Himachal’s New Rs 10 Lakh Health Insurance Scheme Explained: Who Benefits, What Changes From Himcare
Himachal Health Scheme introduces Rs 10 lakh health cover for eligible families. Here’s who benefits and how it differs from the existing Himcare scheme.
Himachal Health Scheme promises health insurance coverage of up to Rs 10 lakh for eligible beneficiaries. Here's who qualifies, what the scheme offers and how it differs from Himcare.
NEW DELHI, Himachal Health Scheme: Himachal Pradesh government is preparing a new health insurance scheme that would double medical cover to Rs 10 lakh per family. It would replace the current Rs 5 lakh Himcare scheme. Naresh Chauhan, Principal Media Advisor to Chief Minister Sukhvinder Singh Sukhu, confirmed the plan in Shimla. He said the tendering process has been completed and the final terms are still being worked out.
Himachal Health Scheme: Eight Insurers in the Race, Birla Sun Life Emerges Lowest Bidder
Eight insurance companies took part in the tender. Birla Sun Life submitted the lowest bid. Chief Minister Sukhu has asked the Health Secretary to hold another round of talks with the company so the process can be finalised and the scheme rolled out quickly. The premium structure is still being negotiated, and the government has said further details will follow once talks conclude.
The state is moving from a government-run model to an insurance-based one. Himcare, which launched in 2019, was designed to cover families who fall outside the central Ayushman Bharat programme. Under the new model, a licensed insurer would carry the financial risk and handle claims, with a focus on cashless treatment for patients.
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Himachal Health Scheme: Why the Government Is Moving Away From Himcare
The decision follows complaints of corruption and misuse of funds under the existing scheme. According to Chauhan, preliminary inquiries pointed to a possible nexus involving certain private hospitals and nursing homes, including some outside Himachal Pradesh. This allegedly led to irregular medical claims. These findings have not been tested in court, and the details of the inquiries have not been made public.
The government argues that an insurance-based system, with its own claim verification and audit processes, will make it harder to inflate bills or file questionable claims. Chauhan said the aim is to use public money effectively and make healthcare delivery more transparent, especially for families who cannot afford costly treatment.
Himachal Health Scheme: Who Will Benefit and What Else Is Planned
Families living below the poverty line and those covered under other eligible welfare schemes are expected to benefit. Chauhan said the government also intends to widen the pool of beneficiaries. Earlier statements from the state put the number of families to be covered at roughly 10 lakh. The government has described the policy as a first of its kind among Indian states, a claim that has yet to be independently verified.
Alongside the insurance overhaul, the government says it is investing in healthcare infrastructure. Plans include advanced medical technology, robotic surgery, PET-CT scan facilities, and more MRI and X-ray machines. The state is also recruiting doctors and other healthcare staff, so that better insurance cover is matched by better hospitals and clinics.
Himachal Health Scheme: What Happens Next
The scheme is not yet in force. Its launch depends on the outcome of the negotiations with the selected insurer and on the final premium structure. Beneficiary eligibility, the list of empanelled hospitals and the claim process are also yet to be announced. Residents who currently use Himcare should wait for official notices from the Health Department before assuming any change to their existing cover.
