Kohima, July 8: The Nagaland Health Protection Society (NHPS) has issued a clarification following a grievance raised by a beneficiary under the Chief Minister Health Insurance Scheme (Employees & Pensioners) [CMHIS (EP)] over a prolonged Neonatal Intensive Care Unit (NICU) admission at an empanelled hospital.
According to the NHPS, the beneficiary was billed ₹5.15 lakh by the hospital, while ₹1.63 lakh was processed and settled under the scheme as the eligible claim amount.
In its press release, NHPS reiterated that CMHIS covers NICU services, newborn care, medicines, diagnostics, oxygen, and other approved treatments as per the scheme guidelines. It also emphasized that consultation charges are included in the approved package rates, except in cases of sanctioned cross-consultations.
The society stressed that empanelled hospitals must fully utilise all available package provisions before concluding that any treatment is not covered. It further reminded hospitals that, under the CMHIS agreement, beneficiaries are entitled to cashless treatment, and additional charges cannot be recovered except for non-payable items permitted under IRDAI guidelines or when beneficiaries voluntarily opt for upgraded room categories or higher-value implants.
NHPS has directed the concerned empanelled hospital to process the claim strictly in accordance with CMHIS package provisions and refrain from recovering any unauthorised amount from the beneficiary.
Reaffirming its commitment to protecting beneficiaries’ interests, NHPS urged both beneficiaries and empanelled hospitals to contact its toll-free helpline 1800-202-3380 (call or WhatsApp) for assistance or grievance redressal before escalating disputes.
