HIMCARE - Mukhya Mantri Himachal Health Care Scheme

Why Was HIMCARE Introduced

It fails to identify families of even the majority of the families of economically vulnerable families in the state of Himachal Pradesh, irrespective of their eligibility under the central Ayushman Bharat Yojana (AB PM-JAY) through SECC-2011 data and RSBY records. This is where the HIMCARE was introduced, to fill this very gap, to bring the same cashless hospitalisation model into the HP families who are not covered under the central scheme. Alongside with enrolment in HIMCARE, beneficiaries are encouraged to open an ABHA (Ayushman Bharat Health Account) card at the website of ABDM (abdm.gov.in).

The TB patients can avail of the Nikshay Poshan Yojana support of ₹1000 per month together. All pregnant women are entitled to institutional delivery benefits under Janani Suraksha Yojana (JSY). Rashtriya Arogya Nidhi (RAN) offers a single-time support of up to ₹15 lakh in government super speciality hospitals in relation to costs of more than ₹5 lakh.

HIMCARE - Key Highlights

HIMCARE Eligibility - Who Can Apply

Eligibility is divided into three categories (hpsbys.in):

Who is NOT eligible: If the family receives AB PM-JAY benefit, current and retired government servants and their dependents, residents of other states. If a wrong category is selected, it will lead to no premium refund (hpsbys.in).

What Does Mukhya Mantri Himachal Health Care Scheme (HIMCARE) Cover

Treatment up to ₹5 lakh per family annually, all procedures covered under AB PM-JAY Health Benefit Packages, no waiting period for pre-existing diseases covered from day one and claims reimbursed directly to the bank account of the hospital via host-to-host payment system (hpsbys.in) for every family unit of 5.

Excluded: Outpatient department services without hospitalisation, non-empanelled hospitals, cosmetic and elective services, government servants and pensioners.

Steps to apply for HIMCARE

1. Online Registration:

   • Go to hpsbys.in and click on the appropriate category.
   • Complete personal and family information correctly
   • Submit all necessary paperwork for the category
   • Make online where necessary, any premiums due.
   • Submit, e-card is issued once verified

2. Offline - Lok Mitra Kendra (Lok Mitra Kendra) and Common Service Centre (CSC):

   • Go to the closest LMK or CSC and present all the requisite documents.
   • The operator helps you register and upload the documents
   • There is a ₹50 per family unit of 5 service fee.
   • Once approved, the E-card is issued.

Documents Required for HIMCARE

All categories also require an Aadhaar card for identity verification and ABHA linkage.

How to Check HIMCARE Status and Download Card

Go to hpsbys.in and log in with the registered username and password, click on the beneficiary search, enter Aadhaar or any other registered details and check the enrollment status and download the e-card. The HIMCARE e-card is valid in all the empanelled hospitals for cashless treatment.

How the Claim Process Works

• Present the HIMCARE e-card and Aadhaar in any Hospital, which is part of AB PM-JAY hospital or PGIMER Chandigarh or GMCH Sector 32.
• The Transaction Management System (TMS) online is used to verify eligibility for the hospital.
• Any planned treatments require pre-authorisation prior to admission.
• Treatment is carried out without paying money: all payments are made directly between the hospital and HP Swasthya Bima Yojana Society.
• The process of claims reimbursement is made to the hospital bank account after the verification of claims online (hpsbys.in)

Grievance and Rejection Process

• Step 1 is to reach out to the help desk of the hospital insurance for the reasons for rejection.
• Step 2: National Health Helpline – 104 and Ayushman Bharat helpline – 14555.
• Step 3: Visit/explain HP Swasthya Bima Yojana Society at hpsbys.in

Widespread reasons of rejection: Wrong category selected, no refund, treatment was given at hospitals other than those in the empanelled list, procedure not included in the package list, documents were not attested correctly, family already had another AB PM-JAY plan.

HIMCARE and Other Schemes

• Ayushman Bharat PM-JAY (Central scheme), which is complementary to the HP families outside of SECC-2011 by HIMCARE.
• Nikshay Poshan Yojana - ₹1000 monthly to TB patients in addition to HIMCARE
• Janani Suraksha Yojana (JSY) - cash incentives for institutional delivery.
• Rashtriya Arogya Nidhi (RAN) - up to ₹15 lakh (when expenses cross over ₹5 lakh)
• Niramaya Health Insurance Scheme - for members of the family who have autism, cerebral palsy or multiple disabilities.
• Chirayu Ayushman Haryana - a parallel scheme for the residents of Haryana who are not covered under AB PM-JAY.
• Mission Vatsalya - hospitalisation benefits for the children in institutional care in HP.

Helpline and Support For HIMCARE

HIMCARE is ensuring that no citizen of the state of Himachal Hindu Rashtra is denied cashless health cover due to absence in the list of AB PM-JAY SECC-2011. The scheme offers financial protection to HP families with a coverage of ₹5 lakh per year. There is zero differential premium for the BPL and vulnerable groups, and it covers all AB PM-JAY empanelled hospitals, including PGIMER and GMCH Chandigarh. Register your ABHA card at www.abdm.gov.in and visit www.hpsbys.in or Lok Mitra Kendra to make an application.