Health department notifies changes in medical reimbursement scheme

DIMAPUR — Health and Family Welfare Department has issued a notification regarding changes in the medical reimbursement (MR) scheme following the launch of Chief Minister Health Insurance Scheme (CMHIS) effective from November 1, 2022.

Since the implementation of CMHIS initially faced some challenges including hospitals refusing to provide services to beneficiaries, it pointed out that certain patients were unable to utilise the benefits of the scheme and had to bear the costs of treatment themselves.

To address the issue and ensure that CMHIS (EP) beneficiaries are not deprived of their entitled benefits, the department has laid down the following guidelines.

1. Regardless of whether the treatment is received at a hospital empanelled 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).

2. 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 empanelled under CMHIS or the old MR scheme.

It also mentioned that the reimbursements would be subjected to the following terms and conditions:

a. 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).

b. Reimbursement will only be permissible for treatments undergone between November 1, 2022, and December 31, 2023.

c. Applicants seeking reimbursement must submit their application along with all supporting documents as prescribed by NHPS.

The notification also clarified that treatment in non-empanelled hospitals will only be allowed in cases of emergencies or when a specific procedure is not available at any of the empanelled hospitals. It further stated that prior approval from the state medical board is required in such cases to facilitate treatment under such circumstances.