Plug gap in MHIS

By Our Reporter

SHILLONG, JAN 4:  Stating that the Megha Health Insurance Scheme (MHIS) is covering only half the population of the state in its second phase and that there is also a gap wherein insurance company can reject claims of beneficiaries,  the state assembly’s Public Accounts Committee (PAC) directed the state health department plug the loophole.

PAC suggested to the state health department to incorporate a “system of redressal” to protect interest of beneficiaries of MHIS.

“You need to build a system of redressal to protect patients (beneficiaries) who are left at whims of the insurance company at present,” PAC chairman Paul Lyngdoh told reporters after a meeting on Wednesday.

He said the fact that the company can reject any claims by beneficiaries unless such system which can act as a referee is in place.

Lyngdoh  informed that there have been substantial number of patients who complained that their claims were turn down by the insurance company.

He felt this was happening as there are some gaps that the committee has found in the implementation of the MHIS phase-I and phase-II and felt that if these are allowed the company can reject on claims on the ground that it is not invalid.

“In view of this, we have asked the health department to ensure that these gaps are plug so as to ensure maximum benefits goes to the patients with weak economic background,” he added.

He also informed that the department assured to incorporate the suggestions of the PAC to ensure a foolproof agreement between the state and the insurance company in the interest of the people.

Stating that the MHIS phase-II has already lapsed since October last year and patients are now left high and dry, Lyngdoh said, “The health department has assured that the technical bid would be opened on January 11.”

“This would enable the department to launch the MHIS phase-III in the first week of April,” he added.

The MHIS launched in 2012, is a universal health insurance scheme (UHIS) in Meghalaya, utilizing the existing RSBY framework to provide health insurance to all persons that are resident in the State, including existing categories of RSBY beneficiaries but excluding state and central government employees.

Lyngdoh, however, lamented on the poor coverage of the MHIS and said, “The coverage of the MHIS was only 46% in the phase-I and 50% in phase-II, which means it is extended only to half of the population,” adding “If this is the case, you cannot call the scheme as universal when the other half are left out.”

He felt the scheme should ensure coverage to all citizens of the state who are not government servants.