Shillong: Under the Megha Health Insurance Scheme (MHIS) and Pradhan Mantri Jan Arogya Yojana (PMJAY), a total claim settlement of ₹3.59 crore has been made by the insurance company from September 2 to September 9, 2024.
The MHIS has significantly benefited Below Poverty Line (BPL) citizens and a majority of Meghalaya’s population. However, challenges emerged when hospitals temporarily halted MHIS services due to pending insurance claims. Following discussions with the government, hospitals resumed accepting MHIS patients but emphasized the need for a swift resolution to the claim settlement delays.
One BPL patient shared with EastMojo how, without timely assistance from MHIS, he would have struggled to pay a ₹1.2 lakh hospital bill. Fortunately, the scheme covered ₹74,000 of his expenses.
From September 2023 to August 2024, 1,89,018 cases were filed under MHIS VI, with 1,55,211 (82%) approved and 29,415 (18%) still pending. The pending cases, affecting both public and private hospitals, are expected to be cleared within the next two weeks.
MHIS CEO Ramkumar S. revealed that, on September 2, 2024, the State Nodal Agency (SNA-MHIS) received a letter from private hospitals expressing concerns over claims processing and settlement. Although similar issues were discussed during the State Grievance Redressal Committee (SGRC) meeting in August, problems persisted, primarily due to technological platform challenges.
The private hospitals had initially suspended cashless services for MHIS-PMJAY patients but later agreed to extend the benefits temporarily, pending the resolution of the issues highlighted in their letter to the Chief Minister.
To address these concerns, the CEO of MHIS and a team held discussions with the National Health Authority in New Delhi, working for four days to resolve the pending claims. While most technical issues have been addressed, a few challenges remain. Weekly reviews are now being conducted with the insurance company to ensure continued progress.
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Additionally, the Government of Meghalaya has extended MHIS Phase VI from September 1, 2024, to August 31, 2025, with a sum insured of ₹5,30,000 per household. All eligible beneficiaries in the state, except state and central government employees, can access benefits at empaneled hospitals.
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