Quick Overview
- HIMCARE is an abbreviation of Mukhya Mantri Himachal Health Care Scheme, which is also referred to as Himachal Pradesh Swasthya Bima Yojana.
- It is a health insurance scheme by the state government that seeks to cover cashless medical treatment to eligible residents of Himachal Pradesh.
- The scheme offers up to ₹5,00,000 per year per family on a family floater basis.
- Coverage is provided at empanelled hospitals, including public and selected private facilities within the state.
- HIMCARE fills coverage gaps for families who are not covered under Ayushman Bharat-PMJAY or similar national schemes.
- Beneficiaries may need to contribute a nominal premium or co-payment depending on their socioeconomic category.
- The program operates through the Himachal Pradesh Swasthya Bima Yojana Society, which manages enrolment, cards, and claim processing.
HIMCARE is an abbreviation of Mukhya Mantri Himachal Health Care Scheme, a state-funded Himachal Pradesh Swasthya Bima Yojana that aims at offering health insurance cover to the residents who otherwise do not have or have limited access to proper medical insurance. It ensures that eligible families receive financial protection and access to quality secondary and tertiary health care without upfront payment at empanelled hospitals.
The programme under which HIMCARE operates is called the Himachal Pradesh Swasthya Bima Yojana. The scheme works similarly to other state health protection programs by offering cashless hospitalization coverage up to ₹5 lakh per year for conditions requiring inpatient care, surgeries, and critical treatment. The enrolment of eligible families is done via a dedicated government portal, which is administered by the Himachal Pradesh Swasthya Bima Yojana Society.
What is Himachal Pradesh Swasthya Bima Yojana?
Purpose of Himachal Swasthya Bima Yojana
Himachal Swasthya Bima Yojana is primarily aimed at helping to make sure that the citizens of Himachal Pradesh, particularly those who do not have other health insurance plans and protections, can receive high-quality medical care without experiencing any financial burden. It is aimed at minimising out-of-pocket costs of hospitalisation and severe illnesses that would otherwise be economically devastating to the vulnerable families.
Government’s Role in Providing Health Insurance
HIMCARE is managed by the government of Himachal Pradesh in the Health and Family Welfare Department and the Swasthya Bima Yojana Society. The state creates eligibility groups, empanels hospitals, establishes the structure of premiums, and liaises between claims and insurance partners and healthcare providers. This position is important in making sure that even those families that are not covered by central schemes such as Ayushman Bharat get protection.
Target Beneficiaries of the Scheme
HIMCARE focuses on the families of Himachal Pradesh that do not fall under the scope of other big health insurance schemes like Ayushman Bharat. The scheme covers low-income groups, people involved in informal employment, elderly people, single women, disabled people, and other vulnerable groups determined by the state.
Key Objectives of the HIMCARE Scheme
Objective |
Details / Explanation |
Providing Affordable Health Insurance Coverage |
HIMCARE also makes sure that families get access to affordable health coverage to save them the financial burden of major medical procedures. This will minimise the use of personal savings, borrowings, or debt to cover the expenses of hospitalisation. |
Reducing Out-of-Pocket Medical Expenses |
The scheme covers cashless treatment of up to 5,00,000 per year per family, which is a huge reduction in out-of-pocket cost incurred during hospitalisation. This renders healthcare affordable to low-income earners and vulnerable groups. |
Expanding Access to Quality Healthcare |
HIMCARE enhances access to both government- and empanelled private-hospitals within Himachal Pradesh, so that beneficiaries are provided with adequate care irrespective of their geographical location, either in urban or rural regions. |
Financial Protection for Vulnerable Groups |
The programme focuses on families with low incomes, elderly citizens, single ladies, and individuals with disabilities, providing them with financial security against huge medical costs. |
Promoting Early Medical Intervention |
The scheme can cover the hospitalisation costs, and this has the benefit of promoting promptness in treating critical conditions and hence minimising complications and enhancing health outcomes. |
Encouraging Preventive and Specialized Care |
HIMCARE favours specialised therapy, operation, and some form of follow-up, facilitating improved long-term health management. |
Streamlining Hospitalization Process |
The scheme facilitates the settlement of claims by facilitating the admission, treatment approvals, and claims settlements of beneficiaries through a cashless claim system and empanelled hospitals. |
Supporting State Healthcare Infrastructure |
HIMCARE collaborates with empanelled hospitals to improve the healthcare ecosystem of Himachal Pradesh and guarantee uniform care and improved treatment quality monitoring. |
Eligibility Criteria for HIMCARE
Eligible Families Under the HIMCARE Scheme
In order to be eligible for HIMCARE, the applicant should be a permanent resident of Himachal Pradesh and should not be under the coverage of the central health insurance programmes such as Ayushman Bharat-PMJAY. The programme is aimed at targeting families that are not covered by other significant schemes.
Income and Socioeconomic Criteria
The nominal premium and co-payment requirements vary with the socioeconomic status of the beneficiaries, who are classified into different categories. These are low-income families, BPL, and daily wage earners, as well as other categories, that are state-defined
Categories Covered Under Himachal Swasthya Bima Yojana
HIMCARE includes:
- BPL families and registered street vendors.
- MNREGA workers who are highly involved.
- Senior citizens above 70
- Ekal Naaris (single women)
- People with disabilities (more than 40% disability)
- Anganwadi workers, ASHA workers, daily wage, part-time, and contractual workers.
- Non-government servants who are not otherwise covered by other health schemes.
Benefits Under the HIMCARE Scheme
Benefit |
Details / Explanation |
Annual Health Insurance Coverage Amount |
Every eligible family is entitled to the coverage of 5,00,000 rupees per annum on a family floater basis. This involves hospitalisation, surgeries, and treatment of severe medical ailments. The coverage will cover catastrophic health costs. |
Cashless Hospitalisation Benefits |
Cashless treatment is available in all government and private hospitals to beneficiaries. The bills are settled directly with the scheme authorities and do not require the patient to make upfront payments to the hospitals. |
Coverage for Critical Illnesses and Major Surgeries |
The scheme includes high-cost medical procedures, including cardiac surgeries, neurosurgeries, dialysis, organ-related surgeries, and cancer treatments, which offer financial cover to critical health conditions. |
Pre-Hospitalisation Expenses |
The scheme comprises the costs incurred on diagnostics and tests prior to hospitalisation, which decreases the financial load on patients prior to admission. |
Post-Hospitalisation Expenses |
Approved treatments include some follow-up consultations, medications, and diagnostics after discharge, which allow the beneficiaries to finish their recovery without paying extra. |
Day Care Procedure Coverage |
The scheme covers procedures that do not involve overnight stay in a hospital e.g. minor surgeries, chemotherapy sessions, and dialysis, making treatment more accessible. |
Emergency Care Coverage |
HIMCARE provides prompt care in the case of medical emergencies in empanelled hospitals, such as trauma, accidents, and critical interventions. |
Family-Based Coverage |
The coverage is made on a family floater basis, and hence all the eligible members of the family mentioned in the application are covered under one policy. |
Coverage Across Empanelled Hospitals |
The beneficiaries have flexibility in selecting healthcare providers, as treatment can be availed in any government or any other empanelled hospital in Himachal Pradesh. |
Support for Vulnerable Groups |
Low-income families, senior citizens, disabled people, and single women are given special consideration so that they can access timely medical treatment without worrying about financial issues. |
Coverage Offered by HIMCARE Health Insurance
Inpatient Hospitalisation Coverage
HIMCARE pays the hospitalisation expenses in hospitals empanelled in the scheme, such as room charges, surgical bills, diagnostics, medication, and other necessary services related to inpatient care.
Day Care Procedures Covered
According to the scheme guidelines, certain day care procedures that do not involve prolonged hospitalisation but are medically essential can be covered under defined package rates.
Pre and Post-Hospitalisation Expenses
The scheme also covers pre-hospitalisation diagnostics and post-discharge follow-up care, which will aid in minimising the extra cost that families incur due to the associated care.
Exclusions Under the HIMCARE Scheme
Treatments Not Covered Under HIMCARE
Some services, like routine outpatient care (OPD), cosmetic services, and services that are not medically necessary, tend to be out of coverage.
Non-Medical Expenses Excluded
HIMCARE does not cover expenses such as food for attendants, travel expenses, or accommodation that is not under the care of the hospital. These are not covered under medical reimbursement.
Conditions Outside Policy Scope
Services that are not covered include treatments that are not included in the approved package list, treatments that are done at non-empanelled facilities, and services that do not require hospitalisation.
Documents Required for HIMCARE Registration
Identity Proof Documents
Theapplicant'st identity and residence must be verified by providing documents like Aadhaar card, voter ID, or any other identity proof issued by the government.
Address and Residence Proof
Evidence of residence in Himachal Pradesh, like a ration card or utility bill, assists in determining the eligibility of the scheme.
Income and Family-Related Documents
Depending on the category of the applicant, income certificates, BPL certificates, MNREGA job cards, disability certificates, and family member information may be needed.
HIMCARE Online Registration Process
How to Apply for HIMCARE Online
The applicants are allowed to apply online by using the official Himachal Pradesh Swasthya Bima Yojana Society portal when the application window is open (usually quarterly). The portal enables the beneficiaries to enter personal information and provide supporting documents.
Step-by-Step HIMCARE Application Process
- Access the official HIMCARE portal during open registration periods.
- Create an account or log in with Aadhaar details.
- Enter family and socioeconomic information.
- Upload required documents (e.g., identity proof, income proof).
- Submit the application and note the reference ID for tracking.
Verification and Approval of Application
The submitted application is verified against state records. Once approved, the applicant is issued a HIMCARE card that enables cashless treatment at empanelled hospitals.
HIMCARE Card Details
What is a HIMCARE Card?
A HIMCARE Card is an identification card issued to eligible beneficiaries under the Himachal Pradesh Swasthya Bima Yojana. It contains family details, coverage limits, and serves as proof to avail cashless treatment at empanelled hospitals.
How to Download the HIMCARE Card
Once approved, the HIMCARE card can be downloaded from the official portal or obtained from local Common Service Centers (CSCs) or Lok Mitra Kendras during the application cycle.
Using the HIMCARE Card for Cashless Treatment
Beneficiaries present the HIMCARE card at empanelled hospitals during admission. The card verifies eligibility and enables cashless access to medical treatment up to the covered amount.
HIMCARE Claim Process
Cashless Claim Procedure Under HIMCARE
When a beneficiary is admitted for a covered treatment at an empanelled hospital, the hospital initiates the cashless claim process by verifying the HIMCARE card and obtaining approval from the scheme authorities before treatment begins.
Reimbursement Claim Process
For certain treatments or specific hospital interactions, claims may be submitted by the hospital directly to the insurance system. Approved claims are paid directly to the hospital’s bank account through the online host-to-host payment system.
Claim Settlement Timeline
Claims are typically processed electronically once all documentation and verification are completed, ensuring timely settlement directly with the hospital.
List of Empanelled Hospitals Under HIMCARE
Government Hospitals Covered Under HIMCARE
All government hospitals in Himachal Pradesh participating in the scheme are empanelled and provide cashless treatment services to HIMCARE beneficiaries.
Private Hospitals Empanelled Under the Scheme
Empanelled private hospitals may include select facilities that meet scheme criteria and participate in the health insurance network. These hospitals provide cashless services for covered procedures.
How to Check the HIMCARE Hospital List Online
The updated list of empanelled hospitals can be checked on the state’s official Swasthya Bima Yojana Society portal. Beneficiaries can use search tools to locate nearby approved hospitals.
HIMCARE vs Private Health Insurance
Differences Between Government and Private Health Insurance
HIMCARE provides subsidized cashless coverage to targeted populations, whereas private health insurance plans can be purchased by anyone but often come with higher premiums and broader coverage options beyond ₹5 lakh. Government schemes focus on social protection, while private plans are commercially driven and customizable.
When HIMCARE is Sufficient
HIMCARE can fit the requirements of families that require basic hospitalisation and critical care insurance to a limit of 5 lakh per year, particularly families with less financial means or those out of central healthcare schemes.
Need for Additional Health Insurance Coverage
Families that want additional outpatient treatments, larger sum insured, and treatment outside the empanelled networks can use the additional coverage of the private health insurance on top of HIMCARE to ensure full protection.
Conclusion
HIMCARE is an important healthcare safety net that promises that a large number of vulnerable and previously uninsured families in Himachal Pradesh access quality and cashless medical care without having to grapple with large medical bills. The plan enhances the healthcare system of the state by increasing coverage, encouraging access to preventive and emergency care, and decreasing the financial strain on severe health issues.
Why You Should Opt for ManipalCigna Health Insurance Along with the HIMCARE Scheme
Although HIMCARE is a good choice with a limit of 5 lakh, the addition of a personal health policy, such as ManipalCigna Health Insurance, can increase the limits of coverage, add OD and wellness benefits, and provide flexibility of choice of hospitals nationwide. The combination strategy will provide additional coverage to the overall health requirements of your family.
Frequently Asked Questions (FAQs)
What is HIMCARE, and who can apply for it?
HIMCARE is the Himachal Pradesh Swasthya Bima Yojan, which provides up to ₹5 lakh cashless health coverage per family per year. Permanent residents meeting the eligibility criteria can apply.
What is the coverage amount under the HIMCARE scheme?
The scheme provides insurance cover of up to ₹5,00,000 per year per family on a family floater basis.
How can I apply for HIMCARE online?
Applicants can apply online through the state’s official Swasthya Bima Yojana Society portal during open registration cycles.
Is HIMCARE renewable every year?
Yes, HIMCARE coverage is renewable annually, and the card may need to be reissued or renewed during designated application periods.
How to check the HIMCARE empanelled hospital list?
The updated list can be accessed on the official scheme portal, where beneficiaries can search for empanelled hospitals in their area.
