CHIEF MINISTER HEALTH INSURANCE (CMHIS)

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 visit https://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.