Nagaland updates medical reimbursement scheme

Nagaland’s Health & Family Welfare Department has updated the Medical Reimbursement (MR) Scheme in the light of the implementation of the Chief Minister Health Insurance Scheme (CMHIS) which came to effect on November 1, 2022, as fresh approval for treatment under the MR Scheme has been discontinued.

The department recognised that the rollout of CMHIS encountered initial hurdles, such as hospitals declining to serve beneficiaries. Consequently, some patients were unable to access the scheme’s benefits and had to cover their treatment expenses independently.

To address this issue and to ensure that the CMHIS (EP) beneficiaries are not deprived of their entitled benefits, certain guidelines have been made.

As per the guideline, 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).

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.

These reimbursements are subject to certain terms and conditions.

As per the new guideline, 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).

It also stated that reimbursement will only be permissible for treatments undergone between November 1, 2022, and December 31, 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-empanelled hospitals will only be allowed in cases of emergencies or when a specific procedure is not available at any of the empanelled hospitals. Prior approval from the State Medical Board is required in such cases to facilitate treatment under these circumstances. EastMojo