Megha Health Insurance Scheme: Cover & Enrollment

The Meghalaya Health Insurance scheme helps eligible residents of Meghalaya access affordable healthcare through a government-backed cashless insurance program. Understanding its eligibility rules, enrollment process, covered treatments, and hospital network is essential for anyone planning to use the scheme. 

This guide explains how the scheme works and highlights situations where additional private health insurance may still be beneficial.

What Is the Meghalaya Health Insurance Scheme?

The Meghalaya Health Insurance Scheme (MHIS) is a government-funded health insurance program introduced by the Government of Meghalaya. The State Nodal Agency was formed in 2012, and MHIS was launched in convergence with the Rashtriya Swasthya Bima Yojana (RSBY) in December 2012.

MHIS later converged with Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Official documents state that MHIS Phase 4 was launched in convergence with PM-JAY in December 2018, with operational implementation beginning in 2019. The scheme has expanded significantly over the years, increasing coverage from ₹1.60 lakh per family in its initial phase to ₹5.30 lakh per family under MHIS Phase 6. Reliance General Insurance Company Limited is the insurer implementing the current phase.

Eligibility Criteria for the Meghalaya Health Insurance Scheme

Core Eligibility Criteria

• Residency: Applicants must be permanent residents of Meghalaya.
• No Income Bar: The scheme is open to all economic categories and is not restricted by income or poverty status.
• No Age Limit: Individuals of all age groups, from newborns to senior citizens, are eligible.
• No Family Size Restriction: There is no cap on the number of family members covered under the family floater policy.
• Beneficiary Identification: A person must generally complete the applicable beneficiary identification and verification process before receiving an individual MHIS-PMJAY card. The presence of a family in the beneficiary database does not remove the need for verification and card generation.

Exclusions

• Government Employees: Serving state and central government employees are not eligible, as they are covered under separate government health schemes.

Coverage, Benefits, and Treatments Covered Under MHIS

Coverage and Benefits

Under MHIS Phase 6, the Megha Health Insurance Scheme (MHIS) provides cashless health coverage of up to ₹5.30 lakh per family per policy year on a family floater basis.

• Total Cover: Up to ₹5.30 lakh per family per policy year, comprising:
  • ₹5 lakh for approved secondary and tertiary hospitalization.
  • ₹30,000 for specified outpatient department (OPD) consultations, diagnostic tests, maternity care, child care, and follow-up care for cardiac and diabetic patients.
• Pre- & Post-Hospitalization: Eligible medical expenses incurred up to one day before hospitalization are included in the applicable package rate. Post-hospitalization expenses are covered for up to five days after discharge for secondary-care procedures and up to 15 days for tertiary-care procedures.
• Pre-existing Diseases: Covered from the commencement of the policy, subject to approved packages and scheme conditions.

Note: The ₹30,000 is not a general OPD allowance. It can only be used for the services and limits specified under the applicable MHIS package schedule.

Treatments Covered

The Megha Health Insurance Scheme (MHIS) covers 2,253+ treatment packages and 2,665+ medical procedures across a wide range of specialties. These include cancer treatments such as chemotherapy and radiation therapy, cardiac procedures like angioplasty and bypass surgery, ICU and critical care, general and orthopedic surgeries, trauma care, maternity and newborn care, as well as eligible outpatient consultations and diagnostic tests. 

What Is Not Covered?

MHIS does not cover treatments that are considered non-essential or fall outside the scheme's approved package list. These include cosmetic or plastic surgery, routine OPD treatment beyond the specified benefits, general dental care unless medically necessary, infertility treatments unless explicitly covered, and vitamins or health supplements unless prescribed as part of a covered treatment.

How to Enroll in the Meghalaya Health Insurance Scheme?

Enrollment under the Megha Health Insurance Scheme (MHIS 6) is completed in person at an authorized district kiosk, government hospital, Community Health Centre (CHC), Primary Health Centre (PHC), or a temporary enrollment camp.

Enrollment Process

1. Visit the nearest MHIS enrollment kiosk or camp.
2. Submit your original identity and family documents for verification.
3. Complete biometric authentication, including fingerprints, iris scan, and a photograph.
4. There is currently no registration fee for MHIS-PMJAY enrolment. Eligible beneficiaries can register free of cost.
5. Receive your MHIS-PMJAY e-card after successful verification.

Documents Required

• Identity Proof: Aadhaar card (preferred), Electors Photo Identity Card (EPIC), Driving License, Passport, or any government-issued photo ID.
• Family Proof: Ration card, family identity card, previous Megha Health Insurance Scheme (MHIS)/Rashtriya Swasthya Bima Yojana (RSBY) card, or a Headman's Certificate listing all family members.
• For Newborns: Birth certificate or hospital discharge summary to link the child with the parent's active MHIS card.

Note: The head of the family can initiate enrollment using the required family documents, but each member must complete biometric verification to receive an individual MHIS-PMJAY e-card. Families must also be listed in the Meghalaya Electoral Roll or the Socio-Economic Caste Census (SECC) database to be eligible for enrollment. For real-time assistance and a live list of functional registration camps, you can reach out via the official Megha Health Insurance scheme contact portal.

Empaneled Hospitals and How to Use Your MHIS Card

According to official March 2026 MHIS data, the scheme had 180 empaneled hospitals in Meghalaya, comprising 159 public hospitals and 21 private hospitals. The network includes public facilities such as Primary Health Centres (PHCs), Community Health Centres (CHCs), civil hospitals, and other government hospitals, along with empanelled private hospitals.

Since hospital empanelment changes over time, beneficiaries should check the live MHIS hospital directory before seeking treatment. Eligible beneficiaries may also obtain treatment outside Meghalaya at appropriately empaneled MHIS or PM-JAY hospitals across participating states.

How to Use Your MHIS Card?

1. Visit an empaneled hospital and report to the MHIS/PM-JAY helpdesk (Ayushman Mitra).
2. Present your MHIS-PMJAY e-card along with a valid government-issued photo ID.
3. Complete the identity and biometric verification process.
4. Once the treatment is approved, eligible hospitalization expenses are settled directly under the scheme, with no upfront payment required.

Note: In an emergency, beneficiaries can still access cashless treatment by providing their registered mobile number, Aadhaar number, or ration card number. The hospital can retrieve the electronic MHIS-PMJAY card from the central database to verify eligibility and process admission.

Meghalaya Health Insurance Scheme vs. Private Health Insurance: Do You Still Need Cover?

The Megha Health Insurance Scheme (MHIS) is an excellent financial safety net, offering day-one coverage for pre-existing diseases and cashless treatment for eligible residents. However, relying on it alone may not be enough for every medical situation.

Here are some limitations to keep in mind:

• Limited Family Floater: The ₹5.3 lakh annual cover is shared by the entire family and can be exhausted quickly during a major illness or multiple hospitalizations.
• Package Rate Limits: MHIS pays only up to its approved package rates, so treatment at higher-cost hospitals may result in out-of-pocket expenses.
• Limited Coverage Outside Meghalaya: The core ₹5 lakh hospitalization cover can be used for eligible PM-JAY packages at PM-JAY-empanelled hospitals across participating states. MHIS also provides an additional ₹30,000 for specified maternity, child-care, cardiac, and diabetes preventive OPD, OPD diagnostics, and follow-up-care benefits. These additional benefits are available only through hospitals or diagnostic centers empaneled for the relevant MHIS package and may not be offered at every PMJAY hospital outside Meghalaya.
• Scheme Renewal: MHIS is implemented in phases, and its benefits depend on periodic renewal by the state government. This risk is particularly relevant now because MHIS Phase 6 ends on 31 August 2026 and the Phase 7 structure is still being evaluated.

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Ditto's Take

The Megha Health Insurance Scheme (MHIS) is a strong government health scheme, offering cashless treatment, day-one coverage for pre-existing diseases, and no limit on family size. However, the ₹5.3 lakh family floater may not be enough for costly treatments such as cancer, major surgeries, or prolonged ICU stays. The scheme also pays only up to its package rates, and the additional MHIS top-up is available only within Meghalaya.

If you live in Meghalaya, check your MHIS eligibility on the official MHIS or PM-JAY portal. If you're not enrolled, visit your nearest district kiosk with your Electors Photo Identity Card (EPIC) and family ration card. Once enrolled, keep both your physical MHIS card and the Ayushman app handy for quick access during hospitalization.

If you want sufficient health insurance coverage beyond MHIS, explore our guide to the best health insurance plans in India and compare policies that provide higher protection for you and your family.