MMHHCC-HIMCARE

Mukhya Mantri Himachal Health Care Scheme-HIMCARE is a health insurance scheme providing cashless treatment coverage up to Rs. 5.00 lakh per year per family in empanelled hospitals. It aims to cover families not included in the Ayushman Bharat scheme.

Mukhya Mantri Himachal Health Care Scheme-HIMCARE is a health insurance scheme under the Department of Health & Family Welfare, Government of Himachal Pradesh to provide cashless treatment coverage up to ₹5,00,000/- per year per family provided in the empanelled hospitals. In case of more than five members, the remaining members are enrolled as a separate unit subject to the capping of five members for each such additional unit. This scheme is being implemented on a co-payment basis. 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 the host-to-host payment system directly in the bank account of the concerned hospital after checking the complete claim papers submitted by these institutions through the online system.

<br>

• For target groups covering below categories have the Zero Premium amount.

• 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.
• Children living in Orphanages.

• For target groups covering below categories have the premium rate ₹365/- per year.

• Ekal Naaris,
• Disabled >40%,
• 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.

• Beneficiaries not covered under category-I and category-II or who are not Govt. servants/pensioners or their dependent family members, having the premium amount ₹1,000/- per year.

• The applicant must be a permanent resident of Himachal Pradesh.
• Families not covered under the Ayushman Bharat Yojana (Pradhan Mantri Jan Arogya Yojana) are eligible to apply for the HIMCARE scheme.
• Applicant should be HIMCARE card holder.
• The scheme is available to Below Poverty Line (BPL) families, Above Poverty Line (APL) families, Senior citizens and daily wage earners, widows, single women, and persons with disabilities.

• Cashless Treatment: The scheme provides cashless treatment coverage, allowing beneficiaries to receive medical services without upfront payment at empanelled hospitals.
• Comprehensive Coverage: HIMCARE offers coverage up to ₹5,00,000/- per year per family, ensuring that families have access to quality healthcare services without financial burden.
• Inclusion of Previously Uncovered Families: The scheme targets families who were not covered under the Ayushman Bharat scheme, extending health insurance benefits to a broader population.
• Categorization for Differential Premium Rates: Beneficiaries are categorized into different groups based on their occupation or socioeconomic status, with corresponding premium rates to make healthcare more affordable for all eligible individuals.
• Wide Range of Eligible Beneficiaries: The scheme covers various groups such as BPL families, registered street vendors, MNREGA workers, senior citizens above 70 years, children living in orphanages, disabled individuals, Anganwari workers, ASHA workers, and more.
• Easy Enrollment Process: Enrollment can be done online through the official website or at Lok Mitra Kendra/Common Service Centers, making it convenient for beneficiaries to apply and upload necessary documents.
• Empanelled Hospital Network: Beneficiaries can receive cashless treatment in empanelled hospitals within Himachal Pradesh, including prestigious institutions like PGIMER Chandigarh and GMCH Sector 32 Chandigarh, ensuring access to quality healthcare facilities.

• Non-Coverage of Government Servants and Pensioners: The scheme does not provide coverage for government servants, pensioners, or their dependent family members. They are not eligible to enroll in HIMCARE.
• Non-Coverage of Beneficiaries Already Covered Under Ayushman Bharat: Families that have already been selected and covered under the Ayushman Bharat scheme, based on SECC 2011 and RSBY, are not eligible for coverage under HIMCARE. The scheme targets those left out of Ayushman Bharat.
• Non-Coverage of Beneficiaries Who Do Not Fall under Eligible Categories: Individuals who do not fall under the eligible categories defined by the scheme, such as those not belonging to BPL families, registered street vendors, MNREGA workers, senior citizens above 70 years, or other specified groups, are excluded from the coverage provided by HIMCARE.