AI SummaryMukhya Mantri Himachal Health Care Scheme-HIMCARE provides essential health insurance to residents of Himachal Pradesh who are not covered under Ayushman Bharat. The scheme offers cashless treatment coverage up to ₹5.00 lakh per year for each family at empanelled hospitals, making quality medical care easy to access. Registration for HIMCARE is open for eligible families through the official website and Lok Mitra Kendras.
HIMCARE is a state health insurance scheme run by the Department of Health and Family Welfare, Himachal Pradesh. It has been in place since 1 January 2019 and continues to serve families left out of the national Ayushman Bharat scheme. The scheme works on a co-payment basis, with different premium rates for different categories of families.
Mukhya Mantri Himachal Health Care Scheme-HIMCARE - Introduction
HIMCARE gives cashless medical treatment of up to ₹5,00,000 every year for each family. If a family has more than five members, the remaining members get coverage as a separate unit, with a five-member cap on each unit. This keeps the scheme simple and fair for larger families.
Hospitals empanelled under Ayushman Bharat within the state also support this scheme, providing treatment through an online Transaction Management System. Claims are paid directly into hospital accounts through a host-to-host payment process after proper checking. Beneficiaries can also take treatment at PGIMER Chandigarh and GMCH Sector 32 Chandigarh.
The premium structure depends on the category of the family. BPL families, registered street vendors, MNREGA workers and orphanage children pay no premium, while other groups pay a small yearly amount.
| Detail | Information |
|---|---|
| Scheme Name | Mukhya Mantri Himachal Health Care Scheme-HIMCARE |
| Level | State |
| Scheme For | Family |
| Beneficiary States | Himachal Pradesh |
| Category | Health and Wellness |
| Benefit Type | Cashless Insurance |
| Coverage Amount | Up to ₹5.00 lakh per family per year |
| Nodal Department | Health and Family Welfare Department, Himachal Pradesh |
| Implementing Agency | Himachal Pradesh Swasthya Bima Yojana Society |
| Official Website | hpsbys.in |
Premium Structure
| Category Group | Annual Premium |
|---|---|
| BPL, Street Vendors, MNREGA Workers (50+ days), Orphanage Children | ₹0 |
| Ekal Naaris, Disabled above 40%, Mid-Day Meal, Contractual, Part-Time, Daily Wage, Outsource Workers | ₹365 |
| General and Others (Non-Govt employees and Pensioners) | ₹1,000 |
Benefits
The scheme gives several advantages that help families get quality healthcare without money worries. Here are the main benefits.
- Cashless Treatment: Medical services can be availed at empanelled hospitals without paying anything upfront.
- Big Coverage: Each family gets medical protection of up to ₹5,00,000 per year.
- Help for Left-Out Families: It specifically supports families who do not qualify for Ayushman Bharat Yojana.
- Affordable Tiers: With fixed premium rates, healthcare stays within reach for low-income families and contract workers.
- Wide Hospital Network: Quality care is available at network hospitals across Himachal Pradesh, including PGIMER Chandigarh and GMCH Sector 32 Chandigarh.
- Easy Enrollment: Families can apply online or visit the nearest Lok Mitra Kendra.
Eligibility
To get the benefit of this scheme, a family should meet the conditions given below.
- The applicant must be a permanent resident of Himachal Pradesh.
- The family should not be covered under Ayushman Bharat (Pradhan Mantri Jan Arogya Yojana).
- Accepted categories include BPL families, registered street vendors, MNREGA workers, Ekal Naaris, persons with disability above 40 percent, and daily wage, contractual, part-time and outsource workers.
- For example, if Ramesh is a daily wage worker with no other government health insurance, he can apply under his category.
Exclusions
Some groups are not covered under this scheme. These are listed below.
- Government servants, pensioners, and their dependent family members.
- Families already covered under Ayushman Bharat based on SECC 2011 and RSBY data.
- People who do not fall in the defined eligible categories.
Application Process
STEP 1 - Visit the official website at hpsbys.in or go to the nearest Lok Mitra Kendra or Common Service Center.
STEP 2 - Keep the ration card and category-specific documents ready. Submit the details and documents to the operator or upload them online.
STEP 3 - Pay the enrollment fee of ₹50 per family unit if applying through a Lok Mitra Kendra or Common Service Center. Once the application is confirmed, it cannot be edited.
STEP 4 - If the category requires a premium, pay it within 30 days of registration. After verification, an E-card is issued for cashless services.
Documents
Keep these documents ready for enrollment, depending on the category.
| Category | Required Documents |
| BPL | Attested BPL certificate (within 1 month) |
| Street Vendors | Attested Registration Certificate (within 1 month) |
| MNREGA Worker | MNREGA Job Card and MIS report |
| Ekal Naaris | Certificate from Child Development Program Officer |
| Disabled above 40% | Medical Disability Certificate |
| Workers (Mid-Day, Daily, Part-Time, Contract, Outsource) | Relevant department certification |
References
Visit Official Website and Guidelines
FAQ's
What is the coverage amount provided by HIMCARE?
HIMCARE provides cashless treatment coverage of up to ₹5.00 lakh per year per family in empanelled hospitals.
Who is eligible to apply for HIMCARE?
Eligibility covers specific groups including BPL families, registered street vendors, MNREGA workers, Ekal Naaris, and others not covered by Ayushman Bharat.
Can government servants and pensioners apply for HIMCARE?
No, government servants, pensioners, and their dependents are excluded from this scheme.
How can I apply for HIMCARE?
Apply online at the official website hpsbys.in or through authorized Lok Mitra Kendra and Common Service Centers.
What documents are required for enrollment?
Category-specific proofs are needed, such as a BPL certificate, MNREGA job card, or disability certificate, depending on the category.
Is there an enrollment fee for HIMCARE?
A fee of ₹50 per family unit may apply if registration is done through a Lok Mitra Kendra or Common Service Center.
Can I get treatment at hospitals outside Himachal Pradesh under HIMCARE?
The scheme mainly works in empanelled hospitals within the state, with specific exceptions for PGIMER and GMCH Chandigarh.
Can I change my category after enrollment?
Accurate data should be submitted during the initial application, as post-enrollment updates may be restricted.