HIMCARE Health Insurance Scheme, Himachal Pradesh

A Comprehensive Guide to Mukhya Mantri Himachal Health Care Scheme (HIMCARE)

The HIMCARE Health Insurance Scheme, also known as Mukhya Mantri Himachal Health Care Scheme, was launched by the Government of Himachal Pradesh on January 1, 2019. It offers families a cashless treatment facility of up to ₹5 lakh per year. Eligible families can receive the required medical care at empanelled hospitals.

The main objective behind launching this scheme is to help families avail medical care services without worrying about finances. It primarily targets the families who are not covered under other government health insurance schemes. Therefore, if a person is already eligible for benefits under schemes such as the Ayushman Bharat scheme, they may not be eligible for HIMCARE.

What is the HIMCARE Scheme?

HIMCARE stands for Himachal Health Care Scheme. Under this program, the Government of Himachal Pradesh offers cashless health insurance covering a broad spectrum of medical treatments. This includes hospitalisation, surgeries, treatment for critical illnesses, and more.

The scheme is quite beneficial for the local people because they can receive cashless treatment at empanelled hospitals across Himachal Pradesh and even in selected hospitals outside the state.

The HIMCARE scheme is specifically designed for the following groups in Himachal Pradesh:

1. The families who are not covered under other government schemes.
2. People with low- and middle-income.
3. Unorganised sector workers

What are the Eligibility Criteria for the HIMCARE Scheme?

One of the most essential eligibility criteria to get the benefit of this scheme is that the person should be a permanent resident of Himachal Pradesh. Secondly, the person should not be covered under Ayushman Bharat (PM-JAY).

The HIMCARE scheme divides beneficiaries into three main categories based on their income level, occupation, and social status. Therefore, each category requires a different premium amount.

Category I – Free Coverage

This category includes people who are financially weak.

People covered under this category are:

• Families living below the poverty line (BPL) who are not already covered under Ayushman Bharat
• Registered street vendors who are not covered under any other scheme.
• MNREGA workers and those who have worked for at least 50 days in the current or previous financial year.

The premium for this category is nil.

Category II- Low Premium Group

This category includes the people who are not extremely poor but still need financial support for healthcare. This category requires a small annual premium.

People covered under this category are:

• Ekal Nari women (women above 40 years who are unmarried, widowed, divorced, or legally separated)
• Disabled individuals with at least 40% disability.
• Senior citizens above 70 years of age
• Anganwadi workers and helpers, ASHA workers and mid-day meal workers
• Daily wage workers working under government departments or related bodies
• Outsourced employees
• Contractual Employees (Employed under Government, Autonomous Bodies, Societies, Boards & Corporations, etc., under the control of State Government)

Beneficiaries in this category pay a premium of ₹365 per year.

Category III – General Category

• This category includes people who are not eligible under the first two categories. This category includes individuals who are not government employees or pensioners, and families without any government-employed member for support

The individual may need to pay a premium of Rs. 1000 per year.

What Expenses are included in HIMCARE?

HIMCARE provides comprehensive coverage for various medical needs, such as:

• Hospitalisation Expenses: According to the scheme guidelines, these include room rent, ICU charges, doctor fees, and nursing expenses.
• Pre- and Post-Hospitalisation: This scheme also covers the expenses incurred before and after hospital admission.
• Day-Care Procedures: Treatments not requiring a 24-hour hospital stay are also covered.
• Critical Illness Treatment: HIMCARE covers life-threatening illnesses. This includes cancer, heart disease, kidney failure, etc.

What are the Benefits of HIMCARE?

Mukhya Mantri Himachal Health Care Scheme offers numerous benefits to its beneficiaries. Some of the benefits are:

1. Cashless Treatment: It is one of the biggest advantages of the HIMCARE scheme. The scheme allows the beneficiaries to receive required medical attention without paying out of their own pocket.
2. Wide Coverage: This scheme provides coverage of up to ₹5,00,000/- per family per year. It covers hospitalisation costs, pre- and post-hospitalisation costs, and surgical and critical-illness treatments.
3. Coverage for Various Groups: The scheme includes BPL families, senior citizens above 70 years, residents of orphanages, disabled individuals, and many others 
4. Easy Enrollment Process: Under the HIMCARE scheme, individuals can easily enrol online or by visiting the Lok Mitra Kendra.
5. Empanelled Hospital Network: Beneficiaries can avail cashless hospitalisation in empanelled hospitals within Himachal Pradesh as well as selected hospitals outside the state.

How to Register Online for HIMCARE?

The documents required for online registration will not be the same for each category. Hence, the applicants need to submit the required documents such as Aadhaar card, ration card, Himachal domicile, income certificate, family-related documents and passport-size photos.

Eligible individuals can easily register for HIMCARE by following the simple steps.

• Step 1: The applicant needs to visit Lok Mitra Kendra (LMK) or the official website of the HIMCARE scheme.
• Step 2: Select the option “Online HIMCARE Enrolment” visible on the screen.
• Step 3: Enter your basic details, such as your name, along with those of family members, age, gender, location, etc.
• Step 4: Now, upload all the required documents. Ensure all documents are scanned and legible.
• Step 5: Fill in the captcha and pay the premium.
• Step 6: Submit your application.
• Step 7: Lastly, upon approval of the authorities, your HIMCARE health card will be issued. Beneficiaries can then avail cashless treatment.

To Wrap Up

The HIMCARE Health Insurance Scheme is a great initiative taken by the government of Himachal Pradesh. It covers treatment at empanelled hospitals within the state. In addition, an eligible individual can receive the required medical attention at hospitals such as PGIMER, Chandigarh, and GMCH, Sector 32, Chandigarh. Eligible individuals simply need to register on the official website.

However, if you know someone eligible for this scheme, encourage them to enrol and make use of its benefits.