Mukhya Mantri Himachal Health Care Scheme-HIMCARE is a health insurance scheme under the Department of Health & Family Welfare, Government of Himachal Pradesh to provide cashless treatment coverage up to ₹5,00,000/- per year per family provided in the empanelled hospitals. In case of more than five members, the remaining members are enrolled as a separate unit subject to the capping of five members for each such additional unit. This scheme is being implemented on a co-payment basis. Hospitals empanelled under Ayushman Bharat within the State are also empanelled for HIMCARE and are providing cashless treatment to the beneficiaries by making online entries through Transaction Management System. The claims are being reimbursed through the host-to-host payment system directly in the bank account of the concerned hospital after checking the complete claim papers submitted by these institutions through the online system.
Benefits
- Cashless Treatment: Beneficiaries can avail medical services without upfront payment in empanelled hospitals.
- Comprehensive Coverage: Up to ₹5,00,000 per year, ensuring that families can access quality healthcare without financial stress.
- Inclusion of Previously Uncovered Families: The scheme extends health insurance to families previously left out of Ayushman Bharat.
- Differential Premium Rates: Beneficiaries are categorized based on socio-economic status with corresponding premium rates.
- Wide Range of Eligible Beneficiaries: The scheme covers BPL families, MNREGA workers, widows, single women, disabled individuals, senior citizens, and more.
Eligibility
- Permanent residents of Himachal Pradesh.
- Families not covered under the Ayushman Bharat Yojana are eligible to apply.
- Applicants should hold a HIMCARE card.
Exclusions
- Government servants and pensioners and their dependents are not eligible for HIMCARE.
- Families already covered under Ayushman Bharat (SECC 2011 and RSBY) are excluded.
- Individuals who do not belong to eligible categories, such as non-BPL families, registered street vendors, etc., are excluded.
Application Process
Online via CSCs
- Step 1: Locate the nearest Lok Mitra Kendra (LMK) or Common Service Center (CSC).
- Step 2: Inform the LMK/CSC staff about your intent to apply for HIMCARE.
- Step 3: Submit required details and documents to the staff for online enrollment.
- Step 4: A ₹50/- fee per family unit (up to 5 members) may be applicable.
- Step 5: After application submission, it will be processed for verification.
- Step 6: Upon approval, an E-card will be issued, which serves as proof of enrollment.
Documents Required
- BPL: BPL certificate attested by the Panchayat Secretary.
- Registered Street Vendors: Registration certificate attested by the Executive Officer.
- MNREGA Worker: Job card and MIS report showing 50 days work.
- Ekal Naaris: Certificate from the CDPO for widows/divorced/unmarried women above 40 years.
- Disabled >40%: Medical disability certificate.
- Mid-Day Meal Workers: Certificate from the Block Education Officer.
- Contractual/ Daily Wage/ Part-Time Workers: Certification from the concerned Department.
- Aadhaar Card and Bank Details for all applicants.
Frequently Asked Questions
- What is the coverage amount provided by HIMCARE?
₹5,00,000 per year per family for cashless treatment. - Who is eligible to apply for HIMCARE?
Permanent residents of Himachal Pradesh who are not covered under Ayushman Bharat. - Can government servants and pensioners apply for HIMCARE?
No, government servants and pensioners and their dependents are not eligible. - How can I apply for HIMCARE?
Applicants can apply online at Lok Mitra Kendra (LMK) or Common Service Centers (CSC). - What documents are required for enrollment?
Documents like BPL certificate, MNREGA job card, disability certificate, Aadhaar, bank details, and more based on the category. - Is there an enrollment fee for HIMCARE?
Yes, a fee of ₹50/- per family unit (up to 5 members) is applicable. - Can I avail treatment at hospitals outside Himachal Pradesh under HIMCARE?
No, the scheme only covers treatment in empanelled hospitals within Himachal Pradesh. - Can I change my category or update my information after enrollment?
Yes, beneficiaries can update their details through CSC or the official portal.
Sources and References
- Website& Guidelines: Official HIMCARE website
- Hospital List