HIMCARE Empanelled Hospitals in Shimla: A Complete Guide

The Mukhya Mantri Himachal Health Care Scheme, widely known as HIMCARE, is a significant health insurance initiative by the Government of Himachal Pradesh. It is designed to provide comprehensive health coverage to the state's residents, particularly those who are not covered under the central government's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY). The scheme aims to reduce the financial burden of medical treatments and ensure that quality healthcare is accessible to a larger section of the population.

Under the HIMCARE scheme, each enrolled family is entitled to cashless treatment coverage of up to ₹5.00 lakh per year. This benefit can be availed at a wide network of empanelled public and private hospitals located within Himachal Pradesh. The scheme is implemented and managed by the Himachal Pradesh Swasthya Bima Yojana Society (HPSBYS), which oversees the enrollment process, hospital empanelment, and claim settlements.

For residents of Shimla and the surrounding areas, knowing which hospitals accept the HIMCARE card is crucial for accessing timely medical care without facing immediate out-of-pocket expenses. This guide provides a detailed list of HIMCARE-empanelled hospitals in the Shimla district, along with essential information on how to utilize the scheme's benefits, the documents required, and the scope of coverage.

List of HIMCARE Empanelled Hospitals in Shimla

This list is based on data from the official HIMCARE portal. Empanelment status can change, so it is advisable to confirm with the hospital or the official website before seeking treatment.

• Civil Hospital Chopal — Chopal
• Civil Hospital Jubbal — Jubbal
• Civil Hospital Nerwa — Nerwa
• Civil Hospital Rampur — Rampur
• Civil Hospital Rohru — Rohru
• Civil Hospital Theog — Theog
• Deen Dayal Upadhyay Zonal Hospital — Shimla
• H.P. Government Dental College & Hospital — Shimla
• Indira Gandhi Medical College & Hospital — Shimla
• Kamla Nehru State Hospital for Mother & Child — Shimla
• Aastha Hospital & Pediatric Centre — Shimla
• Grewal Eye Institute — Sector-1, Shimla
• Haritara Hospital and Pediatric Centre — Shimla
• Newlife Hospital — Shimla
• Prabhudas Clinic And Nursing Home — Lower Totu, Shimla
• Shimla Sanitarium & Hospital — Chaura Maidan, Shimla
• Shiva Hospital — Shimla
• ShriRam Medical Centre — The Mall, Shimla
• Sidhivinayak Hospital — BCS New Shimla
• Sparsh Multispeciality Hospital — ISBT, Tuttikandi
• Tenzin Hospital — Panthaghati, Kasumpti

Rates shown are as per the Himachal Pradesh Swasthya Bima Yojana Society (2024) and are subject to periodic revision. Always verify the latest approved rates on the official source.

Navigating the HIMCARE Scheme in Shimla

The HIMCARE scheme is a vital social security measure that bridges the gap left by the central PM-JAY program, extending health insurance benefits to lakhs of families across Himachal Pradesh. To utilize the scheme in Shimla, a family must first be enrolled and possess a valid HIMCARE card. This card acts as the primary proof of eligibility and is essential for availing cashless services at any network hospital.

The scheme operates on a family floater basis, meaning the ₹5.00 lakh annual coverage can be used by any member of the enrolled family for one or more hospitalizations until the limit is exhausted. The process is designed to be straightforward, with dedicated personnel at hospitals to assist beneficiaries. The official portal for the scheme, www.hpsbys.in, serves as a central resource for information on enrollment, eligibility, and finding empanelled healthcare providers.

How to Avail Cashless Treatment at an Empanelled Hospital

Accessing cashless treatment under HIMCARE involves a simple, standardized procedure. When a beneficiary needs medical attention, they should visit one of the empanelled hospitals listed for Shimla. Upon arrival, the first step is to approach the hospital’s dedicated HIMCARE help desk or contact the 'Swasthya Mitra', a representative appointed to guide scheme beneficiaries.

The Swasthya Mitra will verify the patient's identity using the HIMCARE card and an Aadhaar card. Following a medical consultation and diagnosis, the hospital initiates a pre-authorization request with the insurance authorities, detailing the proposed treatment and estimated cost. Once this request is approved, the hospital proceeds with the treatment on a cashless basis. The patient is not required to pay for covered procedures, as the hospital settles the bill directly with the Himachal Pradesh Swasthya Bima Yojana Society.

• Ensure you carry the patient's HIMCARE card and Aadhaar card to the hospital.
• Locate the HIMCARE help desk or 'Swasthya Mitra' upon arrival for guidance.
• Provide the necessary documents for verification and initiation of the pre-authorization process.
• The hospital staff will manage the paperwork and communication with the scheme authorities.
• Note that any costs for services not covered by the HIMCARE scheme must be paid by the patient.

Essential Documents for HIMCARE Beneficiaries

To ensure a smooth and delay-free admission process at an empanelled hospital, it is crucial to have all the necessary documents readily available. The HIMCARE card is the most important document, as it confirms your enrollment and eligibility for cashless services. Without it, the hospital cannot process your request under the scheme.

In addition to the scheme card, a government-issued photo ID, typically the Aadhaar card, is required for patient verification. It is also advisable to carry any recent doctor’s prescriptions, diagnostic reports, or referral letters, as these will help the hospital in determining the required course of treatment and expediting the pre-authorization process.

• HIMCARE Health Card (mandatory).
• Aadhaar Card of the patient for identity and address verification.
• Proof of residence in Himachal Pradesh, if requested by the hospital.
• Referral slip from a primary doctor or a smaller healthcare center (if applicable).
• All relevant medical documents, such as past treatment records and recent diagnostic reports.

Understanding Coverage: What Is Included and Excluded?

The annual coverage of ₹5.00 lakh per family under HIMCARE is comprehensive and covers most expenses associated with inpatient hospitalization. This includes costs such as room and boarding, nursing charges, surgeon and consultant fees, anesthesia, blood transfusions, oxygen, medicines, and diagnostic tests conducted during the hospital stay. The package rates for most procedures are pre-defined by the government to ensure standardized billing.

However, beneficiaries should be aware that the scheme does not cover all medical expenses. Typically, services of a cosmetic nature, elective surgeries not medically necessary, and most outpatient consultations or treatments that do not require hospitalization are excluded from coverage. It is also important to note that the list of empanelled facilities can change. For example, several Ayurvedic hospitals, including the Regional Ayurvedic Hospital in Chhota Shimla, were de-empanelled from the scheme in a recent update. Always confirm if a specific treatment is covered before admission.

How to Confirm a Hospital's Current Empanelment Status

The list of hospitals empanelled under the HIMCARE scheme is dynamic and subject to change. Hospitals may be added to or removed from the network based on reviews and policy decisions by the Himachal Pradesh Swasthya Bima Yojana Society. Therefore, it is highly recommended that beneficiaries verify a hospital's current empanelment status before seeking treatment.

The most reliable method for verification is to check the updated list on the official HIMCARE portal at www.hpsbys.in. Alternatively, you can call the hospital's administration or reception desk directly and explicitly ask if they are currently accepting patients for cashless treatment under the HIMCARE scheme. This simple step can prevent significant inconvenience and unexpected financial liability at the time of admission.

Frequently Asked Questions

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

HIMCARE is a health insurance scheme from the Government of Himachal Pradesh that provides cashless treatment coverage up to ₹5.00 lakh per family per year. It is designed for state residents who are not covered by the central Ayushman Bharat (PM-JAY) scheme.

How can I find out if I am eligible for HIMCARE?

Eligibility is primarily for residents of Himachal Pradesh belonging to specific categories who are not beneficiaries of Ayushman Bharat. You can check the detailed eligibility criteria and enroll in the scheme through the official portal, www.hpsbys.in, or at a designated enrollment center.

Is Indira Gandhi Medical College (IGMC) in Shimla empanelled under HIMCARE?

Yes, Indira Gandhi Medical College & Hospital (IGMC) in Shimla is empanelled under the HIMCARE scheme. Beneficiaries can avail of cashless treatment at this major public hospital as per the scheme's guidelines.

What should I do if a listed hospital denies cashless service under HIMCARE?

If an empanelled hospital refuses to provide cashless services, you should immediately contact the HIMCARE helpline or grievance redressal number, which can be found on the official HPSBYS website. You can also report the issue to the 'Swasthya Mitra' at the hospital or the Chief Medical Officer of the district.

Does the HIMCARE coverage include the cost of medicines and diagnostic tests?

Yes, the ₹5 lakh coverage under HIMCARE generally includes expenses related to hospitalization, such as medicines, diagnostic tests, doctor's fees, and room charges. It also typically covers specified pre- and post-hospitalization expenses for a certain period.

Are private hospitals in Shimla also covered by the HIMCARE scheme?

Yes, the scheme includes a network of both public and private hospitals to provide wider access to care. The list for Shimla includes several private facilities like Sparsh Multispeciality Hospital, Tenzin Hospital, and Grewal Eye Institute, where you can avail of cashless treatment.

Related

• HIMCARE in Himachal Pradesh: eligibility and how to enrol
• Government hospital OPD appointment guides in Himachal Pradesh
• Mukhyamantri Swasthya Bima Yojana: which state scheme is it?

Medical Disclaimer

The information provided in this article is for general informational and educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.