SHILLONG, Jan 04: Taking note of the current situation wherein the beneficiaries of the Megha Health Insurance Scheme (MHIS) are left to the whims and fancies of insurance companies, the State Assembly’s Public Accounts Committee (PAC) has asked the state health department to incorporate a system of redressal to address this problem.
“The insurance company can reject any claims by beneficiaries unless such system which may act as a referee is in place,” PAC chairman, Paul Lyngdoh said in this regard.
“There have been a substantial number of patients who complained that they have made the claims but were turn down by the insurance company,” Lyngdoh informed after a PAC meeting held here on Wednesday.
According to him, these were some of the gaps that the committee had found in the implementation of the MHIS phase-I and phase-II and felt that if these are allowed, the company can reject claims while questioning their validity.
“In view of this, we have asked the health department to ensure that these gaps are plugged so as to ensure that the maximum benefits go to the patients from a weak economic background,” he added.
He also informed that the department assured to incorporate the suggestions of the PAC to ensure a fool-proof 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 will be opened on January 11.”
“This will 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 residents of the State, including existing categories of RSBY beneficiaries but excluding state and central government employees.
The PAC chairman 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.”
According to him, the scheme should ensure coverage to all citizens of the state who are not government servants.