Mukhya Mantri Himachal Health Care Scheme (HIMCARE)

What is the Mukhya Mantri Himachal Health Care Scheme (HIMCARE)?

Mukhya Mantri Himachal Health Care Scheme, known everywhere in the state simply as HIMCARE, is a state-funded health assurance scheme run by the Himachal Pradesh Swasthya Bima Yojna Society under the Department of Health and Family Welfare. HIMCARE has been in operation since 1 January 2019.

According to the Society's own scheme page, Ayushman Bharat selects its beneficiary families using the Socio Economic and Caste Census of 2011 and the old RSBY database. That leaves a very large number of ordinary Himachali families with no cashless cover at all; not poor enough to appear in SECC lists, not rich enough to absorb a hospital bill. HIMCARE was created to cover exactly those left-out families, on the same design as Ayushman Bharat.

Under HIMCARE, cashless treatment coverage up to Rs 5,00,000 per year per family is provided in empanelled hospitals. The cover is issued against a family unit of five members. Where a household has more than five members, the remaining members are enrolled as a separate unit, subject to the same cap of five members per unit, so a family of eight enrols as one unit of five and one unit of three, and each unit carries its own annual limit.

HIMCARE runs on a co-payment basis: the family pays an annual premium, and the premium differs by category. That is the single biggest practical difference from Ayushman Bharat, which is free at the point of enrolment.

Who is eligible for HIMCARE and who is not eligible?

You can enrol if:

• Your family lives in Himachal Pradesh and is not covered under Ayushman Bharat PM-JAY.
• No member of your family is a serving government employee or a government pensioner. Every applicant signs a written undertaking that neither the head of family nor any dependent is covered under government medical reimbursement schemes for employees and pensioners.
• You can produce the document that matches the category you claim.

You cannot apply if:

• You or your dependents are government servants or pensioners covered under a government medical reimbursement scheme. This is the primary exclusion and the undertaking makes it enforceable.
• Your family is already an Ayushman Bharat beneficiary. HIMCARE exists for the left-out families, not as a second cover on top of PM-JAY.
• You want to add a sixth person to an existing unit, that person has to go into a fresh unit rather than an existing card.

What are the HIMCARE premium categories?

HIMCARE has three categories, and the premium you pay depends entirely on which one you fall in.

Category III at Rs 1,000 a year is the default for a typical private-sector or self-employed Himachali family. Category II at Rs 365 works out to one rupee a day. Category I pays nothing at all.

The Society warns explicitly that there is no refund of premium if you apply under the wrong category. Choosing Category I or II without the matching document does not get you a cheaper card; it gets your application rejected with the money already spent.

What documents does HIMCARE enrolment require?

Aadhaar is needed for every member being enrolled. Beyond that, the document depends on your category:

Note the one-month attestation rule on BPL and street vendor certificates. An attestation older than a month is the most avoidable rejection in the whole process.

How to apply for HIMCARE

1. Open the official portal at hpsbys.in during an enrolment window; March, June, September or December.
2. Choose the HIMCARE enrolment option and verify the head of family's Aadhaar, entering the OTP sent to the linked mobile number.
3. Select the correct category, I, II or III, and add family members up to the unit cap of five. Start a second unit for the sixth member onwards.
4. Upload the authentication document listed for your category, freshly attested where attestation is required.
5. Pay the premium for your category online: zero for Category I, Rs 365 for Category II, Rs 1,000 for Category III.
6. Submit and note the application number, then track it through HIMCARE Enrollment Status on the portal.
7. Once approved, download the e-card using Get My HIMCARE Card. Carry it, or the card number, to any empanelled hospital.

Offline and assisted route: visit any Lok Mitra Kendra or Common Service Centre with Aadhaar and your category document. The operator completes the same online form and uploads your documents. The LMK or CSC may collect Rs 50 per family, for a unit of up to five members, for enrolment and preparation of the e-card. That Rs 50 is the only service charge permitted; the premium is separate.

How do I use a HIMCARE card in hospital?

All hospitals empanelled under Ayushman Bharat inside Himachal Pradesh are also empanelled for HIMCARE. Beyond the state border, HIMCARE beneficiaries can also be treated at PGIMER Chandigarh and GMCH Sector 32, Chandigarh.

At the hospital, the Ayushman Mitra or empanelment desk records the case in the Transaction Management System, the online claim platform the Society runs. The hospital does not take money from the patient for a covered package; instead the claim is reimbursed to the hospital's bank account through a host-to-host payment system after the complete claim papers are checked online. The list of covered packages is published on hpsbys.in under Packages.

Before admission, use Check Card Balance on hpsbys.in. The Rs 5 lakh limit is an annual family limit, so an earlier admission by another member reduces what is left for you.

How do I check status, renew or add a member?

The HIMCARE section of hpsbys.in carries a distinct link for each of these:

1. HIMCARE Enrollment Status — for a new application still under approval.
2. Renewal Of Card, then Renew Application Status, for an existing card approaching the end of its policy year.
3. Add/Edit Family Member, HIMCARE, then Add Family Member Status, for a birth, marriage or a member who was missed at enrolment.
4. Manage Expiry Card, for a card that has already lapsed.
5. Get My HIMCARE Card, to download the e-card at any time.

The policy period is one year for all new registrations and renewals from the date of notification; the Society notified the current cycle from 24 June 2025. Renew before expiry: a lapsed card means the hospital cannot raise a cashless claim and you pay out of pocket.

Why do HIMCARE applications get rejected?

• Wrong category chosen with no matching document. The premium is not refunded, so this is an expensive mistake.
• Stale attestation, a BPL or street vendor certificate attested more than one month before submission.
• MGNREGA claim without the MIS report proving 50 days of work in the previous or current financial year.
• Government employee or pensioner in the family, which contradicts the undertaking signed at enrolment.
• Family already in Ayushman Bharat, in which case the correct route is the PM-JAY card, not HIMCARE.
• Applying outside an enrolment window. New registrations are accepted only in March, June, September and December.

Where do I complain about HIMCARE?

• PM-JAY / HIMCARE toll-free helpline: 1800-202-1311
• Card approvals: 7018606884 and 7008605212
• Technical support: 8091773886, working days, 10:00 to 13:30 and 14:30 to 17:00
• Technical queries by email: technicalquerieshpsbys@gmail.com
• Contact Us page on hpsbys.in for written grievances to the Society

If an empanelled hospital asks a HIMCARE cardholder to pay cash for a package that is on the published list, that is a matter for the helpline and the district's nodal officer, not something the patient should settle at the counter.