Morung Express News
Dimapur | January 10
One of the commendable initiatives by the Government of Nagaland (GoN) in recent years has been the flagship Chief Minister’s Health Insurance Scheme (CMHIS), aimed at achieving universal access to quality healthcare.
Designed to provide cashless treatment to eligible beneficiaries, CMHIS “bridges the gap” to healthcare for government employees, pensioners, and Indigenous Inhabitants or Permanent Residents of Nagaland who are not covered under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
In convergence with AB PM-JAY, the scheme is also referred to as AB PM-JAY CMHIS and offers comprehensive health insurance benefits across two categories: Employee & Pensioner (EP) with coverage of up to Rs 20 lakh per year per family, with a nominal monthly deduction; and General Category (GC) with annual coverage of Rs 5 lakh per family.
Officially launched on October 14, 2022, AB PM-JAY CMHIS, however, has periodically been in the spotlight for the wrong reasons, particularly over the past year as its implementation gained momentum.
For instance, in April-May 2024, alleged “technical glitches” interrupted service delivery to beneficiaries. Reports of private hospitals putting up notices suspending cashless treatment services offered under AB PM-JAY and CMHIS also surfaced in December 2024 and are currently being reported again.
While the governing body or executing agency for AB PM-JAY CMHIS, the Nagaland Health Protection Society (NHPS), has been proactive in clarifying or troubleshooting, the recurring crises point to the crucial need for streamlining the process.
The January 10 statements/clarifications from both the NHPS and the Future Generali India Insurance Company (FGI), the insurer of the scheme, also highlight a concerning development.
The NHPS noted reports of alleged fraud and abuse/misuse, including the financial exploitation of vulnerable patients by certain empanelled hospitals. The department has initiated an investigation into these allegations to assess any fraudulent or abusive practices by hospitals and has cautioned against violations of guidelines or statutory compliance.
FGI also pointed to certain challenges and stated that the Government of Nagaland is focused on controlling fraud and ensuring the premiums remain viable without burdening the state's exchequer. However, it critically noted that the responsibility of controlling “leakages” would ultimately fall on honest taxpayers.
Both assertions require greater scrutiny. Ultimately, as the parties at the helm of affairs, it is incumbent upon them to address any misuse, leakages, and fraud to ensure seamless services, as intended.
