Andaman & Nicobar Islands Scheme for Health Insurance (ANISHI)

What is ANISHI?

ANISHI, the Andaman & Nicobar Islands Scheme for Health Insurance, is the health assurance scheme of the Health Department of the Union Territory of Andaman and Nicobar Islands, administered by the Directorate of Health Services. The Administration launched ANISHI on 26 January 2015.

The scheme exists because of geography. Tertiary care: cardiac surgery, oncology, neurosurgery, advanced orthopaedics: is largely unavailable in the islands, so a serious diagnosis at Port Blair usually means a journey of over a thousand kilometres to a mainland hospital. According to the scheme documentation, many of these patients come from economically disadvantaged backgrounds and are unable to bear the cost of hospital expenses in a mainland hospital. The Administration therefore decided to run its own health insurance scheme rather than rely on a reimbursement counter.

ANISHI provides cashless medical treatment of up to Rs 5 lakh per patient per illness, covering both indoor and outdoor treatment. Because the limit is denominated per illness rather than per family per year, a patient who develops a second, unrelated condition is assessed against a fresh limit.

Who is eligible for ANISHI?

Three categories can avail the benefits:

• BPL and priority households settled in the A&N Islands. A person who belongs to the Below Poverty Level category and is settled in the islands qualifies on the strength of a BPL ration card.
• Government pensioners of the A&N Administration who have settled in these islands after retirement, together with their dependent family members. This is an unusual and generous inclusion: most state health schemes exclude pensioners, and it reflects the number of retired Administration staff who stay on in the islands.
• Permanent residents of the Andaman and Nicobar Islands whose family annual income is below Rs 3 lakh. There is no BPL requirement in this category; the income ceiling alone decides it.

Who cannot apply or is not eligible:

• People who are not permanent residents of the Andaman and Nicobar Islands cannot apply. Tourists, contract visitors and short-term workers are outside the scheme.
• Permanent residents whose family annual income is Rs 3 lakh or above are not eligible under the third category, though they may still qualify if they fall in the BPL or pensioner category.
• Pensioners of departments other than the A&N Administration are not covered by the pensioner category.
• A patient who took treatment without completing the codal formalities at the State Nodal Cell is not eligible for reimbursement of that episode, even if he or she is otherwise a valid beneficiary. This is the single most important exclusion in ANISHI and it catches families every year.

What benefits does ANISHI provide?

• Cashless treatment up to Rs 5 lakh per patient per illness, covering indoor and outdoor treatment at empanelled hospitals.
• Free travel expenses for the patient with one attendant, reimbursed at bunk class fare — the standard ship class on the Port Blair to Chennai, Kolkata and Visakhapatnam routes.
• Air ticket reimbursement for the patient and one attendant where a critically ill patient is referred under the scheme to travel by flight. A ship passage takes three to four days, so this provision is what makes ANISHI usable in a genuine emergency.
• Emergency cover during a private mainland visit. In the rare case of a beneficiary falling sick during a personal visit to the mainland and requiring emergency treatment, benefits under the scheme can be availed, but travel expenses are not allowed, because the journey was not a medical referral.

What documents are required for ANISHI?

The document set depends on which of the three categories the patient falls into.

Every case additionally needs the referral letter from the concerned specialist at GB Pant Hospital, Port Blair, together with the case sheet and investigation reports that support the referral.

How to apply for ANISHI treatment

ANISHI is not a scheme you enrol in ahead of time and then forget. Approval is obtained per episode of illness, before treatment starts.

1. Get examined and referred. The patient must be referred by the concerned specialist of GB Pant Hospital, Port Blair. This referral is the entry point to the whole scheme.
2. Approach the State Nodal Cell (ANISHI) located at the Directorate of Health Services office, carrying the referral, the category documents listed above and the medical records.
3. Complete the codal formalities at the Nodal Cell. Do not travel or get admitted before this step. Treatment taken without completing these formalities is not reimbursable.
4. Wait for processing. The State Nodal Cell processes the case within two days and places it before the Chairman ANISHI for approval.
5. Collect the approval order. After the Chairman's approval, orders are issued to the empanelled hospital to provide cashless treatment to the referred patient under the ANISHI scheme.
6. Report to the empanelled hospital named in the order and present the approval. The hospital bills the Administration directly; the patient does not pay and then claim.
7. Submit travel tickets afterwards to the Nodal Cell for reimbursement of the bunk class fare, or of the air fare where flight travel was approved.

What to do in a mainland emergency

A beneficiary who falls ill unexpectedly while on a personal visit to the mainland follows a different route:

1. Get admitted to one of the empanelled hospitals under the scheme.
2. The Medical Superintendent or Director of that hospital must first inform the Nodal Officer (ANISHI) of the patient's particulars and clinical condition. The hospital initiates this, not the family.
3. The State Nodal Cell verifies the records and conveys approval to treat the patient as per the guidelines of the scheme.
4. The patient or relatives then submit the documents required for the case.

Travel expenses are not payable in this situation because the trip to the mainland was private.

Why ANISHI claims get rejected

• Codal formalities not completed at the Nodal Cell before admission. This is the commonest and most expensive mistake. A family that flies out on its own and seeks reimbursement afterwards has no claim.
• Treatment taken at a non-empanelled hospital. Only hospitals empanelled and notified by the Administration are covered.
• No specialist referral from GB Pant Hospital, so the Nodal Cell has nothing to process.
• Income certificate above the Rs 3 lakh ceiling for an applicant relying on the permanent resident category.
• Pensioner category claimed without a Pension Payment Order, or claimed by a pensioner of a department other than the A&N Administration.
• Islander Card or Voter ID not produced, leaving residence unproven.

Key facts to remember

• ANISHI was launched on 26 January 2015 by the Health Department of the Andaman and Nicobar Islands.
• The cover is Rs 5 lakh per patient per illness, not per family per year.
• The Nodal Cell processes cases in two days; the Chairman ANISHI approves.
• Prior approval is mandatory. Nothing in the scheme reimburses treatment that began before the Nodal Cell cleared it.

Help and grievance redressal

• State Nodal Cell (ANISHI), Directorate of Health Services, Port Blair, the office that processes every case and the first place to raise a delay.
• GB Pant Hospital, Port Blair, the referring institution for specialist opinion.
• Directorate of Health Services, Andaman & Nicobar Administration, for written grievances about a rejected case or a pending travel reimbursement.

Availing ANISHI is free. The scheme is funded by the Andaman and Nicobar Administration, and no payment to any agent is required to have a case placed before the Nodal Cell.

How to check your ANISHI application status

ANISHI has no online tracking portal and no SMS or app-based status check. Since approval is processed per illness episode rather than through a one-time registration, "checking status" means following up on a specific case with the office that is handling it, at whichever of the two stages the case is in.

While the case is still at the Nodal Cell (before approval):

1. Note the date the referral and documents were submitted to the State Nodal Cell (ANISHI) at the Directorate of Health Services, Port Blair. The Nodal Cell states a two-day processing target before a case goes to the Chairman ANISHI for approval, so this date is the reference point for any follow-up.
2. If two working days have passed with no word, the patient or an attendant should visit or call the Directorate of Health Services and ask for the case by the patient's name and the referring specialist's name at GB Pant Hospital, since ANISHI does not issue a separate application number that a caller can quote.
3. Because no dedicated ANISHI helpline is published, the general Directorate of Health Services office at Port Blair is the contact point; check the official page at dhs.andaman.gov.in for the current office phone number, as numbers listed on government pages change from time to time.

Once the case has been approved:

1. The approval order is sent directly to the empanelled hospital named for treatment, not to the patient by post, so the confirmation that a case has gone through is the hospital's own admission desk telling the family that orders have been received for cashless treatment under ANISHI.
2. If the family has reached the empanelled hospital and the admission desk has no record of the order, that means approval has not yet reached the hospital, and the follow-up should go back to the Nodal Cell rather than to the hospital.

For a travel fare reimbursement submitted after treatment:

1. Since the ticket reimbursement claim is a separate, later step from the treatment approval, its status has to be tracked separately by keeping the receipt or acknowledgement given at the Nodal Cell when tickets were submitted.
2. Follow up in person or by phone at the same State Nodal Cell (ANISHI) with that acknowledgement in hand, quoting the patient's name and the dates of travel.

Because every step of ANISHI runs through one office rather than a portal, keeping a written or photographed record of every document handed in, and the date it was handed in, is the only reliable way to have something to point to when asking about a pending case.