Name of the Scheme – CHIEF MINISTER HEALTH INSURANCE (CMHIS)
Department – Health and Family Welfare
The Chief Minister Health Insurance Scheme (CMHIS) is a public health insurance scheme implemented by the Government of Nagaland to offer cashless treatment to its employees and pensioners as well as to citizens of the State who are not covered under AB PM-JAY.
The Chief Minister Health Insurance Scheme (CMHIS) has been implemented in conjunction with the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), a flagship program of the Government of India. The combined scheme is also known as the “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana – Chief Minister Health Insurance Scheme” or “AB PM-JAY CMHIS”. The scheme provides two types of coverage:
1. CMHIS (EP) – Health Insurance Cover of Rs. 20 lakhs per year per family for regular government employees, pensioners getting medical allowance, and their dependents.
2. CMHIS (GEN) – Health Insurance Cover of Rs. 5 lakhs per year per family for contractual & ad-hoc employees, non-dependent family members of CMHIS (EP), employees without PIMS number, accredited journalists, and any household not covered by CMHIS(EP) or the AB PM-JAY Scheme.
What are the benefits of CMHIS (EP)?
Eligible beneficiaries can avail the following benefits-
· Rs. 20 lakhs coverage for cashless treatment in any CMHIS (EP) empanelled hospital both within the state and outside the state. To check the list of empanelled hospitals under CMHIS (EP), please visithttps://cmhis.nagaland.gov.in/hospitals
· Apart from 20 lakhs of health coverage, government employees are entitled to Medical Reimbursement (MR) (TOP-UP) if they exhaust 20 lakhs within the one-year policy period.
· CMHIS (EP) beneficiaries get access to private/semi-private or general wards as per pay-level entitlement.
· CMHIS(EP) beneficiaries can avail treatment in non-empanelled hospitals in case of emergencies provided there are no CMHIS(EP) empanelled hospitals in the city/town or when specific procedures are not available in any of the empanelled hospitals. Beneficiaries can then avail reimbursement for the treatment undertaken.
· Health Benefit Packages have been constructed on a fixed rate base Central Government Health Scheme (CGHS) Health Benefit Package Construct. The HBP rate includes all the expenses for in-patient treatment and specific daycare procedures like minor surgery, dialysis, chemo/radiation therapy, etc. Visit https://cmhis.nagaland.gov.in/category/health-benefits-packages to check the HBPs covered by the scheme.
What are the benefits of CMHIS (GEN)?
Eligible beneficiaries can avail the following benefits-
· Rs. 5 lakh coverage for cashless treatment in any AB PM-JAY/CMHIS (GEN) empanelled hospitals both within and outside the state. To check the list of empanelled hospitals under the AB PM-JAY/CMHIS (GEN) within the state, visit https://cmhis.nagaland.gov.in/hospitals. To check the list of empanelled hospitals under the AB PM-JAY/CMHIS (GEN) outside the state, visit https://hospitals.pmjay.gov.in/Search/empnlWorkFlow.htm?actionFlag=ViewRegisteredHosptlsNew
· CMHIS (GEN) beneficiaries have access to General Ward rooms.
· Health Benefit Packages have been constructed on a fixed rate base PM-JAY Health Benefit Package. The HBP rate includes all the expenses for in-patient treatment and specific daycare procedures like minor surgery, dialysis, chemo/radiation therapy, etc. Visit https://cmhis.nagaland.gov.in/category/health-benefits-packages to check the HBPs covered by the scheme.
Note:
· CMHIS (EP) & CMHIS (Gen) beneficiaries will have to pay individually if the beneficiaries wish to upgrade services or access items not covered by the scheme, such as room upgrades, cosmetics, implants, etc.
· CMHIS (Gen) beneficiaries are not eligible for medical reimbursement as the beneficiaries are not contributing any funds for the scheme.
What is CMHIS?
The Chief Minister Health Insurance Scheme (CMHIS) Nagaland was initiated with the aim to alleviate financial hardships due to hospitalization expenses and to prevent inaccessibility to medical care on account of unaffordability, by providing free and cashless benefits for treatment of various ailments, to every citizen of the State.
Who are Eligible under CMHIS (GEN) Category:
1. CMHIS (GEN) category includes all Indigenous and/or Permanent residents of the State who are not beneficiaries under the AB PM-JAY or any other public funded health insurance scheme of the government and who are not covered under CMHIS (EP) category.
2. CMHIS (GEN) category also includes non-dependant family members of CMHIS (EP) categories, employees without PIMS number, contractual, adhoc, fixed pay employees of the State government and contractual employees under various CSS, and their household members.
Who are Eligible under CMHIS (GEN) Category:
1. CMHIS (GEN) category includes all Indigenous and/or Permanent residents of the State who are not beneficiaries under the AB PM-JAY or any other public funded health insurance scheme of the government and who are not covered under CMHIS (EP) category.
2. CMHIS (GEN) category also includes non-dependant family members of CMHIS (EP) categories, employees without PIMS number, contractual, adhoc, fixed pay employees of the State government and contractual employees under various CSS, and their household members.
Who are Eligible under CMHIS (EP) Category:
CMHIS (EP) category includes State government employees who are eligible for monthly Medical Allowance (MA) and or reimbursement of medical expenses under Medical Re-imbursement scheme viz
- Regular employees
- Pensioners
- Serving Legislators/ Ex- Legislators
- Employees of State Public Sector Undertakings, Corporations and Autonomous Bodies
- Workcharge employees (on Scale Pay), and their dependent family members.
What is the definition of Family under CMHIS(EP):
The term ‘family’ means and includes- “Husband or wife as the case may be and dependant family members.”
Who are not to be treated as members of a household?
1 Temporary visitors and guests whose total period of stay is less than 6 months in the past one year.
2. Members who have permanently migrated or left the household on marriage, employment etc. even if they occasionally visit the HH.
3. A resident employee, or domestic servant or a paying guest taking common meal and living with the household.
4. Those who are not considered normal member. NB:
- AB PM-JAY Beneficiaries including Building and other Construction Workers will not be covered under CMHIS (GEN) category.
- There is no financial /economic dependency criteria for households under the AB PM-JAY/ CMHIS (General) Category.
How much is the Annual Risk Cover/ Sum Insured per family:
1. For CMHIS (GEN) beneficiary families, the Sum Insured is Rs. 5,00,000/- (Rupees Five Lakhs Only) per family per annum on a family floater basis, similar to AB PM-JAY.
2. For CMHIS (EP) beneficiary families, the Sum Insured is Rs. 20,00,000/- (Rupees Twenty Lakhs Only) per family per annum on a family floater basis. Further, for Government employees, any additional expenses beyond the sum insured shall be reimbursed on a case-to-case basis by the State government on recommendation of the State Medical Board
Are all medical treatments covered under the CMHIS scheme?
No, certain medical treatments and procedures, such as cosmetic surgeries, dental treatments, and infertility treatments, are not covered under the CMHIS scheme.
Can I apply for the CMHIS scheme if I already have health insurance from another provider?
Yes, you can still apply for the CMHIS scheme if you already have health insurance from another provider. However, you cannot claim benefits from both insurance policies simultaneously for the same treatment
Can I include all my family members under the CMHIS scheme?
Yes, you can include your spouse and up to three dependent children under the CMHIS scheme. However, parents, siblings, and other relatives are not covered under the scheme.
How can I check my eligibility for the CMHIS scheme?
You can check your eligibility for the CMHIS scheme by visiting the official website of the Health and Family Welfare Department of Nagaland, contacting the empaneled hospitals and healthcare providers who are implementing the scheme, or visiting the nearest Common Service Center (CSC) in your area.
What documents are required to apply for the Chief Minister’s Health Insurance Scheme?
You will need to provide proof of identity, proof of address, and proof of income to apply for the Chief Minister’s Health Insurance Scheme. You may also be required to provide additional documents, such as medical certificates or hospital bills.
What is the coverage provided under the Chief Minister’s Health Insurance Scheme?
The Chief Minister’s Health Insurance Scheme provides coverage for medical treatment up to Rs. 5 lakh per family per year. The coverage includes hospitalization expenses, medical consultation fees, laboratory tests, and other medical expenses incurred during the treatment.
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