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.
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.
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 (1). Regular employees, (2). Pensioners, (3). Serving Legislators/ Ex- Legislators, (4). Employees of State Public Sector Undertakings, Corporations and Autonomous Bodies, (5). Workcharge employees (on Scale Pay), and their dependent family members.
The term ‘family’ means and includes- “Husband or wife as the case may be and dependant family members.”
a. Parents, sisters, widowed sisters, widowed daughters, minor brothers and minor sister, children and stepchildren wholly dependent upon the Government Servant and are normally residing with the Government Servant/ Pensioner”. Also includes, dependent divorced / separated daughters and stepmother. Elaborated as follows:
1) Son: Till he starts earning, gets married or attains the age of 25 years, whichever is earlier.
2) Sons above 25 years who are unmarried and unemployed and suffering from any permanent disability as per the Rights of Persons with Disability Act, 2016.
3) Daughter: Till she starts earning or gets married, whichever is earlier, irrespective of age limit.
4) Dependent daughters who are divorced / abandoned or separated from their husband/widowed, irrespective of age limit.
5) Dependent sisters who are unmarried/ divorced / abandoned or separated from their husband/widowed, irrespective of age limit.
6) Minor brothers upto the age of becoming a major (18 years).
b. The term dependency means that income from all sources including pensions and pension equivalent of Death-Cum-Retirement Gratuity (DCRG) benefit is less than Rs. 9000/- plus amount of DA on Basic pension of Rs. 9000/- per month.
Note:
1. The dependency clause shall not apply to spouses.
2. Families where both spouses are government employees/ pensioners/ Legislator/ex-Legislator, shall be considered as a single household for the purpose of Insurance Coverage, ward entitlement for the merged household shall be according to the higher entitlement of any of the spouses.
a. For this, the spouse with higher entitlement should register in the State Beneficiary portal as head of household, and declare the spouse under his/her household.
b. However, dependency can be declared under any of the spouses in such households.
3. For a pensioner,
a. Apart from all the other dependency rules, dependents shall be restricted only to those already declared as nominees in the PPO book.
b. Only those with valid PPO numbers will be considered.
c. In case valid PPO number could not be found in the system, respective district treasury office will verify their details and forward for further processing.
d. The point of contact for any other issue with Pensioners (including PPO number) details shall be submitted to the concerned district Treasury Office to be taken up with concerned competent Authority, and issued proper PPO for availing benefits.
4. Entitlement for the family where both spouses are either government Employees/ Pensioners/ Legislators/ ex-Legislators (CMHIS EP category).
a. In cases where both spouses are CMHIS EP Category, and ward entitlement is as per spouse1 who has a higher pay level, in the event of death of spouse1, the ward entitlement of the household will revert to the ward entitlement as per the pay level of spouse 2.
b. In cases where both spouses are CMHIS EP Category, and ward entitlement is as per spouse1 who has a higher pay level, in the event of death of spouse2, the ward entitlement of the household will remain as per the ward entitlement as per the pay level of spouse1.
c. In cases where only 1 spouse (spouse 1) is an CMHIS EP Category, in the event of death of the Employee/Pensioner, the ward entitlement of the family pensioner household will remain as per the ward entitlement as per the pay level of spouse1.
d. In the case of existing family pensioners, who are also not government employees, ward entitlement will be only L1(General Ward).
e. In the case where a person is enjoying 2 pensions currently, both family and life pension, the ward entitlement will be as per the ward entitlement of the life pension.
f. In cases where a person is a serving Government employee/legislator and also drawing a pension or family pension, she/he will be considered an employee, and ward entitlement will be as per the serving employee pay level.
1. A household is usually a group of persons who normally live together and take their meals from a common kitchen/common cooking unless the exigencies of work prevent any of them from doing so.
2. Institutional households- rescue homes, jails, ashrams, orphanages to be considered as a household under CMHIS (GEN) and all inmates shall be declared as household members, provided that such members cannot be linked to any beneficiary household under AB PM-JAY, CMHIS or other public funded insurance scheme of the government and satisfies the eligibility criteria of the scheme.
3. Existing PM-JAY Beneficiaries who were recorded in their parent’s household in SECC 2011, but has now married/formed separate household may also declare as household under CMHIS (GEN) category, provided their PM-JAY card is deactivated if already issued.
1. All persons normally living together are to be recorded as household members.
2. All persons normally living together but staying away from the household on a short-term seasonal migration and expected to come back within 6 months from the date of enumeration are to be recorded as member of the household.
3. In case the household head is staying away from the household for more than 6 months in the last one year, his/her individual particulars will not be recorded with the family. However, the household members currently employed in military/ paramilitary services will be recorded with their household.
4. Any Family/household members of CMHIS (EP) Category families who do not satisfy the Dependency criteria under the existing Central Services (Medical Attendant) Rules,1944, shall be eligible under CMHIS (GEN) and such members will be clubbed together and considered as a separate single household under CMHIS (GEN).
5. The Head of Household of CMHIS (EP) shall declare the non-dependent family members residing with the Government Employee/Pensioner at the time registration and a separate household ID shall be allocated to the non-dependent family members and treated as a household under CMHIS(GEN).
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:
a. AB PM-JAY Beneficiaries including Building and other Construction Workers will not be covered under CMHIS (GEN) category.
b. There is no financial /economic dependency criteria for households under the AB PM-JAY/ CMHIS (General) Category.
Status of husband will not change the status of the wife, if wife is indigenous inhabitant of natural descent from indigenous inhabitant father, she will continue to be eligible, however the non-indigenous husband and children shall not be eligible.
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.
All beneficiaries of the scheme are entitled to free and cashless hospitalization care for various ailments including pre-existing conditions/diseases, which can be availed from any empaneled hospital across the country. The treatment will include both surgical and medical procedures and limited day-care packages. However, OPD services and standalone diagnostics investigations will not be covered.
1. CMHIS (GEN) beneficiaries will be entitled to more than 1950 medical and surgical packages across 27 major clinical specialties as well as entitlement to General Ward, similar to AB PM-JAY.
2. CMHIS (EP) beneficiaries will be entitled similar to that available for central government employees under the Central Government Health Scheme (CGHS) as well as differential room entitlement as per their employee grade.
1. CMHIS (GEN) beneficiaries can avail treatment at all hospitals empaneled under AB PM-JAY within and outside the State. There are more than 28,000 hospitals empaneled under AB PM-JAY across the country. For details of hospitals empaneled under AB PM-JAY, please visit our website at https://cmhis.nagaland.gov.in.
2. CMHIS (EP) beneficiaries can avail treatment at all hospitals empaneled under CGHS and hospitals within the state empaneled under CMHIS (EP). There are more than 1500 hospitals empaneled under CGHS across the country. For details of CGHS empaneled hospitals, please visit https://cghs.nic.in/reports/view_hospital.jsp and for empaneled hospital within the state at: https://cmhis.nagaland.gov.in.
No Referral or Outside State Treatment approval required for CMHIS (EP). A beneficiary can walk-in to any empanelled under CGHS across the country to avail treatment for various ailments.
1. Mandatory KYC Document Required for CMHIS (GEN) category:
Ø for General Population :
a. Valid Mobile Phone number.
b. Indigenous Inhabitant Certificate (IIC) or Permanent Residential Certificate (PRC) issued by competent authority of respective district Administration after 2016.
NB:
Ration Card holders must get their eCards issued using their ration card in the BIS portal directly without registering in the CMHIS Portal (Ration Card data is already integrated with NHA BIS. Operators to go directly to the BIS URL).
(OR)
Filled and downloaded online registration form with household member details (FORM 1), countersigned by Village council Chairman/Ward Chairman.
Ø For employees without PIMS number:
a. Valid Mobile Phone number
b. Govt issued Photo ID card
c. Engagement/ Appointment Order.
d. Proof of continuity of being engaged (Letter from controlling officer)
e. Filled and downloaded online registration form with household member details (FORM), countersigned by Village council Chairman/Ward Chairman.
2. Mandatory KYC Document Required under CMHIS (EP) category:
Ø For Pensioners:
a. Valid Mobile Phone number
b. First Three pages of the Pensioner’s PPO book indicating PPO number, last pay scale or designation of the post held or last pay drawn prior to retirement
Ø For Government employees:
a. Valid Mobile Phone number
b. PIMS code.
Ø For dependent family members:
1) Document proving dependency for each dependent member to be added:
Proof of Relationship/DOB- Birth Certificate/Aadhaar/Class X Admit Card/voter‘s ID/Pancard or any other Govt. issued ID indicating relationship with any one of the parent and Date of Birth.
2) Disability Certificate in case of PwD
|
Employee classification as per Pay Level |
Room entitlement |
|
Pay Level 15 and above |
Private ward |
|
Pay Level 10-14 |
Semi-private ward |
|
Pay Level 9 and below |
General Ward |
1. The online registration facility for Beneficiary household/ family under CMHIS as well as for AB PM-JAY.
2. The Registration under CMHIS or enrolment under AB PM-JAY can be done either Online by Self or through various Registration Centres or through to any Registration Centres.
3. for self-registration Login to https://cmhis.nagaland.gov.in .
4. Walk-in to any Registration Centres:
a. All Primary Health Centre/ Community Health Centre empanelled under the AB PM-JAY CMHIS in the state and partner BIS Operators/ agencies are deemed authorized Registration Centres.
b. Further, various departments at directorate and district offices are also designated as Registration Centres for respective employees.
c. Empanelled private hospitals interested to provide registration services can be designated as Registration Centres.
d. Registration can also be done during the Outreach Enrolment Camps of AB PM-JAY CMHIS, eSHRAM or registration camps of various welfare schemes in your locality.
5. On verification and approval of the application for registration, the applicant will get a confirmation message over his/her registered mobile number along with Household ID assigned for his/her household/ family.
6. Registration alone does not imply eligibility under the scheme unless the antecedent of person is verified by the verifying authority.
NB:
a. Empanelled Card Vendor will setup Registration Centres at various District Hospitals.
b. Registration Centres shall be responsible for Registration of beneficiaries at State beneficiary Portal and eKYC collection for generation of Ayushman Card at Beneficiary Identification System (BIS) portal of the National Health Authority (NHA).
c. Registration is not required for AB PM-JAY beneficiaries.
Ayushman card is issued to every beneficiary to avail the benefits at empanelled hospitals.
1. Using the Household ID assigned to every household/ family as reference number and collection of eKYC, Ayushman card is generated for every member of beneficiary household/ family by:
i) the empanelled Card Vendors
or
ii) by self through the PM-JAY Mobile app (how to tutorial - https://cmhis.nagaland.gov.in/pages/video-tutorials).
a. Download App- https://play.google.com/store/apps/details?id=org.nha.pmjay&hl=en&gl=US
b. Register Self-User
c. Login
d. Enter Household ID and collect/submit eKYC
e. Once approved, download eCard
2. Ayushman card generated during the Outreach Enrolment Camps of AB PM-JAY CMHIS, eSHRAM or registration camps of various welfare schemes in your locality upon registration.
Aadhaar eKYC is mandatory for issuance of Ayushman Card.
Irrespective of whether the both spouses are either government employees or pensioners or one spouse is government employee and the other is pensioner, they should register as a single household.
Spouse drawing higher pay should be declared as Head of Household and other spouse will be declared as member.
In such situation, parents, children and grand-parents who are Government Employees or Pensioners should be registered as separate households even if they are normally living together. However, spouses should be registered together as a single household irrespective of their employment or income or residency status. Further, the dependent family members will be registered with any of the above-mentioned household provided the conditions of dependencies are fulfilled.
He/ she cannot get Card made under CMHIS for employees /Pensioners unless his/ her AB PM-JAY eCard is surrendered and disabled. Please email card with reason for disabling to nagaland.nhpm@gmail.com to get card disabled, in order to get a new card issued under a different category.
No, AB PM-JAY beneficiary cannot be enrolled under CMHIS.
All dependant members of the family including spouse should register with the Government employee/Pensioner in order to avail the higher coverage available to Government Servants/pensioners.
Splitting of families under different categories should be avoided.
Government employees and/or Pensioner households should not make Card through ration card even though in posession of one.
NB: For any queries, please contact the following HELPLINE numbers: 8880515011; 8880515012; 8880515013; 8880515014; 8880515015 OR CALL CENTRE Toll Free Number: 14555 OR email to nagaland.nhpm@gmail.com
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