Senior Citizen Health Insurance Scheme (SCHIS) in Himachal Pradesh

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The state government of Himachal Pradesh Government is implementing the Senior Citizen Health Insurance Scheme (SCHIS) in the state. The objective of this insurance scheme is to provide easy access to various health services by providing an insurance cover to all senior citizen (above the age of 60 years).

Under Senior Citizen Health Insurance Scheme (SCHIS), the government will provide top-up coverage of up to Rs. 30,000 per senior citizen in the state. This scheme will cover all senior citizens who are the smart card holders of Rashtriya Swasthya Bima Yojna (RSBY). Moreover, if there are more than 1 senior citizen in a RSBY rolled family, the additional insurance coverage in multiples of Rs. 30,000 per senior citizen will be provided on floater basis.

In other words, if there are two senior citizens in a family then cover of Rs. 60,000 would be accessible on a floater basis to each the senior citizen.

Highlights of Senior Citizen Health Insurance Scheme (SCHIS)

Below are some of the main features / highlights of the SCHIS

  • The benefit of SCHIS is available to senior citizen (above 60 years).
  • The candidate should be Rashtriya Swasthya Bima Yojna (RSBY) smart card holder.
  • The beneficiary has to pay only a nominal annual premium for SCHIS which is up to Rs. 500 per family.
  • Moreover, Central and State government will share the insurance premium in the ratio of 90:10 under the Trust Model.
  • In addition, the state government will not issue any separate enrollment process. The beneficiary will be selected only among the smart card holders of RSBY.
  • The beneficiary can take health care services by showing their health card into any of the RSBY empaneled hospitals.
  • All the financial transactions between government and insurance company will be done through bank channel. Apart from this, the unspent fund will be refunded at the closing of the financial year.

The candidates can check the name of nearly hospital by clicking on the below link
RSBY Empaneled hospitals

Surgical Packages List
Ministry of health and Family Welfare has prepared a separate list of the surgical packages that costs more than Rs 30,000. Below given is the list of those packages

Surgical OncologyCardiothoracic Surgery
Poly-Trauma and RepairNeuro Surgery
Medical OncologyCardiology
BurnsCardiovascular Surgery

The beneficiary can avail cashless treatment in any of the RSBY empaneled hospitals under Senior Citizen Health Insurance Scheme (SCHIS). Moreover, the government is also providing two additional covers that will be compensated from existing top-up of RSBY for critical care up to Rs. 1.75 lakh in addition up to Rs. 2.25 lakh for cancer.

The trust/ society will receive the claims directly from the hospitals. Subsequently, these trusts will settle these claims on the basis of the package rates defined by the Central govt. Furthermore, state govt. will borne the expenses for IEC and other certain expenses.

The Trust Model will get all claims directly from the hospitals, not to the beneficiary and will settle claims in accordance with the defined package rates.

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