Overview of Mukhya Mantri Himachal Health Care Scheme (HIMCARE)

The **Mukhya Mantri Himachal Health Care Scheme**, popularly known as **HIMCARE**, is a flagship health protection initiative launched by the Government of Himachal Pradesh on January 1, 2019. This scheme is designed to provide comprehensive health coverage to those families in Himachal Pradesh who are not covered under the central government's Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) or are not eligible for government medical reimbursement schemes (e.g., government employees and pensioners).

• Objective: To provide cashless treatment coverage on the analogy of Ayushman Bharat to all families not covered under PM-JAY or state government's medical reimbursement.
• Coverage Amount: Up to ₹5,00,000 per family per year for secondary and tertiary care hospitalization.
• Family Floater Basis: The coverage amount is on a family floater basis, meaning it can be utilized by one or all members of the family.
• Pre-existing Diseases: All pre-existing medical conditions are covered from day one of enrollment.
• Cashless Treatment: Beneficiaries receive cashless access to healthcare services at any empanelled public or private hospital within Himachal Pradesh and also at PGIMER Chandigarh and GMCH Sector 32 Chandigarh.

HIMCARE ensures that no family is left behind in accessing quality healthcare due to financial constraints.

Eligibility Criteria for HIMCARE

HIMCARE categorizes beneficiaries to offer differential, subsidized premium rates. The scheme specifically targets those not covered by other major health schemes:

Ineligible Categories (already covered by other schemes):

• Government servants, pensioners, and their dependents.
• Beneficiaries already covered under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

Eligible Categories (and associated premium):

Category 1: Zero Premium (Free Enrollment)

• BPL (Below Poverty Line) families (who are not covered under Ayushman Bharat).
• Registered Street Vendors (who are not covered under Ayushman Bharat).
• MNREGA workers who have worked at least 50 days in the previous or current financial year.
• Senior citizens above 70 years of age.
• Orphan children living in orphanages.

Category 2: ₹365 Premium per year

• Ekal Naaris (Widows, Divorced, Legally Separated, or Unmarried women over 40 years of age).
• Individuals with more than 40% disability.
• Anganwadi workers and helpers.
• ASHA (Accredited Social Health Activist) workers.
• Mid-day meal workers.
• Daily wage workers, Part-time workers, Contractual, and Outsourced employees under the State Government.

Category 3: ₹1000 Premium per year

• All other families residing in Himachal Pradesh not covered under PM-JAY and not eligible for government medical reimbursement schemes.
• In case of more than five family members, the remaining members can be enrolled as a separate unit (subject to capping of five members per additional unit), each unit requiring a separate premium payment.

Applicants must provide necessary documents to authenticate their category at the time of enrollment.

Benefits and Coverage Under HIMCARE

The HIMCARE scheme provides comprehensive health benefits to its enrolled beneficiaries:

• Cashless Hospitalization: Beneficiaries receive cashless treatment, eliminating the need for upfront payments at empanelled hospitals.
• High Coverage Limit: Provides a health cover of up to ₹5 lakh per family per year, safeguarding against high medical expenses.
• Extensive Network of Hospitals: Treatment can be availed at all government hospitals and empanelled private hospitals within Himachal Pradesh. Additionally, major hospitals outside the state like PGIMER Chandigarh and GMCH Sector 32 Chandigarh are also empanelled.
• Wide Range of Covered Procedures: The scheme covers a wide array of secondary and tertiary care procedures, including medical examination, treatment, consultation, pre-hospitalization expenses (up to 3 days), post-hospitalization follow-up care (up to 15 days), medicines, diagnostics, surgical procedures, and accommodation.
• Family Floater Benefit: The ₹5 lakh cover can be utilized by any or all members of the enrolled family unit.
• No Age or Family Size Restrictions (with unit capping): While there's no overall age limit or family size restriction, for families larger than five, additional units must be created, each with its own coverage and premium.

HIMCARE ensures financial security for a wide range of medical treatments.

Application and Enrollment Process

Enrolling in HIMCARE is a straightforward process, available both online and offline:

Online Enrollment:

1. Prepare Documents: Ensure you have scanned copies of all required documents specific to your eligibility category (refer to the "Documents Required" section below).
2. Visit Official Website: Go to the official HIMCARE portal: www.hpsbys.in.
3. Navigate to Enrollment: Look for the "Online HIMCARE Enrolment" or "Apply for HIMCARE" section.
4. Fill Application Form: Enter all personal details, family details, and category-specific information accurately.
5. Upload Documents: Upload the scanned copies of all necessary supporting documents.
6. Submit Application: Review all details carefully before final submission.
7. Receive URN: Upon successful submission, you will receive a Unique Reference Number (URN) to track your application status.
8. Pay Premium (if applicable): If your category requires a premium payment, complete the payment online to finalize your registration.

Offline Enrollment (Lok Mitra Kendra / CSC):

1. Gather Documents: Collect all original and attested copies of required documents.
2. Visit LMK/CSC: Go to your nearest Lok Mitra Kendra or Common Service Center.
3. Assistance: The LMK/CSC operator will assist you in filling the application form and uploading the documents online.
4. Pay Fee: A nominal fee of ₹50 will be collected per family unit by the LMK/CSC for enrollment/e-card preparation.
5. Pay Premium (if applicable): Pay the applicable premium amount based on your category.

E-Card Generation:

Once your application is approved and premium (if any) is paid, you can download your HIMCARE E-Card from the official website using your URN, ration card number, or Aadhaar number. This E-Card is essential for availing cashless treatment.

Annual renewal is required; beneficiaries are typically notified via SMS about policy expiry.

Documents Required for Enrollment

The specific documents required depend on the category under which you are applying. Always ensure documents are attested by the concerned authority where specified.

• General Documents (Common for most categories):
  • Aadhaar Card of all family members.
  • Ration Card (if applicable).
  • Bank Passbook (first page with account details).
  • Passport size photographs of the Head of Family.
• Category-Specific Documents:
  • BPL: Attested copy of BPL certificate (issued within previous month) by Panchayat Secretary.
  • Registered Street Vendors: Registration Certificate attested by Executive Officer, MC/NP/NAC (within previous month).
  • MNREGA Worker: MNREGA Job Card and online MIS Report showing 50 days of work in previous/current financial year, attested by Panchayat Secretary/BDO.
  • Ekal Naaris: Certificate issued by Child Development Program Officer (CDPO) of the concerned area.
  • Disabled (>40%): Medical Disability Certificate indicating permanent disability.
  • Senior Citizens above 70 years: Any valid age proof document.
  • Orphan Children: Relevant orphanage certificate or government issued document.
  • Anganwadi Workers/Helpers, ASHA workers, Mid-day meal workers: Certificate from concerned CDPO/BMO/Block Elementary Education Officer.
  • Daily Wage/Part-time/Contractual/Outsourced Employees: Certification from the concerned Department/Organization.
  • Other Categories: Proof of residence (Himachali Bonafide Certificate) and income certificate (if applicable based on scheme guidelines).

Always refer to the official HIMCARE website for the most accurate and updated list of required documents for each specific category.

Finding Empanelled Hospitals

HIMCARE has an extensive network of empanelled hospitals to ensure wide accessibility to cashless treatment:

• Official Website: The official HIMCARE website (www.hpsbys.in) provides a dedicated section to view empanelled hospitals.
• Steps to Find Hospitals:
  1. Visit the HIMCARE website.
  2. Click on "View Hospitals" on the homepage.
  3. Select your district and desired specialty (optional).
  4. Click "Search" to view the list of empanelled hospitals with their contact details.
• Coverage Outside HP: Besides hospitals within Himachal Pradesh, PGIMER Chandigarh and GMCH Sector 32 Chandigarh are also part of the HIMCARE empanelled network.

Always verify the empanelment status of a hospital before seeking treatment.

Official Website and Contact Information

For any queries, enrollment, or further details regarding the HIMCARE scheme, refer to the following official resources:

• Official HIMCARE Portal (Himachal Pradesh Swasthya Bima Yojana Society):
  Website: www.hpsbys.in
  This is the primary source for online enrollment, card download, hospital list, and scheme information.
• Helpline Numbers:
  • HIMCARE Helpline: 1800 599 3588 (Toll-Free)
  • PMJAY/HIMCARE Common Helpline: 14555 (Toll-Free)
  • For contact support: 0177-2629802
• Technical Support:
  Phone: 8091773886 (10 AM - 1:30 PM & 2:30 PM - 5 PM)
  Email: technicalquerieshpsbys@gmail.com
• Card Approvals Contact: Various mobile numbers are provided on the official website's contact page for card approval related queries.
• Department of Health & Family Welfare, Himachal Pradesh: For broader health policy and scheme information.
  Website: health.hp.gov.in (though HIMCARE has its dedicated portal)

Always rely on official government websites and helplines for accurate and updated information.