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Megha Health Insurance Scheme, Meghalaya
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Subject Area="Health financing." Objective="Mobilising community participation."
Details for Reform Option "Megha Health Insurance Scheme, Meghalaya"
Summary

Megha Health Insurance Scheme (MHIS) is an initiative of the Govt. of Meghalaya that has been designed in convergence mode with the Govt. of India existing Health Insurance Scheme – Rashtriya Swasthya Bima Yojana (RSBY). The Scheme excludes State and Central Government Employees (already covered), in addition to providing a top up for BPL families under RSBY. The Phase – I of the MHIS was launched on 15th December, 2012 and provides for an insurance cover of upto Rs. 1, 60, 000/- for a family of 5 members, each family having to pay only Rs. 31/- at the time of registration in the first phase of implementation, the Govt. had ICICI Lombard General Insurance Co. Ltd. as its partnering agency for implementation. In June, 2015, the Phase – II of the MHIS was launched and enhanced the coverage up to Rs. 2, 00, 000/- for each family, consisting of 5 members, having to pay only Rs. 30/- Currently in its due course of implementation, the Govt. of Meghalaya has partnered this phase of implementation with the New India Assurance Co. Ltd.

Cost Premium per Household MHIS I: Rs. 478 * Number of Households Enrolled.(for one policy year subjected to renewal or policy extension). MHIS II: Rs. 431 * Total Number of Households Enrolled (MHIS II enrollment is under process).
Place Meghalaya
Time Frame MHIS I. May, 2013 – April, 2014. 1st Extension: May, 2014 – September, 2014. 2nd Extension: October, 2014 – April, 2015. 3rd Extension: May, 2015 – July, 2015. MHIS II: Policy period starts 1st August, 2015.
Advantages

1.Universal Health Insurance entitlement. 2.Effective Financing Mechanism. 3.No age limit in coverage and pre-existing diseases are also covered. 4. Absolute insurance coverage – primary, secondary and tertiary care. 5.beneficiaries entitlement to a comprehensive spectrum of health services including super specialty treatment with main focus in cancer treatment, advance diagnostics,comprehensive outpatient services for pregnant women and children and long term consultation and treatment services for life style. 6. Beneficiary option to choose between public and private hospitals. 7.scientifically designed packages prices. 8.Increase of coverage from 1036 procedures in RSBY to 1704 in MHIS II. 9.Hospital impanelment – Public and Private Hospitals including specialty hospitals outside the state. 10. Public hospitals Empowerment – Improving public hospitals infrastructure and health facilities. 11. It Server at the SNA office (one of the only state in the North East to have its own server) to maintain records during the enrolment process and to process the receipt and payment of claims.

Challanges

1.Enrollment Challenges: Climatic conditions, data mismatch, socio cultural issues, time management. 2. Empanelment: Unwillingness of some private hospitals in the state to be empanelled. 3. Low packages rates. 4. No normal OPD coverage. 5. Lack of awareness about the scheme among the beneficiaries and health care provides. 6. Lack of monitoring and control, MIS reporting mechanisms and IT challenges.

Prerequisites

Partnership with an insurance provide including its Third Party administrators

Who needs to be consulted

1.Different Government Departments for preparation of Beneficiary database for categories such as BPL, APL, Building and other Construction Workers, Weavers and Artisans, MGNREGA and ASHAs. 2.District Administration – Deputy Commissioners, District Medical Officers, Medical Officer and private hospital administrators. 3. Block Administration: Block Development Officers, Village Administrators, headmen, ASHA and Anganwadi workers.

Risks

Nil

Sustainability

1.Financial Stability – Utilization of the registration fee for various administrative costs to implement the scheme with financial assistance from both the central and the state government (RSBY – 90% Central Share and 10% State Share, MHIS – 100% State Share). 2. Public Hospitals involvement – A comprehensive claim utilization structure whereby 70% of the claimed amount is for development of hospital infrastructure and 30% is for staff incentives. 3. MHIS claim ratio which is more than 80% indicating complete utilization of the scheme by the beneficiaries which has cross Rs. 14 crores and public hospital facilities improvement which is about Rs. 4 crores approximately.

Chances of Replication

Citing India embankment to achieve Universal Health Coverage during the 12th Plan period, some states have already adopted similar schemes

Comments

Inspite of the challenges the scheme faced during its initial stages major strategies have been undertaken – The Government of Meghalaya has sought assistance from International Fiancé Corporation (IFC) to formulate and regulate the various features of the scheme, enhance awareness activities, training and capacity building of all stakeholders, involving of a data mining agency for beneficiary’s database preparation, introduction of an incentive structure for Field Key Officers to boost enrolment, strengthening of monitoring and control activities and strengthening of MIS and IT systems

Contact

State Nodal Agency, Megha Health Insurance Scheme, Shillong

Submitted By

State Nodal Agency, Megha Health Insurance Scheme, Shilling

Status Active
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