H&FW deptt notifies changes in Medical Reimbursement Scheme

Health & Family Welfare (H&FW) department has notified changes in Medical Reimbursement (MR) Scheme following the launch of CM Health Insurance Scheme (CMHIS) effective from November 1, 2022, while fresh approval for treatment under MR Scheme has been discontinued.

Implementation of CMHIS faced some initial challenges, including hospitals refusing to provide services to beneficiaries. As a result, certain patients were unable to utilise the benefits of the scheme and had to bear the costs of treatment themselves.

To address this issue and ensure that CMHIS (EP) beneficiaries were not deprived of their benefits, H&FW issued guidelines. Accordingly, regardless of whether the treatment was received at a hospital empanelled under CMHIS or under old MR scheme, if the treatment cost was deducted from the beneficiary’s Medical Allowance, reimbursement for the cost of treatment would be covered under CMHIS (EP).

For government employees, if the treatment was undertaken before the deduction of Medical Allowance from the beneficiaries, reimbursement for the cost of treatment would fall under the old MR scheme, regardless of whether the treatment was received at a hospital empanelled under CMHIS or the old MR scheme.

The reimbursements would however be subject to various terms and conditions. For instance, the cost of treatment would 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).

Also, reimbursement would only be permissible for treatments undergone between November 1, 2022, and December 31, 2023, while applicants seeking reimbursement must submit their application along with all supporting documents as prescribed by NHPS.

The notification clarified that treatment in non-empanelled hospitals would only be allowed in cases of emergencies or when a specific procedure was not available at any of the empanelled hospitals. But, prior approval from the State Medical Board was required in such cases to facilitate treatment under these circumstances, the notification stated.