Difference between AB PM-JAY/CMHIS (GEN) & CMHIS (EP)

PM-JAY/CMHIS General Category:
a.5 lakh annual coverage
b.PM-JAY network/empanelled hospitals
c.Base: PM-JAY Health Benefit Package
d.Funding of PM-JAY: 1. The scheme is to be funded in the ratio of 90:10 by the Centre & State. However, with the current premium cap of Rs. 1052 per household by the Ministry, the actual funding ratio between the Centre and State Government is 51.45 % State Share and 48.55 % Central Share instead of 10 % and 90 % respectively. 2. CMHIS(Gen): 100% by State Government. Funded through the conversion of 50% of the Medical Allowance of government employees and pensioners
e.Room access? General Ward Only
f.Implants: Covered up to a fixed rate; if high-end implants are chosen, the patient must cover the cost difference
CMHIS (EP) Category:
a.Government employees and pensioners are covered for ₹20 lakhs. Employees can access Medical Reimbursement (MR) Top-Up if this amount is exhausted within a year, with excess costs reimbursed by their respective departments. Pensioners, however, are not eligible for MR.
b.CMHIS empanelled hospitals
c.Base: Central Government Health Scheme (CGHS) Health Benefit Package with location/quality incentives up to 64% over the base rate.
d.Funded through the conversion of 50% of the Medical Allowance of government employees and pensioners.
e.Room access? Access to private/semi-private or general ward as per pay level entitlement
f.Implants: If high-end implants are chosen not covered by the fixed rate, the patient must pay the price difference.
NOTE: The above particulars apply to dependents of AB PM-JAY/CMHIS (GEN) and CMHIS (EP) categories. If beneficiaries would like to access services/benefits not covered under the schemes, empanelled hospitals will charge an additional amount which beneficiaries have to pay.
Issued by Nagaland Health Protection Society