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CMHISN

Chief Minister’s Health Insurance Scheme - Nagaland

Launched on 16th October 2022, the scheme "Chief Minister Health Insurance Scheme (CMHIS)" is a Public Health Insurance Scheme by the Health and Family Welfare Department, Government of Nagaland. This scheme provides cashless treatment up to ₹20 lakhs for employees and pensioners and ₹5 lakhs.

State In Kind

States / UT: Nagaland

Nodal department: Health and Family Welfare Department, Nagaland

Scheme for: Individual

Scheme profile

Scheme open date: 2022-10-14

Categories: Banking,Financial Services and Insurance, Health & Wellness

Target beneficiaries: Individual

Tags: Health Coverage, Health Insurance, Nagaland Government Health Insurance, Affordable Health Insurance, Cashless Health Insurance, Nagaland

Details

Launched on 16th October 2022, the scheme "Chief Minister Health Insurance Scheme (CMHIS)" is a Public Health Insurance Scheme by the Health and Family Welfare Department, Government of Nagaland. This scheme provides cashless treatment up to ₹20 lakhs for employees and pensioners and ₹5 lakhs for the general category, covering inpatient and specific daycare procedures in empanelled hospitals across India.
The applications are accepted through Primary Health Centres (PHCs), Community Health Centres (CHCs), District and Sub-division Treasury Offices, outreach camps, and designated private hospitals.
The scheme is being implemented by the Department of Health and Family Welfare, Government of Nagaland.

Benefits

  • 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 empanelled 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. 1. 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. <br> Annual Risk Cover/ Sum Insured per family: 1. For CMHIS (GEN) beneficiary families the Sum Insured is ₹5 00 000/- (Rupees Five Lakhs Only) per family per annum on a family floater basis similar to AB PM-JAY. 1. For CMHIS (EP) beneficiary families the Sum Insured is ₹20 00 000/- (Rupees Twenty Lakhs Only) per family per annum on a family floater basis. 1. 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 empanelled 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.

Annual Risk Cover/ Sum Insured per family:

  1. For CMHIS (GEN) beneficiary families, the Sum Insured is ₹ 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 ₹ 20,00,000/- (Rupees Twenty Lakhs Only) per family per annum on a family floater basis.
  3. 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.

Eligibility

Eligibility
The Chief Minister Health Insurance Scheme is available to all permanent and indigenous residents of Nagaland. They are divided into two categories:
1. For CMHIS (EP):

  • The applicant should be a government employee, pensioner, or dependent family member.
  • The applicant should possess valid supporting documents such as the PIMS Code, PPO book, Aadhaar card, and certificates for dependents.
    2. For CMHIS (GC):
  • The applicant should be an Indigenous Inhabitant or Permanent Resident of Nagaland not covered under AB PM-JAY.
  • The applicant should possess an Indigenous Inhabitant Certificate (IIC) or Permanent Resident Certificate (PRC) issued after 2016, along with an Aadhaar card and valid mobile number.

Application Process

Online

Step 1: Visit the Official Website of the Chief Minister’s Health Insurance Scheme (CMHIS) Nagaland.
Step 2: Click on the Register. Read out the Registration instructions carefully.
Step 3: Fill in the application form with all the required details, including personal details, family details, income details, and medical history.
Step 4: Submit the completed application form along with the necessary documents to the nearest Common Service Center (CSC) in your area or the empanelled hospital.
Step 5: The CSC or the empanelled hospital will verify the application form and documents and upload the details to the online portal.
Step 6: The insurance provider will verify the application and approve or reject the application based on the eligibility criteria.

Note: For any query call us at 14555 or mail at nagaland.nhpm@gmail.com.

Clarifications

Additional points from the scheme information published on myScheme (not legal advice).

What is CMHIS?
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.
Who are Eligible under CMHIS (GEN) Category:
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.
Who are Eligible under CMHIS (EP) Category:
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.
What is the definition of Family under CMHIS(EP):
The term 'family' means and includes- "Husband or wife as the case may be and dependant family members."
Who are not to be treated as members of a household?
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.
How much is the Annual Risk Cover/ Sum Insured per family:
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
Are all medical treatments covered under the CMHIS scheme?
No, certain medical treatments and procedures, such as cosmetic surgeries, dental treatments, and infertility treatments, are not covered under the CMHIS scheme.
Can I apply for the CMHIS scheme if I already have health insurance from another provider?
Yes, you can still apply for the CMHIS scheme if you already have health insurance from another provider. However, you cannot claim benefits from both insurance policies simultaneously for the same treatment
Can I include all my family members under the CMHIS scheme?
Yes, you can include your spouse and up to three dependent children under the CMHIS scheme. However, parents, siblings, and other relatives are not covered under the scheme.
How can I check my eligibility for the CMHIS scheme?
You can check your eligibility for the CMHIS scheme by visiting the official website of the Health and Family Welfare Department of Nagaland, contacting the empaneled hospitals and healthcare providers who are implementing the scheme, or visiting the nearest Common Service Center (CSC) in your area.
What documents are required to apply for the Chief Minister's Health Insurance Scheme?
You will need to provide proof of identity, proof of address, and proof of income to apply for the Chief Minister's Health Insurance Scheme. You may also be required to provide additional documents, such as medical certificates or hospital bills.
What is the coverage provided under the Chief Minister's Health Insurance Scheme?
The Chief Minister's Health Insurance Scheme provides coverage for medical treatment up to Rs. 5 lakh per family per year. The coverage includes hospitalization expenses, medical consultation fees, laboratory tests, and other medical expenses incurred during the treatment.

References

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Documents Required for Government Schemes

Most government schemes require basic documents for verification. While the exact requirements vary, common documents include:

  • Aadhaar Card
  • Income Certificate
  • Caste Certificate (if applicable)
  • Residence Proof
  • Bank Account Details
  • Educational Certificates (for student schemes)

How to Apply for Government Schemes?

The application process for government schemes may be online or offline depending on the scheme. In most cases, you can follow these steps:

  1. Check eligibility criteria
  2. Collect required documents
  3. Fill the application form
  4. Submit the application online or at the relevant office
  5. Track application status