MIZORAM STATE HEALTH CARE SOCIETY & AB PM-JAY

Achievement Report for the year 2023-2024 

 

Mizoram State Health Care Society handles three health insurance schemes of Mizoram, which are: -

  • Implementation of Mizoram State Health Care Scheme (MSHCS)
  • Implementation of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)
  • Screening of Medical Reimbursement claims of Government Employees and their dependants

Mizoram State Health Care Scheme: -

Mizoram State Health Care Scheme 2023-2024 policy has a sum insured of ₹2,00,000/- per family fro the policy year. Enrollment fees are collected as per Ration card, the fees are as below-

  • For AAY                                              : ₹200/-
  • For PHH                                             : ₹1,000/-
  • For Non-NFSA                                   : ₹2,000/-
  • Families without Ration Card          : ₹2,000/-

Number of families enrolled in Mizoram State Health Care Scheme for the Policy Year 2023-2024 (District Wise):-

District

No. of Families Enrolled

Aizawl

19,445

Lunglei

1,608

Champhai

1,355

Kolasib

1,545

Serchhip

706

Mamit

1,005

Saiha

385

Lawngtlai

520

TOTAL

26,569

 

Claim status for the policy 2023-2024 (status as on June 25, 2024)

Particulars

Count

Amount (₹)

Total Claims approved

12,188

44,11,19,276

Total Claims rejected

408

2,81,12,006

Total Claims paid

9,890

35,93,82,001

Claims Pending payment

2,298

8,17,37,275

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY): -

AB PM-JAY provides a health benefit cover of ₹5,00,000/- per family per year for in-hospitalization for its beneficiaries. The Cabinet of Govt. of India has expanded the beneficiary base of AB PM-JAY to 12 Cr. families from existing 10.74 Cr. families. With the revised beneficiary base, Mizoram beneficiary base also increased from 1,94,856 families to 2,16,584 families (NHA OM No. S-12018/130/2021-NHA dated 12th Jan, 2023). With the increase in beneficiary base, the State of Mizoram has decided to include beneficiaries under NFSA into AB PM-JAY on 1st August, 2023.

BIS Drive (Ayushman Card/Golden Card creation Drive) planned under Component 2 of the Mizoram Health Systems Strengthening Project (MHSSP) was executed from 6thDecember, 2023. And as a result Mizoram has achieved in identifying (Ayushman Card generated) 1,88,635 families from the target of 2,16,584 families, i.e 87.09% saturation.

District wise Ayushman Cards generated during 2023-2024: -

District

Families Verified

(Families with at least one Ayushman Card created)

Individuals verified

(Individual Ayushman Card created)

Aizawl

     18,224 

     41,459 

Champhai

        3,632 

        5,620 

Kolasib

        2,850 

        5,103 

Lawngtlai

     10,187 

     22,244 

Lunglei

        7,881 

     15,850 

Mamit

        3,679 

        6,042 

Siaha

        5,024 

     11,715 

Serchhip

        1,761 

        2,766 

Hnahthial

           354 

           564 

Saitual

           324 

           487 

Khawzawl

              30 

              33 

TOTAL

     53,946 

  1,11,883 

 

AB PM-JAY Claims paid during policy year 2023-2024(status as on June 13, 2024): -

Claims Paid Count

Claims Paid Amount (₹)

24,885

27,06,27,372

 

 

 

 

 

Govt. MR - Medical Reimbursement claims of Government Employees and their dependants: -

Claim status for the FY 2023-2024 are as below:

Claim Issued

Count

Amount(₹)

Treatment Inside Mizoram

14,221

63,80,40,419

Treatment Outside Mizoram

1,884

27,33,48,078

TOTAL

16,105

91,13,88,497

 

Claim Rejected

Count

Amount(₹)

Treatment Inside Mizoram

88

23,54,196

Treatment Outside Mizoram

3

4,18,867

TOTAL

91

27,73,063

 

 

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Mizoram State Health Care Society

Achievement Report for the year 2019-2023

Abstract: The Society’s Governing Body, the apex body is chaired by the Hon’ble Chief Minister of the State and the day-to-day function is being managed by the office of the Principal Chief Executive Officer, whose office is located at Dinthar, Aizawl. In summary, the three activities that the society currently performs are:

 

 

1.      Implementation of Mizoram State Health Care Scheme (MSHCS)

2.      Implementation of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).

3.      Screening of Medical Reimbursement claims of Government Employees andtheir dependants.

4.      Implementation of activities under Mizoram Health Systems Strengthening Project (MHSSP).

 

  1. Mizoram State Health Care Scheme (MSHCS):

 

 

The Mizoram State Healthcare Scheme strengthen and gave social security to each bonafied residents enrolled under the scheme by providing health insurance coverage up to 3 lakhs with each family enrolled themselves by a minimal user fee of charge Rs.100 for BPL families and Rs.1000 for APL families. Since October 2019, MSHCS has been revised to incorporate all ailments as benefits for the enrolled beneficiaries but limited to a sum insured of Rs.2 lakhs per family per year. However, as decided by the Governing Body of MSHCS to change the policy year which is October to September against April to March, an additional window of 6 months policy was implemented during October 2021 to March 2022 providing health coverage of Rs. 1 lakh for 6 months by collecting user charge of Rs. 50 for BPL families and Rs.500 for APL families. The list of families for segregation of poverty linewas earlier adopted from Department of Economics & Statistics, Government of Mizoram and had been changed as per category of Ration Card for premium payment/user charge (AAY-Rs.200, PHH-Rs.1,000, Non-NFSA-Rs.2,000). The following table represent the status of achievement under the scheme:

 

 

Policy Period

No. of 

Claims Paid

Amount (₹)

1st April, 2018 – 30th September, 2019 (18 months)

4,924

17,51,40,982

1st October, 2019 – 30th September, 2020 (12 months)

14,716

42,03,61,718

1st October, 2020 – 30th September, 2021 (12 months)

28,650

76,84,90,046

1st October, 2021 – 31st March, 2022 (6 months)

785

2,03,43,754

TOTAL

49,075

1,38,43,36,500

 

 

  1. Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB PM-JAY):

 

AB PM-JAY, a replacement of RSBY scheme (RashtriyaSwasthyaBima Yojana) provides a health benefit cover of Rs. 5 lakhs per family per year for in-hospitalization for its eligible vulnerable families. It is a cashless access to health care services for the beneficiary at all empanelled hospitals and helps mitigate catastrophic expenditure on medical treatment.Unlike other health insurance scheme, it is mandatory that all eligible member of the household must have e-card also named as golden card to avail the benefits under the scheme.

 

There are 1.9 lakhs eligible families in the state and as each member needs to have their own identity card, the challenge of verification process and issue of card arises. For this, as it would be a big burden for hospitals alone to issue e-card, State Health Agency, Mizoram liaised with Department of Information & Communication Technology (ICT) by integrating withCommon Service Centres (CSC’s) available at almost every locality along the State. Further, State Health Agency, Mizoram also setup teams to visit hardship places with no or poor internet connectivity to make sure each eligible beneficiary has their own identity golden card prior to exposure from diseases. The endeavour of the sincerity and hard work of all stakeholders is highlighted in below table:

 

District Wise Golden Card Issued Records

Aizawl

112184

Champhai

93936

Lunglei

72781

Kolasib

47976

Serchhip

38599

Mamit

34692

Lawngtlai

23077

Siaha

15937

Golden Card Status


Issued

Percentage to Eligible

Individual Golden Card

439183

46%

Families Verified

135017

69.20%

 

 

 

 

Policy Year

Claim Paid Count

 Amount (₹) 

2018-2019

21946

        17,71,43,623 

2018-2020

22246

        21,88,71,932 

2018-2021

6904

           8,14,40,868 

2018-2022

10877

        12,92,62,489 

2018-2023

16379

        20,40,16,858 

Total

78352

      81,07,35,770 

*Policy Year of AB PM-JAY was October to September until 2021.

 

 

  1. Government Employee & Dependants Medical Re-imbursements:

 

As an economic measure, the Government of Mizoram had assigned MSHCS to screen and scrutinise all medical reimbursement claims of Government servants and their dependents since 2018, though payment is not done by the Society, it screens and recommends the approved amount based on Government Notified rates, whereupon, the concerned Treasury makes the payment to the Government Servant. The details of claim scrutinised during the year 2021 to 2022 is highlighted in below table.

 

Year

Claims Screened/ Received

Claims Received Amount

No. of Claims Approved

Claims Approved Amount

Claims Deducted/

Adjusted Amount

No. of Fraudulent Claims Rejected

Average Claim Size

2019-20

18049

90,58,11,406

17986

78,40,06,468

12,18,04,938

63

43,438

2020-21

12,161

68,31,45,269

12114

60,85,74,368

7,45,70,901

47

50,043

2021-22

14,251

85,97,98,910

14100

731027711

128771199

151

51,297

2022-23

14,271

87,37,01,221

14141

750492728

122408493

130

52,589

 

  1. Implementation of activities under Mizoram Health Systems Strengthening Project (MHSSP):

 

Under the Mizoram Health Systems Strengthening Project (World Bank), the following activities are being undertaken.

 

  1. Improved accountability of the organisation (MSHCS) and empanelled hospitals through Internal performance Agreement (IPA)- Component I by 10 indicators.
  2. Learning Visits of Model States Telangana & Tamil Nadu under Component II.
  3. Approval of evaluation report for strengthening under domain 3&4 and improved communication strategy under Domain 5 of MHSSP.