This policy shall be called ‘The Himachal Health Care Scheme’ in short HIMCARE.

 

  • Commencement

The scheme shall come into effect from the date of notification.

 

  • Benefit Package

Cashless treatment coverage of Rs. 5.00 lakh per year per family will be provided under the scheme on family floater basis subject to maximum of five members per family unit. In case family size exceeds five members, the remaining members can be enrolled as a separate unit subject to the capping of five members for each such addition unit. The treatment will be provided on the basis of pre-defined package rates in the empanelled hospitals.

 

  • Differential premium

Following premium shall be collected from beneficiaries at the time of enrollment under Him Health Care Scheme based on the categories defined below:

 

  •  

Target group

Premium amount

  1.  

BPL and Registered Street Vendors (Not covered under Ayushman Bharat)

  •  

    2. 

  • Ekal Naaris
  • Disabled >40% (At present  >70% Disabled are covered and it is proposed to cover >40% disabled under the new scheme)
  • Sr. Citizens above 70 years of age (At present Sr. Citizens above 80 years are covered and it is proposed to cover Sr. Citizens above 70 years of age under new scheme)
  • Anganwari Workers
  • Anganwari Helpers
  • ASHA workers (Category not included under MMSHCS and it is proposed to include ASHA workers)
  • Mid-Day meal workers
  • Daily Wage Workers (Govt., Autonomous Bodies, Societies, Boards & Corporations etc.),
  • Part Time Workers (Govt., Autonomous Bodies, Societies, Boards & Corporations etc.)
  • Contractual Employees (Govt., Autonomous Bodies, Societies, Boards & Corporations etc.)

Rs. 365 per year

    3. 

  • All the beneficiaries covered under HP Universal Health Protection Scheme
  • Beneficiaries not covered under category-I and category-II or who are not govt. servants or their dependent family members.

Rs. 1000 per year

 

The various beneficiaries shall give proof of concerned category through uploading of relevant document at the time of enrolment and renewal as per Annexure-A.

 

 

 

  • Enrolment & Renewal

The scheme shall be implemented through e-cards. The enrolment shall be done in a simple way through a user friendly web interface capturing Aadhar, Ration Card, Mobile Number and proof of category. The beneficiary will apply through online system directly or through Lok Mitra Kendra/Common Service Centres. He/she will make online payment of premium by using online payment gateway. After the approval of enrolment from back-end, the beneficiary will receive SMS regarding his enrolment and he/she will be able to download/generate the E-Card under the scheme.The CSC/LMK will collect Rs. 50/- per family from the beneficiaries for enrollment and uploading the documents under the scheme. After the approval message is received, the beneficiary can get his/her card printed from the concerned CSC/LMK within the user fee of Rs. 50/- initially given to the CSC/LMK. The data of the existing beneficiaries shall be ported onto the new system (unique ID will remain same) and they shall automatically receive link for downloading of the e-card on their registered mobile numbers. Option to generate the E-Card at hospital level shall also remain available.

The beneficiary will be informed through SMS on registered mobile alongwith policy renewal link for renewal of policy 15 days before the expiry of policy period.

The enrollment/renewal shall be open only for three months in a year i.e. from January to March to avoid the issues of adverse selection. The policy period for individual beneficiary household shall commence from the date of approval of enrollment/renewal till the expiry of twelve months.

 

  1. Transaction Management System

A Card less Transaction Management System will be used at the hospitals for treatment of beneficiaries under the scheme. This system will be used for authentication of beneficiary at hospital and online treatment entries of beneficiaries. The claims will be checked by the support agency through online system and recommended for payment/rejection. Thereafter the society will reimburse the amount to the concerned hospitals through electronic transfer/RTGS/NEFT etc.

 

  • Empanelment Process & Package rates

The hospitals empanelled under Ayushman Bharat will stand automatically empanelled for HIMCARE and package rates of Ayushman Bharat (customized for the state by HPSBYS) will be adopted for this scheme.

 

  • Him Care Sathi

Under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna, the hospitals have engaged Pradhan Mantri Arogya Mitra who are responsible for Beneficiary Identification System (BIS) and working on Transaction Management System (TMS) for implementation of Ayushman Bharat. These PMAM will also look after the work of Him Health Care Scheme and they may be designated as HIMCARE SATHI for the said scheme.

 

 

 Annexure-A

 

Category

Documents required for authentication

BPL

 

 

Copy of BPL certificate attested by the Panchayat Secretary within previous one month.

Registered Street Vendors

Registration Certificate attested by the Executive Officer, MC/NP/NAC within previous one month.

Ekal Naaris

 

Certificate to be issued by Child Development Program Officer (CDPO) of the concerned area and shall include Widows/Divorced/Legally Separated /Unmarried more than 40 years.

Disabled >40%

 

Medical Disability Certificate showing permanent disability.

Sr. Citizens above 70 years of age

Any valid age proof

Anganwari Workers/Helpers

Certificate from Child Development Program Officer (CDPO) of the concerned area.

ASHA workers

Certificate from Block Medical Officer (BMO) of the concerned area.

Mid-Day meal workers

Certificate from Block Elementary Education Officer of the concerned area.

Contractual Employees

Certification from concerned Department

Daily Wage Worker

Certification from concerned Department

Part Time Workers

Certification from concerned Department