI CIVIL HOSPITAL
8 SOUTH WEST KHASI HILLS DM&HO OFFICE MAWKYRWAT
9 WEST GARO HILLS DM&HO OFFICE TURA
10 WEST JAINTIA HILLS DM&HO OFFICE LATHADLABOH
11 WEST KHASI HILLS OLD NONGSTOIN CHC

Beneficiaries can check their eligibility at the MHIS website www.mhis.org.in or the PMJAY eligibility portal www.mera.pmjay.gov.in

All efforts were made to include all eligible beneficiaries in the data. If any one of the family members are in the database, they can add themselves under the identified member of family by providing necessary proof of relationship. However, if none of the family members are included in the data, they are requested to contact the MHIS Helpdesk or Tollfree number. Alternatively, they can walk into to the state and district offices of MHIS along with the Photocopy of their Epic card and the Old MHIS/RSBY card if available.

Packages Rates are pre-approved rates that are available for specified surgical and medical procedures. The same can be viewed at www.mhis.org.in

For unspecified procedures, there is an Unspecified Package for which the concerned hospital will need to seek approval from the Insurance Company.

There are certain common exclusions under the scheme, which are as follows –

  1. Conditions that do not require hospitalization
  2. Congenital external diseases
  3. Sterilization, Fertility and Sex Change procedures
  4. Vaccinations and Cosmetic Treatments
  5. War, Nuclear invasion
  6. Suicide
  7. Others

Almost all public hospitals and private hospitals in the state are empanelled under MHIS. The list of hospitals is available on the website –  www.mhis.org.in

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.

OPD coverage includes coverage for maternity benefits, child care benefits, cardiac and diabetes preventive care benefits, OPD diagnostic and follow-up care benefits.

A new-born is covered under MHIS since birth automatically for the remaining period of the health insurance policy. They can be covered either under the Mother or the Father of the child.

The scheme is implemented along with Pradhan Mantri Jan Arogya Yojana; and under the scheme beneficiaries can avail benefits in any empanelled hospital in the country. The list of hospitals is available at www.mhis.org.in and www.pmjay.gov.in

Grievances can be lodged through the Tollfree No., MHIS Helpdesk Number, Letters, Email, MHIS website, PMJAY Website, Walk-ins, Grievance Register at Health Facilities/Hospital and the Grievance Redressal Committees.

1800-102-4762

0364-250 7477

Beneficiaries will have to visit any of the identified District Kiosks to get a new card printed. Alternatively, in case of hospitalization, hospital authorities will ask for the personal mobile number submitted at the time of registration so he/she can avail the benefits in any empanelled facility.

The beneficiary needs to take the PMJAY/MHIS card issued to them after registration along with any other Govt issued Identity Card at the time of hospitalisation.

The PMJAY/MHIS card needs to be handed over to the Arogya Mitra (MHIS Operator) in the MHIS counter present at the hospital on the day of admission.

There is no transportation allowance or economic compensation under MHIS – PMJAY.

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Institutions

Department of HealthPradhan Mantri Jan Arogya Yojana
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