Achievement-Healthcare & Reports

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):-

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

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 12^th Jan, 2023). With the increase in beneficiary base, the State of Mizoram has decided to include beneficiaries under NFSA into AB PM-JAY on 1^st 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 6^thDecember, 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: -

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

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

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

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Mizoram State Health Care Society

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:

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:

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.

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.