Introduction to Himcare Scheme
Access to modern secondary and tertiary medical care across rugged mountainous terrains without suffering financial catastrophe is a top public health priority in Himachal Pradesh. To ensure universal health coverage for all state residents who are not covered under the central Ayushman Bharat PM-JAY scheme, the Government of Himachal Pradesh launched the flagship Himcare Scheme (Himachal Health Care Scheme) through the Himachal Pradesh Swasthya Bima Yojna Society (HPSBYS).
Under Himcare, the state government provides cashless medical treatment up to ₹5 Lakh per family per year on a family floater basis. Beneficiaries can access over 1,800 medical, surgical, and oncology procedures across premier state government medical colleges—such as IGMC Shimla and RPGMC Tanda—as well as empaneled private super-specialty hospitals within and outside the state (including PGIMER Chandigarh).
Program Overview and Key Financial Highlights
| Component | Policy Provision |
|---|---|
| Scheme Name | Himcare (Himachal Health Care Scheme) |
| Administering Agency | HP Swasthya Bima Yojna Society (HPSBYS) / Health Dept, Himachal Pradesh |
| Annual Health Coverage | ₹5 Lakh per family per year on family floater basis |
| Target Beneficiaries | All residents of Himachal Pradesh not covered under Ayushman Bharat or government medical reimbursement |
| Treatment Mode | 100% Cashless and paperless inpatient hospitalization |
| Hospital Network | Medical colleges, district hospitals, PGIMER Chandigarh, and empaneled private hospitals |
| Official Portal | hpsbys.in |
Premium and Registration Fee Slabs
To ensure progressive equity, annual enrollment/renewal fees under Himcare are categorized across economic tiers:
- Category 1 (Free / Zero Premium): BPL families, registered street vendors, and single women / widows earning under prescribed thresholds receive 100% free cards with zero premium.
- Category 2 (Highly Subsidized – ₹365/year): Senior citizens aged 70 years and above, anganwadi workers, ASHA workers, mid-day meal workers, and contractual employees pay a nominal fee of ₹365 per year.
- Category 3 (General Citizens – ₹1,000/year): All other general families not covered by government reimbursement pay an affordable fee of ₹1,000 per year for ₹5 Lakh family health protection.
Scope of Medical Procedures Covered
Himcare covers comprehensive diagnostic, surgical, and therapeutic packages:
- Cardiovascular Diseases: Coronary bypass surgery (CABG), angioplasty, heart valve repair, and emergency cardiac interventions.
- Oncology & Cancer Care: Surgical resections, linear accelerator radiotherapy, and systemic chemotherapy cycles.
- Nephrology & Kidney Care: Maintenance hemodialysis, kidney stone lithotripsy, and renal transplants.
- Orthopedics & Polytrauma: Major mountain road traffic accident trauma stabilization, joint replacements, and spinal surgeries.
- Daycare & Surgical Packages: Eye surgeries (cataract), laparoscopic surgeries, hernia repairs, and gall bladder extractions.
Eligibility Criteria
Families qualify for the Himcare card under the following conditions:
- The family must be permanent residents of Himachal Pradesh holding a valid Bonafide Certificate or state Ration Card.
- The family must NOT be already enrolled under the central Ayushman Bharat (PM-JAY) scheme.
- Regular employees of the Central/State Governments and pensioners receiving official medical reimbursement allowances are excluded.
- All family members included in the ration card are covered under the ₹5 Lakh family floater limit.
Documents Required for Himcare Card Generation
Applicants must assemble the following digital records:
- Himachal Pradesh Digital Ration Card.
- Aadhaar Cards of all family members seeking card inclusion.
- Category Proof (BPL certificate for Category 1; Employee/ASHA ID for Category 2; none required for Category 3).
- Active mobile number for OTP authentication.
Step-by-Step Card Generation and Hospital Admission Workflow
Enrolling in Himcare and accessing treatment is fully digitized:
- Visit the Portal: Access the official portal at
hpsbys.inand click on Online Himcare Enrolment. - Enter Ration Card Details: Enter your 12-digit digital ration card number. The portal automatically populates the family composition and member details.
- Upload Category Proof & Fee: Upload the required category verification document and complete the nominal fee payment (if applicable) via UPI or net banking.
- Download Himcare e-Card: Once approved, download the digital Himcare card containing the unique family health ID.
- Hospital Admission: When medical treatment is required, present your Himcare card and Aadhaar at the Pradhan Mantri / Himcare Arogya Mitra desk at any empaneled hospital (e.g., IGMC Shimla, RPGMC Tanda, or PGIMER Chandigarh) for cashless pre-authorization.
Frequently Asked Questions (FAQs)
1. Does Himcare cover treatments at PGIMER Chandigarh?
Yes. PGIMER Chandigarh is a premier empaneled referral institute under Himcare, enabling mountain patients to access top-tier tertiary care without paying cash.
2. When must the Himcare card be renewed?
Himcare policies are valid for one year (or three years for multi-year cards). Policyholders must renew their card online on the HPSBYS portal prior to the expiration date.
3. Are pre-existing diseases covered under Himcare?
Yes. All pre-existing medical conditions and chronic ailments are covered from the first day of card activation without waiting periods.
Disclaimer: JanSarkariYojna.com is an independent educational and public information portal. We are not affiliated with the Government of Himachal Pradesh. Beneficiaries must verify all official notices and administrative criteria on the official state portal at hpsbys.in.