Himachal Health Care Scheme-HIMCARE

Under Ayushman Bharat, families have been selected by the Government of India on the basis of SECC, 2011 and RSBY. For providing the cashless treatment coverage on the analogy of Ayushman Bharat to the left out families, the State is implementing Himachal Health Care Scheme (HIMCARE) since 1st January, 2019.

Under HIMCARE Scheme, cashless treatment coverage up to Rs. 5.00 lakh per year per family is being provided on family floater basis. In case of more than five members, the remaining members are being enrolled as a separate unit subject to the capping of five members for each such additional unit.

This scheme is being implemented on co-payment basis. Under this scheme, differential premium rates have been decided based on the categories.

    Category

     Target group

  Premium amount

       I

  • BPL (Not covered under Ayushman Bharat)
  • Registered Street Vendors (Not covered under Ayushman Bharat)
  • MNREGA worker who have worked minimum 50 days under MNREGA during previous financial year or current financial year.

   Zero

       II

  • Ekal Naaris
  • Disabled >40%
  • Sr. Citizens above 70 years of age
  • Anganwari Workers
  • Anganwari Helpers
  • ASHA workers
  • Mid-Day meal workers
  • Daily Wage Workers (Govt., Autonomous Bodies, Societies, Boards & Corporations etc. under the control of State Government),
  • Part Time Workers (Govt., Autonomous Bodies, Societies, Boards & Corporations etc. under the control of State Government)
  • Contractual Employees (Govt., Autonomous Bodies, Societies, Boards & Corporations etc. under the control of State Government)
  • Outsource Employees

Rs. 365 per year

      III

  • Beneficiaries not covered under category-I and category-II or who are not Govt. servants/pensioners or their dependent family members.

Rs. 1000 per year

 

Following documents are mandatory for enrollment under HIMCARE:

 

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.

MNREGA Worker

MNREGA Job Card and Online MIS Report indicating 50 days work under MNREGA in previous or current financial year duly attested by concerned Panchayat Secretary/BDO.

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

Outsource Employees

Certification from concerned Department

 

E-card on the analogy of Ayushman Bharat is being issued to the families. The beneficiary can apply through online system directly by visiting www.hpsbys.in or through Lok Mitra Kendra/Common Service Centers for enrollment and uploading relevant documents under the scheme. The LMK/CSC will collect Rs. 50 per family up to unit of five for enrollment/preparation of E-Card under this vibrant scheme. The enrollment is open only for three months i.e. from January to March to avoid the issues of adverse selection. However, the renewal process will be on for 12 months as per the policy period of card holder. It is the responsibility of concerned beneficiary to apply under relevant category only for which above mentioned documents are required to be uploaded on website. There is no provision for reimbursement of premium if the beneficiary will apply under wrong category for getting subsidized benefit under the scheme. The HP Swasthya Bima Yojna Society will not be responsible for reimbursement of premium if wrong category is selected by the beneficiary.

Hospitals empanelled under Ayushman Bharat within the State are also empanelled for HIMCARE and are providing cashless treatment to the beneficiaries by making online entries through Transaction Management System. The claims are being reimbursed through host to host payment system directly in the bank account of concerned hospital after checking the complete claim papers submitted by these institutions through online system.

A robust IT system has been developed for implementation of Himachal Health Care Scheme-HIMCARE in the State of Himachal Pradesh.