Mukhya Mantri Himachal Health Care Scheme (HIMCARE) in Himachal Pradesh: A Guide

The Mukhya Mantri Himachal Health Care Scheme, widely known as HIMCARE, is a health coverage initiative by the Government of Himachal Pradesh. It is designed to provide financial protection against significant health expenses for residents of the state who are not covered by the central government's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) or any other government medical reimbursement policy.

Managed by the Himachal Pradesh Swasthya Bima Yojana Society, the scheme offers cashless treatment for a variety of medical procedures. HIMCARE aims to extend health coverage to a broad section of the state's population, including economically weaker sections, specific occupational groups, and other families who do not have access to similar benefits.

HIMCARE Scheme: At a Glance

Coverage is provided on a family floater basis for a unit of up to five members. If a family has more than five members, the additional members are enrolled as a separate unit.

• Coverage per Family — Up to ₹5 lakh per year
• Implementing Agency — Himachal Pradesh Swasthya Bima Yojana Society
• Official Portal — www.hpsbys.in
• Helpline (Toll-Free) — 1800-202-1311
• Card Approval Queries — 9418593553, 9816006120
• Technical Support — 8091773886 (during working hours)

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.

What HIMCARE Covers (and What It Doesn't)

The HIMCARE scheme provides cashless treatment coverage of up to ₹5 lakh per family per year. This benefit operates on a family floater basis for a family unit of up to five individuals. For families with more than five members, any additional members are enrolled as a new, separate unit to receive the same coverage.

The scope of coverage is comprehensive and is based on the treatment packages defined under the national Ayushman Bharat PM-JAY scheme. This includes a wide range of medical needs.

• **Hospitalization Expenses:** Coverage for room rent, ICU charges, and doctor fees during a hospital stay.
• **Pre- and Post-Hospitalization:** Costs incurred before admission and after discharge related to the treatment.
• **Day-Care Procedures:** Medical procedures that do not require a 24-hour hospital stay.
• **Critical Illnesses:** Treatment for serious conditions such as cancer and heart disease.
• **Exclusions:** The scheme generally does not cover routine outpatient department (OPD) consultations, cosmetic or elective surgeries, or any treatments received at hospitals that are not empanelled under the scheme.

Who is Eligible for HIMCARE?

HIMCARE is specifically for residents of Himachal Pradesh who are not beneficiaries of the Ayushman Bharat (PM-JAY) scheme or covered by any government medical reimbursement policy. Consequently, government employees and pensioners are not eligible for HIMCARE. The scheme divides eligible beneficiaries into three categories, each with a different annual premium.

**Category I (Zero Premium):** No annual premium is required for individuals in this category.

**Category II (₹365 per year):** Beneficiaries in this group pay a nominal annual premium.

**Category III (₹1000 per year):** This category is for all other eligible residents who do not fall into the first two groups.

• **Category I Beneficiaries (₹0 Premium):** BPL families, registered street vendors (not covered by PM-JAY), MNREGA workers with at least 50 days of work, children in orphanages, and individuals with over 40% disability.
• **Category II Beneficiaries (₹365 Premium):** *Ekal Naaris* (single women), senior citizens over 70, Anganwadi workers and helpers, ASHA workers, mid-day meal workers, and contractual, daily wage, part-time, or outsourced employees of government bodies.
• **Category III Beneficiaries (₹1000 Premium):** Any individual or family residing in Himachal Pradesh who is not eligible for Category I or II and is not a government servant or pensioner.

How to Enrol and Get Your HIMCARE Card

The enrollment process for the HIMCARE scheme can be completed either online or offline. For online registration, applicants can visit the official portal at www.hpsbys.in. For offline assistance, individuals can go to a nearby Lok Mitra Kendra (LMK) or a Common Service Center (CSC). It is important to note that new registrations are typically opened only during specific periods each year.

To apply, certain documents are mandatory for all applicants, while others are required based on the specific eligibility category.

**Mandatory Documents:** Aadhar card and ration card.

**Category-Specific Documents:**

An attested BPL certificate for BPL families.

An MNREGA job card and an online MIS report showing 50 days of work for MNREGA workers.

A certificate from the concerned Child Development Program Officer (CDPO) for *Ekal Naaris*.

A medical certificate confirming over 40% disability for disabled persons.

A certificate from the relevant Block Officer (CDPO, BMO, or BEEO) for Anganwadi, ASHA, or mid-day meal workers.

After the application is submitted and verified, an e-card is generated for the family. This card can be downloaded from the official website. For services related to enrollment and card preparation, LMKs and CSCs may charge a fee of ₹50 per family.

Using HIMCARE at Empanelled Hospitals

The primary benefit of the HIMCARE scheme is the provision of cashless treatment at empanelled healthcare facilities. When a beneficiary needs medical care, they must present their HIMCARE e-card at the hospital's designated counter. The hospital staff will then verify the cardholder's eligibility through the system.

Once eligibility is confirmed, the hospital provides the necessary treatment for covered procedures without requiring any upfront payment from the patient, up to the ₹5 lakh limit. The hospital later submits the treatment claim directly to the Himachal Pradesh Swasthya Bima Yojana Society for reimbursement.

Treatment under HIMCARE can be availed at all government hospitals within Himachal Pradesh and a network of empanelled private hospitals. Hospitals that are empanelled under the central Ayushman Bharat scheme are automatically included in the HIMCARE network. Additionally, beneficiaries can receive treatment at two major hospitals in Chandigarh: PGIMER and GMCH, Sector 32. A complete and updated list of empanelled hospitals is available on the official HIMCARE website.

HIMCARE and Ayushman Bharat (PM-JAY)

It is important to understand the relationship between HIMCARE and the national Ayushman Bharat PM-JAY scheme. HIMCARE is a state-sponsored health scheme that operates in parallel with the central government's program.

The main purpose of HIMCARE is to fill the gap in coverage left by PM-JAY. The eligibility for Ayushman Bharat is determined by the Socio-Economic and Caste Census (SECC) 2011 data. Many families and individuals in Himachal Pradesh, while in need of health coverage, were not found eligible under these central criteria. The HIMCARE scheme was launched by the state government to provide similar benefits to these left-out families who are permanent residents of Himachal Pradesh.

Recent and Proposed Changes to the Scheme

The Government of Himachal Pradesh has initiated several reforms and proposed enhancements to the HIMCARE scheme to improve its effectiveness and transparency.

In April 2026, the state government began implementing reforms to rationalize payment procedures to government hospitals. These changes aim to prevent misuse by requiring hospitals to submit actual expense bills for claims. Charges like registration fees and bed charges, which are already funded through direct budgetary allocations to government hospitals, are being excluded from HIMCARE claims to improve transparency.

Furthermore, in June 2026, the Himachal Pradesh Cabinet approved a proposal to enhance the scheme's coverage by shifting it to an insurance-based model. Under this proposed arrangement, beneficiaries might receive increased health coverage of ₹7 lakh and ₹10 lakh. Following this, in August 2026, the Chief Minister announced plans for a new health insurance policy that would offer coverage up to ₹10 lakh for economically weaker families at a nominal premium, intended to build upon the existing HIMCARE and Ayushman Bharat framework.

Frequently Asked Questions

How much does it cost to enrol in the HIMCARE scheme?

The cost depends on your eligibility category. It is free for BPL families, MNREGA workers, and others in Category I. For Category II, which includes senior citizens over 70 and Anganwadi workers, the annual premium is ₹365. For all other eligible families in Category III, the premium is ₹1000 per year.

Are government employees eligible for HIMCARE?

No, government employees, pensioners, and their dependents who are covered under any government medical reimbursement policy are not eligible for the HIMCARE scheme.

What if my family has more than five members?

A single HIMCARE card covers a family unit of up to five members. If your family is larger, the additional members must be enrolled as a separate unit to receive coverage.

Can I use my HIMCARE card for treatment outside Himachal Pradesh?

Yes, treatment under the HIMCARE scheme can be availed at two designated hospitals outside the state: the Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, and the Government Medical College and Hospital (GMCH), Sector 32, Chandigarh.

How is HIMCARE different from Ayushman Bharat PM-JAY?

HIMCARE is a state government scheme for Himachal Pradesh residents who are not eligible for the central Ayushman Bharat PM-JAY scheme. PM-JAY's eligibility is based on the SECC 2011 database, while HIMCARE aims to cover the remaining population of the state.

Where can I find a list of hospitals that accept the HIMCARE card?

A complete and updated list of all empanelled government and private hospitals is available on the official HIMCARE portal, www.hpsbys.in. All government hospitals in the state are automatically empanelled.

Related

• Government hospital OPD guides in Himachal Pradesh
• How to find an Ayushman Bharat (PM-JAY) hospital near you
• Government health schemes in India: a guide
• Ayushman Bharat PM-JAY eligibility check

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.