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Himachal Pradesh

Profile


Overview
Name of the Scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY);
>Himachal Health Care Scheme-HIMCARE
Date of roll-out 23-09-2018
Mode of Implemetation Trust
Number of PM-JAY eligible families as per SECC/RSBY data 4,78,985
Number of PM-JAY additional families covered by the State -
Number of Non-PM-JAY families covered by the State scheme 5,00,000
Insurance
Name of the insurance company (if applicable) Not Applicable
Name of the ISA/TPA Med Save Health Insurance TPA Ltd.
Health Packages
Number of Health Benefit Packages (HBP 2.0) 872
Number of packages reserved for government hospitals 14
Description of the State Scheme
Himachal Health Care Scheme is being implemented since 1st January, 2019. The scheme provides for cashless treatment coverage up to Rs. 5.00 lakh per year per family is being provided on family floater basis. In case there are 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. The following are the beneficiaries under the scheme:
  • Category I- BPL, Registered Street Vendors, MNREGA worker (worked minimum 50 days in previous or current FY)
  • Category II - Ekal Naaris, Disabled >40%, Sr. Citizens above 70, Anganwari Workers and Helpers, ASHA workers, Mid-Day meal workers, Outsource Employees.
    Daily Wage Workers, Part Time Workers, Contractual Employees (Govt., Autonomous Bodies, Societies, Boards & Corporations etc. under the control of State Government)
  • Category III - Beneficiaries not covered under category-I and category-II or who are not Govt. servants/pensioners or their dependent family members.
Contact Details of the State Team
Name of State Health Agency (SHA) Himachal Pradesh Swathya Bima Yojna Society
Address Himachal Pradesh Department of
Health and Family Welfare, Block 6 Swasthya Bhawan,
SDA Complex, Kasumpti, Shimla, Himachal Pradesh-171009
Contact No. 0177-2629840 / 0177-2629802
Email Id snoabnhpm.hp@gmail.com
Name of CEO Dr. Nipun Jindal, IAS
Toll Free no NA
Note:   Data as on 14 April 2020

Himachal Pradesh Factsheet


Name of the State HIMACHAL PRADESH Mode of implementation Trust Date of data download 03-Feb-20
I. Demographic Details
1 Name of the scheme in the State "Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)Himachal Health Care Scheme-HIMCARE"
2 Number of PM-JAY eligible families as per SECC/RSBY data 4,78,985
3 Number of Additional PM-JAY families covered by the State 0
4 Number of non-PM-JAY families covered under the State scheme 5,00,000
5 Percentage of families covered under PM-JAY 32%
6 Percentage of non-PM-JAY families covered under the State scheme 34%
II. Hospital Emapanelment
Till Date
Public Private Total
7 Number of empaneled hospitals
149 58 207
III. Beneficary Identifcation
Till Date
8 E-cards generated 8,16,306
III. Transaction Management
Jan-20 Till Jan 2020
9 Hospital Admissions Authorized Numbers
4,445 50,688
Amount (In Rs.)
4,60,90,657 51,04,73,088
IV. Claims
Jan-20 Till Jan 2020
10 Claims submitted Numbers
4,173 43,612
Amount (In Rs.)
4,17,70,133 41,98,01,908
V.Portability
Total Outgoing
Jan-20 Till Jan 2020
Total Incoming
Jan-20 Till Jan 2020
11 No. of hospital admissions authorized
496 4,184
27 377
12 No. of claims submitted
444 3,322
26 338
Himachal Pradesh Factsheet
Note:
1.     Non-PM-JAY families covered under contribution based State scheme-HIMCARE with healthcare cover of Rs. 5 Lakhs per family

District Profile


 
 
Note:
1. Map not to scale

2. Data as on 01st Jan 2020

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