Mizoram Health Insurance Scheme: Complete Guide & Benefits

TeamAckoMar 18, 2024

Medical costs are often a very big worry for many families. People tend to sell their assets and take loans to undergo medical treatment. Many families turn poor as a result of healthcare expenses.

To help families avoid such tragedies, the Mizoram government introduced the Mizoram Health Insurance Scheme. It protects vulnerable families from financial and medical emergencies. Keep reading to know everything about this initiative.

Contents

• What is the Mizoram Health Insurance Scheme?
• Benefits of the Mizoram Health Insurance Scheme
  • Hospitalisation
  • Critical Illness
  • Transport Allowance 
  • Pre- And Post-Hospitalization Cover
  • Day Care Procedures
  • Coverage of Pre-Existing Diseases
  • Maternity And Newborn Child
  • No Age Restrictions
  • Eligibility Criteria For Mizoram Health Insurance Scheme
• Cases Not Included Under Mizoram Health Insurance Scheme
• Critical Illnesses Under Mizoram Health Insurance Scheme
• Documents Required For Mizoram Health Insurance Scheme
• Fees For Enrolling In Mizoram Health Insurance Scheme
• How To Enroll For Mizoram Health Insurance Scheme
• Frequently Asked Questions (FAQs)

What is the Mizoram Health Insurance Scheme?

The government of Mizoram started Mizoram State Health Care Scheme (MSHCS) in April 2008. The basic aim was to improve access to medical treatment for diseases which require hospitalisation and surgery. It provides health insurance cover of up to Rs. 3 lakh.

In the beginning, it was a public-private partnership between the Mizoram government, an insurance company, a third-party administrator and a network of empanelled hospitals. However, it led to dissatisfaction and distrust with the insurance companies. It was due to the companies’ apathy and lack of flexibility in settling insurance claims. That’s why the health care scheme in Mizoram has been running on a self-finance basis since 2011.

Mizoram State Health Care Society runs the scheme throughout Mizoram. Since 2010, it has also run the Rashtriya Swasthya Bima Yojana (RSBY) under MSHCS.

The scheme's primary targets are those with no health insurance coverage. Before the Mizoram health care scheme started, the most vulnerable people either had to borrow or sell assets or simply avoid medical treatment. Thus, the health care scheme in Mizoram aims to reduce financial barriers to accessing primary health care. 

Benefits of the Mizoram Health Insurance Scheme

The MSHCS offers the following advantages to its beneficiaries.

Hospitalisation

Under the Mizoram Health Insurance Scheme, a Below Poverty Line (BPL) beneficiary can first use up the amount of Rs. 30,000 under the RSBY. After that, the family can claim up to Rs. 70,000 for hospitalisation and surgical treatments. The amount is available on a floater basis, which implies that the insured amount can be utilised individually or by the whole family.

Critical Illness

The scheme has listed certain critical illnesses for coverage. BPL families can claim insurance of up to Rs. 2 lakh for critical illnesses. This is in addition to the amount of Rs. 70,000  and RSBY coverage under hospitalisation expenses. 

APL families can avail of coverage of up to Rs. 3 lakh only under the provision for critical illnesses.

Transport Allowance 

For travelling within Mizoram with an attendant, beneficiaries can claim a transport allowance of up to Rs. 1000. For travelling outside Mizoram, the ceiling has been fixed at Rs. 10,000.

Pre- And Post-Hospitalization Cover

Pre-hospitalisation cover of up to 1 day before admission and post-hospitalisation of up to 10 days after discharge are covered by the Mizoram state health care scheme. The pee-hospitalisation coverage also includes investigations related to the hospitalisation and is not subjected to the 1-day limit.

In the case of organ transplantation patients, the post-hospitalisation coverage would last for 30 days.

Day Care Procedures

The Mizoram Health Insurance Scheme also covers several day care (OP) services. Some of them are listed below.

• Dialysis

• Hepatitis B & C 

• Drug-resistant TB 

• Hysterectomy 

• Epilepsy 

• Radiotherapy 

• Parenteral chemotherapy

• Eye surgery 

• Surgery of the ear, nose and throat

• Lithotripsy 

• Laparoscopic Therapeutic Surgeries

• Dental Surgery Following An Accident

• Any Surgery Under General Anaesthesia

• Treatment of fractures/dislocations (excluding hairline fracture)

• Minor reconstructive operations of limbs which need hospitalisation

Coverage of Pre-Existing Diseases

All pre-existing diseases falling within the ambit of the scheme are covered from day one of enrollment.

Maternity And Newborn Child

BPL families can avail of maternity coverage, while medical expenses for newborn children are covered for both APL and BPL families.

No Age Restrictions

There are no age restrictions for enrolling in the Mizoram Health Insurance Scheme.

Eligibility Criteria For Mizoram Health Insurance Scheme

The scheme covers BPL and APL families with annual income of up to Rs. 5 lakh. A family includes everyone living under the same roof. The head of the family has to be enrolled on the voter's list for the family to be eligible.

Employees of the Central and State governments, however, are excluded from the scheme.

Cases Not Included Under Mizoram Health Insurance Scheme

In certain cases, a person will not be eligible to apply for Mizoram State Health Care Scheme. We have listed them below.

• Patients with conditions that do not require hospitalisation are not covered by daycare procedures.

• Vaccination

• Surgeries for cosmetic or aesthetic purposes, unless it is required due to an accident or an illness.

• Cost of spectacles, contact lenses and hearing aids.

• Dental treatment or surgery unless it leads to hospitalisation.

• Intentional self-injury.

• Unless vitamins or tonics have been prescribed for treatment, they will not fall under the Mizoram Health Insurance Scheme.

Critical Illnesses Under Mizoram Health Insurance Scheme

The following major categories of illnesses are categorised as ‘critical illness’ under the scheme.

• Cardiology and cardiothoracic surgery

• Oncology

• Plastic surgery

• Ophthalmology

• ENT

• Orthopaedic surgery

• Paediatrics

• Dermatology

• Psychiatry

• OBS and gynaecology

• Dental surgery

• ICU care

• Seizure disorders which need hospitalisation

Medicines for the following are also covered under ‘critical illness’.

• Nephrology

• Respiratory system

• Gastrointestinal tract

• Endocrinology

• CNS

• Hepatology

• Haematology

• Infective diseases

• Connective tissue disease

• Organ transplant

Documents Required For Mizoram Health Insurance Scheme

The following documents are required to register for the Mizoram Health Insurance Scheme.

• Voter ID card of the head of the family

• Ration card

• Aadhaar card

Fees For Enrolling In Mizoram Health Insurance Scheme

Registration fees play an important role in settling claims under Mizoram's health care scheme. Here’s how much different categories of beneficiaries have to pay.

How To Enroll For Mizoram Health Insurance Scheme

The Mizoram Health Care Society is responsible for registering people for the insurance scheme. Here’s how to do it.

1. Gather the essential ID proofs, including voter ID card, ration card, and BPL card, if applicable.

2. Visit your closest health sub-centre.

3. Pay the fee and show the voter ID card of the head of the family.

4. After verifying your identity, a laminated photo ID card will be issued to you.

In this blog, we have covered all the major aspects of the Mizoram Health Insurance Scheme. The Mizoram government is providing coverage of up to Rs. 3 lakh to some of the state’s most vulnerable families under the scheme. It is a crucial step towards achieving the goal of universal health coverage.

As a friendly piece of advice, we would recommend you buy health insurance to protect yourself against the expensive cost of healthcare. Medical expenses have taken a financial toll on many families in our country. So, for your peace of mind and financial safety, consider buying health insurance coverage.

Frequently Asked Questions (FAQs)

Here are some commonly asked questions about the Mizoram Health Insurance Scheme.

1. What is the Mizoram Health Insurance Scheme?

To promote access to quality and affordable healthcare, the Mizoram government runs this scheme to provide health insurance of up to Rs. 3 lakh.

2. Is the RSBY included under MSHCS?

Yes, the Mizoram Health Insurance Scheme includes the Rashtriya Swasthya Bima Yojana (RSBY).

3. What are the enrollment fees for the Mizoram Health Insurance Scheme?

We have listed the fees that beneficiaries have to pay at the time of enrollment.

Sum Insured	BPL	APL family with up to 5 members	APL family with more than 5 members
Up to Rs. 1 lakh	Nil	Rs. 500	Rs. 100 per additional member
Up to Rs. 2 lakh	Nil	Rs. 750	Rs. 200 per additional member
Up to Rs. 3 lakh	Nil	Rs. 1000	Rs. 300 per additional member

 

4. Does Mizoram Health Insurance Scheme include coverage for day care expenses?

Yes, the scheme includes coverage of daycare expenses.

5. Which critical illnesses are covered by the Mizoram Health Insurance Scheme?

These are the major critical illnesses covered by Mizoram Health Insurance Scheme.

• Cardiology and cardiothoracic surgery
• Oncology
• Plastic surgery
• Ophthalmology
• ENT
• Orthopaedic surgery
• Paediatrics
• Dermatology
• Psychiatry
• OBS and gynaecology
• Dental surgery
• ICU care
• Seizure disorders which need hospitalisation

 

6. Does the Mizoram Health Insurance Scheme include pre and post-hospitalization expenses?

Yes, it includes pre-hospitalisation cover of up to 1 day before admission and post-hospitalisation of up to 10 days after discharge.

7. Are there any age restrictions for enrollment in the Mizoram Health Insurance Scheme?

No, there are no age restrictions for enrollment in the scheme.

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