The Government of Nagaland has announced a significant change in the implementation of the Pradhan Mantri Jan Arogya Yojana (PM-JAY) and the Chief Minister’s Health Insurance Scheme (CMHIS) in the state. Effective from April 1, 2025, both schemes will transition to a ‘Trust Mode’, as per the approval of the state government.
The Nagaland Health Protection Society (NHPS) will directly manage the financial liabilities of the schemes, eliminating the involvement of an insurance company. Instead, NHPS will oversee claim processing and disbursement of payments through a designated Third Party Administrator (TPA).
Key changes under the ‘Trust Mode’:
1. Direct Management by NHPS: All claims and financial liabilities under PM-JAY & CMHIS will be handled by NHPS through a Third Party Administrator.
2. Claims Processing: Empanelled hospitals will continue to submit claims through the existing IT platform, which will now be managed by NHPS.
3. Payments & Reimbursements: The State Government will be solely responsible for processing and disbursing claim payments.
4. Operational Guidelines: Further details on revised operational protocols, claim processing timelines, and grievance redressal mechanisms will be issued in due course.
This was informed in a circular issued by Thavaseelan K, IAS, CEO, Nagaland Health Protection Society, Department of Health & Family Welfare, Government of Nagaland on March 28.
“All empanelled hospitals are requested to take note of this change. For any clarifications, please contact the NHPS office,” the circular added.