Ayushman Bharat PM-JAY Himachal Pradesh

How PM-JAY Works in Himachal Pradesh

The PM-JAY Himachal Pradesh scheme was launched on September 23, 2018, where Himachal Pradesh Swasthya Bima Yojana Society (HPSBYS) acts as the State Nodal Agency (SNA) under the Department of Health & Family Welfare, Government of Himachal Pradesh.

The HPSBYS takes care of activities, which include empanelment and monitoring of public and private hospitals for maintaining the quality of treatment. The society also manages the entire process of claims settlements through special digital portals in order to ensure hassle-free payment to healthcare facilities.

Key Highlights: PM-JAY Himachal Pradesh

Who Is Eligible for PM-JAY Himachal Pradesh

• SECC 2011 Beneficiaries (Rural & Urban):
  • Rural Areas: Households that qualify on the basis of specific categories of deprivation (e.g., households staying in single-room kucha houses, SC/ST households, landless casual workers, and households without able-bodied males).
  • Urban Areas: Persons who qualify on the basis of belonging to specified occupational categories (e.g., street vendors, domestic workers, construction workers, sanitation workers, transport workers, and pavement workers).
• Automatic Inclusion: Homeless families, beggars, manual scavengers, primitive tribal people, and released bonded labour.
• RSBY Families: Those who belong to the RSBY scheme can apply for PM-JAY Himachal Pradesh.
• Senior Citizens (70+ years): All citizens above the age of 70 qualify for insurance cover up to ₹5 lakh per annum, irrespective of their income.

Benefits and Coverage Under PM-JAY Himachal Pradesh

• Coverage Limit: ₹5 lakh cashless coverage per family unit per year for secondary and tertiary treatment.
• Family Capping Guidelines: In contrast to several states, HP practices a cap of a 5-member family unit per card. If a family is more than 5 in number, the other family members will get cards separately for a total ₹5 Lakh coverage limit.
• Pre-Existent Diseases: All pre-existing diseases will be covered from Day 1.

Medical Coverage:

• Inpatient Facility: Charges for bed, ICU, consultation by doctors, nursing, operating room services, and medicines.
• Surgeries and Critical Services: Cardiac surgeries, joint replacements, neurosurgery, cancer treatment services (chemotherapy and radiotherapy), and dialysis for long-term periods.
• Diagnostics & Implants: Laboratory or radiological imaging charges (such as MRI or CT) and medical implants (including stents, pacemakers, and orthopaedic implants) used during hospitalisation.
• Pre and Post Hospitalisation: Diagnostics and medicines up to 3 days before admission and 15 days after discharge.
• Automatic Provision for Newborn Child: Automatic inclusion of newborn babies on the mother’s card.
• Top-Up for Existing Enrollees: If a senior citizen's family is already covered under PM-JAY, the 70+ senior gets an additional, dedicated ₹5.00 Lakh top-up cover per year that is not shared with family members under 70

How to Apply for an Ayushman (Golden) Card in Himachal Pradesh

Through an Online Mode (using the NHA Portal or Ayushman App)

Step 1: Login into the NHA Portal

Log in to the NHA Beneficiary Portal (beneficiary.nha.gov.in) or Ayushman App.

Step 2: Search Household Information

Select Himachal Pradesh, choose your Scheme (PMJAY or PMJAY-Vay Vandana 70+), select your district, and then search your Aadhar Number or HP Ration Card Number.

Step 3: Complete the e-KYC Authentication

From the list, select your name, do the e-KYC and choose your verification process using Aadhar OTP, Face recognition, and biometric.

Step 4: Submit Photograph and Personal Details

Submit your application after taking your photograph and providing all the personal details.

Step 5: Approve and Download the Ayushman card

After the approval of your Ayushman card by HPSBYS, select the Download card link to download your Ayushman Card.

Through Offline Mode: Register and Download Your Ayushman Card Offline (Assisted Registration)

Step 1: Identify a Service Centre

Go to the Lok Mitra Kendra (LMK)/CSC of your nearest Gram Panchayat or reach out to the Pradhan Mantri Aarogya Mitra (PMAM) service desk of an authorised hospital such as IGMC Shimla, RPGMC Tanda, or AIIMS Bilaspur.

Step 2: Provide Required Identification Documents

Submit your Aadhar Card and HP Family Ration Card to prove your eligibility.

• Complete Biometric Verification process: The operator will locate your family record on the portal and scan your fingerprint or iris to complete the e-KYC authentication.
• Card Generation: Once the biometric authentication is successful, the operator submits the application to the state portal and prints the physical copy of the Ayushman Card.

Documents Required for Applying to PM-JAY Himachal Pradesh

• Identity Proof: Your Original Aadhaar Card of each family member is required to register for PM-JAY Himachal Pradesh.
• Family Proof: such as Himachal Pradesh Family Ration Card (HimPariwar e-Ration ID) to prove the connection between the family.
• Registered Mobile Number: A mobile number that is registered with Aadhaar for receiving the OTP.
• Age Proof: Aadhaar Card with the date of birth of senior citizens above 70 years under Vya Vandana Card.

How to Find Empanelled Hospitals in Himachal Pradesh

Step 1: Go to the official website of the NHA or the HPSBYS portal.

Visit the official website of the National Health Authority at hospitals.pmjay.gov.in or the HPSBYS Portal.

Step 2: Click Find Hospital under the menu bar.

Step 3: Enter your Location details

• State: Himachal Pradesh
• District: Your district name

Step 4: Specify Additional Preferences (Optional)

• Type of Hospital: Public (Government), Private
• Specialisation: Required Medical Department, e.g. Cardiology, Oncology, Orthopaedics, etc.

Step 5: Filter by Hospital Type (Public or Private) or required Speciality (e.g., Cardiology, Oncology, Orthopaedics), and click Search.

Step 6: View the Results

Click the Search button for a listing of all hospitals that match your search criteria, along with other details such as address and facilities offered.

What If You are Not Eligible for PM-JAY in Himachal Pradesh?

If your household is not listed under the SECC 2011 database for Ayushman Bharat, Himachal Pradesh residents can apply for a different scheme that covers those who are not covered under PM-JAY Himachal Pradesh.

• Financial Coverage: HIMCARE aligns with PM-JAY by offering cashless secondary and tertiary hospitalisation coverage up to ₹5 lakh per family per year.
• Universal Inclusion: It provides coverage to those people who do not fall under SECC criteria and hence are excluded from central schemes.
• Flexible Premium Structure: Depending on the beneficiary category, enrollment under HIMCARE is provided either free of cost (for single women, street vendors, and persons with disabilities) or at a subsidised annual premium (ranging from ₹365 to ₹1,000 per family per year).
• Shared Network of Hospitals: Beneficiaries can access cashless treatment across the same network of empanelled public and private hospitals using a unified digital transaction platform.

Helpline and Support

Other Health Schemes in Himachal Pradesh

• HIMCARE: Provides a cashless healthcare scheme with an amount of ₹5 lakh per family per year for the residents of Himachal Pradesh who do not fall within the coverage of AB-PMJAY.
• Mukhya Mantri Chikitsa Sahayata Kosh (MMCSK): Direct financial help to the poor patients for undergoing major medical treatment and critical ailments which cannot be covered by other insurance schemes.
• Mukhya Mantri SAHARA Yojna: A state-sponsored scheme that offers financial help to poor patients suffering from particular chronic diseases like cancer, paralysis, or renal failure.
• PM-JAY Ayushman Bharat: National flagship scheme which provides a cashless health insurance scheme with a limit of ₹5 lakh per family per year for secondary and tertiary care hospitalisation.
• Central Government Health Scheme (CGHS): A comprehensive health scheme which provides complete healthcare facilities (both inpatient and outpatient) to central government employees and their family members.