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Himachal Pradesh Swasthya Bima Yojana: About, Eligibility, Benefits and More

TeamAckoMar 18, 2024

The Government of India started Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to give health insurance of up to Rs. 5 lakh to the vulnerable people in our country. It aims to achieve Universal Health Coverage (UHC) throughout India.

Himachal Pradesh Swasthya Bima Yojana

Unfortunately, several families in Himachal Pradesh were not covered by PMJAY. To provide them with health coverage and secure them against emergencies, the state government launched a similar health insurance scheme under the Himachal Pradesh Swasthya Bima Yojana.

Here’s all you need to know about it.

Contents

Himachal Pradesh Swasthya Bima Yojana
Mukhya Mantri Himachal Health Care Scheme (HIMCARE)
Eligibility Under Himachal Pradesh Swasthya Bima Yojana
Benefits Of Himachal Pradesh Swasthya Bima Yojana
Documents Needed For Himachal Pradesh Swasthya Bima Yojana
Exclusions Under Himachal Pradesh Swasthya Bima Yojana
How To Apply For Himachal Pradesh Swasthya Bima Yojana
- Himachal Pradesh Swasthya Bima Yojana Society Online Registration
- By Visiting Lok Mitra Kendra Or Common Service Centres
Premium for Himachal Pradesh Swasthya Bima Yojana
Wrapping up!
Frequently Asked Questions (FAQs)

Himachal Pradesh Swasthya Bima Yojana

The Himachal Pradesh Swasthya Bima Yojna Society is responsible for implementing five major health schemes in Himachal Pradesh. They are as follows.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY)
Mukhya Mantri Himachal Health Care Yojna (HIMCARE)
Mukhya Mantri Chikitsa Sahayata Kosh (MMCSK)
Ayushman Bharat Digital Mision (ABDM)
Mukhya Mantri SAHARA Yojna (SAHARA)

Mukhya Mantri Himachal Health Care Scheme (HIMCARE)

When the Ayushman Bharat was implemented in Himachal Pradesh, many families were not included in it. That’s when the government decided to cover them with an insurance scheme similar to PMJAY.

As per Himachal Swasthya Bima Yojna, HIMCARE lets families avail of medical treatment of up to Rs. 5 lakh per year per family. The scheme is available only in empanelled hospitals.

Under the Himachal Swasthya Bima Yojana, the state government started the HIMCARE on 1st January 2019. It aims to provide affordable healthcare to its beneficiaries. Treatment under HIMCARE is cashless.

Eligibility Under Himachal Pradesh Swasthya Bima Yojana

To implement HIMCARE, the beneficiaries have been divided into three categories. Here are the eligible categories under the Mukhyamantri Swasthya Bima Yojana Himachal Pradesh.

Category I

BPL families that are excluded from Ayushman Bharat.
Registered street vendors who are excluded from Ayushman Bharat.
MNREGA workers who have worked at least 50 days under MNREGA in the previous or current financial year.
Senior citizens over the age of 70.
Children currently in orphanages

Category II

Women who are divorced, widowed, legally separated, or unmarried and are over the age of 40. They are called Ekal Naaris.
Individuals with at least over 40% disability.
Anganwadi workers and helpers
ASHA workers
Mid-day meal workers
Employees working as daily wage workers, part-time workers, contractual and outsourced employees under the state government.

Category III

This category includes those who are not covered by the first two categories and those who are not government servants, pensioners, or dependent on such people as family members.

Benefits Of Himachal Pradesh Swasthya Bima Yojana

With coverage of up to Rs. 5 lakh per year per family, HIMCARE offers several advantages to its beneficiaries. Some of them have been listed below.

It facilitates cashless treatment without the requirement of upfront payment.
Comprehensive coverage of up to Rs. 5 lakh per year per family.
Families excluded from the Ayushman Bharat in Himachal Pradesh don’t need to worry about it as they are now covered by HIMCARE.
Different premium rates for different categories of beneficiaries depending on their socioeconomic status.
Easy procedure for enrolment.
Wide network of empanelled hospitals including PGIMER Chandigarh and GMCH Sector 32 Chandigarh.

Documents Needed For Himachal Pradesh Swasthya Bima Yojana

You will have to submit certain documents to register for HIMCARE depending on the category you belong to. They have been listed below.

Category	Documents required for authentication
BPL	The Panchayat Secretary should have attested a copy of your BPL certificate.
Registered street vendors	A registration certificate attested by the Executive Officer, MC/NP/NAC in the previous month.
MNREGA worker	MNREGA job card along with online MIS report. It should show that you have worked under MNREGA for at least 50 days in the previous or current financial year. It should be attested by the concerned Panchayat Secretary or BDO.
Ekal Naaris	Child Development Program Officer (CDPO) should issue a certificate with details of the applicant.
Disability of over 40%	Medical certificate to prove permanent disability.
Senior citizens above 70 years of age	Any document which proves the age.
Anganwadi workers/helpers	The Child Development Program Officer (CDPO) of the concerned area should issue a certificate.
ASHA workers	The Block Medical Officer (BMO) of the concerned area should issue a certificate.
Mid-Day meal workers	The Block Elementary Education Officer of the concerned area should issue a certificate.
Contractual employees	Respective department should issue a certificate.
Daily wage worker	Respective department should issue a certificate.
Part-time workers	Respective department should issue a certificate.
Outsource employees	Respective department should issue a certificate.

Exclusions Under Himachal Pradesh Swasthya Bima Yojana

The government also lists the following categories as ineligible for HIMCARE.

Government servants, pensioners, and their dependents are not eligible for this scheme.
Ayushman Bharat beneficiaries are excluded from the scheme.
Those who are not eligible as per the categorisation under the eligibility criteria are excluded from the scheme.

How To Apply For Himachal Pradesh Swasthya Bima Yojana

You can apply for HIMCARE by visiting the official website as well as going to the nearest Lok Mitra Kendra (LMK) or Common Service Center (CSC). Here are the steps you would need to follow to enrol for HIMCARE.

Himachal Pradesh Swasthya Bima Yojana Society Online Registration

Step 1: Create scanned copies of the necessary documents.

The documents that you will have to present shall vary depending on the category you belong to. It could include a BPL card, registration certificate, proof of age, disability certificates, and certificates provided by relevant authorities.

Step 2: Visit the official website of HIMCARE.

Step 3: Go to the enrollment section for HIMCARE

Step 4: Fill in your personal details.

Step 5: Upload the scanned copy of the required documents.

Step 6: Submit the application form.

Once your application is approved by the authorities, you will get an E-card with which you can use the insurance scheme.

By Visiting Lok Mitra Kendra Or Common Service Centres

Here’s how to enrol for Himachal Pradesh Swasthya Bima Yojana by visiting an official centre.

Assemble the necessary documents depending on the category you belong to.
Find out about your nearest Lok Mitra Kendra or Common Service Center.
Fill in the application form.
The authorities will help you to upload your documents online.
A family with up to five members will have to pay an enrollment fee of Rs. 50.

The authorities should issue your E-card after your application is approved.

Premium for Himachal Pradesh Swasthya Bima Yojana

The government has fixed premium amounts for different categories of beneficiaries. They have been listed below.

Category	Premium amount
I	No premium/Free
II	Rs. 365 per year
III	Rs. 1000 per year

Wrapping up!

In this blog, we have discussed all the major features of Himachal Pradesh Swasthya Bima Yojana. Its key aspect is the coverage of Rs. 5 lakh per year per family. Those who have been excluded from the PMJAY can now avail of the benefits of HIMCARE to avail cashless treatment.

Before you leave, we would request you to consider buying insurance. The cost of medical expenses often pushes families into poverty. To avoid such a tragedy, we recommend you to buy insurance coverage for yourself and your family.

Frequently Asked Questions (FAQs)

Here are some commonly asked questions about Himachal Pradesh Swasthya Bima Yojana.

1. What is the Himachal Pradesh Swasthya Bima Yojana Society?

The Himachal Pradesh Swasthya Bima Yojna Society is responsible for running five major health schemes in Himachal Pradesh. They are listed below.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY)
Mukhya Mantri Himachal Health Care Yojna (HIMCARE)
Mukhya Mantri Chikitsa Sahayata Kosh (MMCSK)
Ayushman Bharat Digital Mision (ABDM)
Mukhya Mantri SAHARA Yojna (SAHARA)

2. Who is eligible for HIMCARE?

The government has divided beneficiaries into three categories for implementing the scheme. You can find the details on the official website.

3. What is the premium for HIMCARE?

The premium is based on the category to which the beneficiary belongs. You can find the details in the following table.

Category	Premium amount
I	No premium/Free
II	Rs. 365 per year
III	Rs. 1000 per year

4. Why was HIMCARE launched?

The HIMCARE was launched as a health insurance for those who were not covered by the PMJAY in Himachal Pradesh.

5. If I am covered by PMJAY, will I be eligible for HIMCARE?

No, PMJAY beneficiaries are excluded from HIMCARE.

6. How many family members can be enrolled for HIMCARE?

Each family is treated as a unit for enrollment under HIMCARE. The maximum size of such a unit is five. If a family has more than five members, then the other members will be part of another unit. That unit too can have a maximum size of five.

7. Is HIMCARE compulsory?

No, it is not compulsory to enrol for HIMCARE.

8. Which documents are required to enrol for HIMCARE?

The documents that you have to submit depend on the category to which you belong. It could include a BPL card, MNREGA job card, age proof and medical certificate.