Kohima, 4 April (MTNews): The Health & Family Welfare Department has issued a notification regarding changes in the Medical Reimbursement (MR) Scheme following the launch of the Chief Minister Health Insurance Scheme (CMHIS), effective from 1 November 2022. Further, fresh approval for treatment under the MR Scheme has been discontinued.
However, the implementation of CMHIS faced some initial challenges, including hospitals refusing to provide services to beneficiaries. As a result, certain patients were unable to utilize the benefits of the scheme and had to bear the costs of treatment themselves.
To address this issue and ensure that CMHIS (EP) beneficiaries are not deprived of their entitled benefits, the following guidelines have been issued:
Regardless of whether the treatment is received at a hospital empaneled under CMHIS or under the old MR scheme, if the treatment cost is deducted from the beneficiary’s Medical Allowance, reimbursement for the cost of treatment will be covered under CMHIS (EP).
For government employees, if the treatment was undertaken before the deduction of Medical Allowance from the beneficiary, reimbursement for the cost of treatment will fall under the old MR scheme, regardless of whether the treatment was received at a hospital empaneled under CMHIS or the old MR scheme.
These reimbursements are subject to certain terms and conditions. The cost of treatment will be considered for reimbursement according to the approved CMHIS (EP) health benefit package rate or as recommended by the State Medical Board constituted under the Nagaland Health Protection Society (NHPS).
Reimbursement will only be permissible for treatments undergone between 1 November 2022 and 31 December 2023. Applicants seeking reimbursement must submit their application along with all supporting documents as prescribed by NHPS.
The notification also clarified that treatment in non-empaneled hospitals will only be allowed in cases of emergencies or when a specific procedure is not available at any of the empaneled hospitals. Prior approval from the State Medical Board is required in such cases to facilitate treatment under these circumstances.