Himachal Pradesh Swasthya Bima Yojana
- Author :
- TATA AIG Team
- ●
- Published on :
- 17/04/2024
The Indian government came up with the Ayushman Bharat scheme to aid families who could not avail of cashless treatment facilities due to their financial status. Under this scheme, the Government of India selects families based on the Socio- Economic Caste Census 2011 (SECC, 2011) and Rashtriya Swasthya Bima Yojana (RSBY).
SECC, 2011 includes families that belong to deprivation and occupational criteria from both rural and urban areas. The Ayushman Bharat PM-JAY scheme offered medical insurance to underprivileged patients and provided a cover of up to ₹5 lakhs per year.
However, many families from Himachal Pradesh were left out of the scheme, and thus, the state government launched a health insurance plan similar to PM-JAY to secure the families from healthcare emergencies.
What is Himachal Pradhesh Swasthya Bima Yojana?
The state government launched the Himachal Pradesh Swasthya Bima Yojana to aid families in availing healthcare services without worrying about finances. One of the major reasons for poverty remains to be spending an entire life’s savings into fighting a disease.
Many low-income families do not choose to buy a health insurance plan, fearing the premiums, and end up losing the benefits of having a cashless treatment facility.
Thus, this scheme aims to contribute to the Universal Health Coverage (UHC) across India and facilitate faster treatment plans. Under this scheme, approximately 1800 procedures and 1100 diseases are covered.
Under this umbrella, the Himachal Pradesh Swasthya Bima Yojana Society implements five major health schemes in the state, which are:
Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY)
Mukhya Mantri Chikitsa Sahayata Kosh (MMCSK)
Ayushman Bharat Digital Mision (ABDM)
Mukhya Mantri Himachal Health Care Yojna (HIMCARE)
Mukhya Mantri SAHARA Yojna (SAHARA)
Mukhya Mantri Himachal Health Care Yojana (HIMCARE Scheme)
The HIMCARE scheme is run by the government of Himachal Pradesh to provide cashless treatment facilities. This scheme offers coverage of up to ₹5 lakhs per year per family on a family floater basis. In case a family has more than five members, the other members are enrolled as a separate unit.
The HIMCARE is implemented on a co-payment basis, and the premium rates vary based on social class. However, the services under this scheme are available at the empanelled hospitals only.
Eligibility Criteria of HIMCARE
The most important eligibility criterion that a beneficiary must fulfil to receive the benefits is to be a permanent resident of the Himachal Pradesh state. Additionally, if a person is eligible for receiving benefits under the Ayushman Bharat scheme, they may not be eligible for HIMCARE.
The beneficiaries of this scheme have been categorised into three categories for better implementation of the scheme. These categories define the eligibility of beneficiaries based on their social and economic status. The three categories also have a varied amount of premiums that need to be paid. Here are the categories and their eligibility criteria:
| Category | Target Group/ Beneficiaries | Premium |
|---|---|---|
| I | BPL (Not covered under Ayushman Bharat) Registered Street Vendors (Not covered under Ayushman Bharat) MNREGA workers who have worked for a minimum of 50 days under MNREGA during the previous or current fiscal year. | Zero |
| II | Ekal Naaris (Women who are divorced, legally separated, unmarried, widowed and above 40 years of age come under this category.) Disabled individuals with at least >40% disability Senior citizens above 70 years of age Anganwari Workers Anganwari Helpers ASHA workers Mid-Day meal workers Daily Wage Workers (Employed under Government, Autonomous Bodies, Societies, Boards & Corporations, etc., under the control of State Government) Part-time Workers (Employed under Government, Autonomous Bodies, Societies, Boards & Corporations, etc, under the control of State Government) Contractual Employees (Employed under Government., Autonomous Bodies, Societies, Boards & Corporations etc., under the control of State Government) Outsource Employees | ₹365/year |
| III | This category has people who do not fit into the first two categories and who are not government employees, pensioners or have such family members to depend on. | ₹1000/year |
Benefits Under the HIMCARE Scheme
Along with the ₹5 lakhs per year per family coverage, the HIMCARE scheme offers several other benefits to the receivers:
Cashless treatment.
Healthcare protection for families who were excluded from PM-JAY
Coverage of ₹5 lakhs per year per family on a family floater basis
Option of family size extension by enrolling the remaining family members exceeding the five family member rule as a separate unit
Varied and affordable premium rates based on the beneficiaries’ category
Easy and quick enrolment
Receiving standardised and affordable healthcare services
Huge network of empanelled hospitals
HIMCARE Online Registration
Follow these easy steps to apply for the HIMCARE scheme online:
Before starting the online registration process, ensure that you have scanned copies of all the necessary documents. These documents will be different for each category. These may include proof of identity, proof of age, registration certificate, BPL card, disability certificates, etc.
Next, go to the official website of the HIMCARE scheme.
Go to “Online Himcare Enrolment”
Enter all your personal details.
Upload the scanned copies of the relevant documents.
Enter the details of the dependants.
Fill in the Captcha and submit your application.
Once you successfully submit your application, you will receive a Unique Reference Number (URN) to track the status of your application. If you are eligible for a payment, complete the payment to complete the registration process.
How to Apply and Check the HIMCARE Card Status?
Once your application is approved, you will receive an SMS and have an option to generate an E-card.
To generate/download your HIMCARE card, follow these steps:
Visit the official website and go to “HIMCARE Enrolment.”
Go to “Get my HIMCARE Health Card”
Enter any one of the three: the URN, ration card number or Aadhaar card number
Click on Download
To check the application status, follow the steps:
Visit the official website and go to “HIMCARE Enrolment.”
Select “HIMCARE Enrolment Status”
Enter your URN or ration card number
Check the status of your application.
Note that unless your application is approved, you cannot generate an E-card. Once it is approved, the E-card can be downloaded by following the above steps in just a few clicks.
HIMCARE Renewal
You are notified 15 days prior to your policy expiry date via an SMS on your registered mobile number. To renew your HIMCARE card/policy, follow the renewal process, which is available only within a three-month period from January to March. The renewal process can be carried out easily via the online portal.
Visit the official website.
Go to “HIMCARE Enrolment”
Click on “Renewal of Card”
The page will display a set of instructions before proceeding with renewal. Go through them and follow them to avoid adverse issues.
Enter your URN or HIMCARE number and proceed to complete the renewal process.
How to Find the List of The Empaneled Hospitals?
A wide network of empaneled hospitals is registered under this scheme to provide affordable and cashless healthcare. You can find the list of these hospitals only and visit the nearest one to avail the insurance benefits. Here is how to find the list online:
Visit the official website of HIMCARE
Find “View Hospitals” on the homepage and click on it.
Enter your district and the speciality.
Click on “Search” and find the list of the hospitals below.
You can also click on the hospital name to get directions for reaching the hospital.
Conclusion
To sum it up, the Himachal Pradesh Swasthya Bima Yojana works diligently to provide care and a good health insurance plan for the underprivileged families of Himachal Pradesh. These families that are eligible to benefit from this scheme can avail of cashless treatment at any of the empaneled hospitals. All they need to do is complete a simple online/offline registration process and be assured of the future.
Importance of Health Insurance
The launch of Himachal Pradesh Swasthy Bima Yojana and AB-PMJAY promoted the importance of having health insurance to receive quick and hassle-free treatment. Regardless of social status or age, a health insurance plan serves as the best tool to fight the uncertainties of healthcare emergencies.
With the steep rise in health concerns as a person ages, health insurance for parents is especially beneficial for senior citizens, who require the utmost care and compassion, for them to age gracefully.
Tata AIG offers access to cashless treatment facilities nationwide at a hospital of your choice. We offer flexibility of plans, distinct mediclaim policy for different entry ages, and most importantly, adequate coverage to secure your peace of mind along with the health of your loved ones and yourself.
FAQS
In which year was the Himachal Pradesh Swasthya Bima Yojana launched?
The government of Himachal Pradesh launched the Himachal Pradesh Swasthya Bima Yojana in January 2019.
What can I do if I do not find a network hospital listed under the HIMCARE Scheme in my vicinity?
If you do not find a network hospital in your vicinity, you visit the nearest local hospital to avail the treatment and reimburse the bill amount under the Himachal Pradesh Swasthya Bima Yojana.
Disclaimer / TnC
Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.
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