The Himachal Pradesh Govt has revised its HIMCARE health insurance scheme's reimbursement norms. Govt hospitals can now only claim the lower of actual expenditure or the package rate, aiming to rationalize claims and prevent duplication of funds.
The Himachal Pradesh Government on Thursday has revised the reimbursement norms under its flagship HIMCARE health insurance scheme, restricting claims by government healthcare institutions to the actual expenditure incurred or the prescribed package rate, whichever is lower.
According to an official notification issued on Thursday by Secretary (Health) Ashish Singhmar, the revised norms will apply to all government hospitals, medical colleges and dental colleges across the state.
New Guidelines Aim to Rationalise Reimbursements
Under the new guidelines, government healthcare institutions will be entitled to reimbursement based on the actual cost of treatment, along with remuneration payable to HIMCARE Sathis. The move is aimed at rationalising reimbursements and preventing duplication in claims.
Restrictions and Exclusions in Claims
Under the earlier improved Himcare Scheme in April, government hospitals were to be paid the lower amount between the actual cost of treatment (including consumables) and the fixed package rate. Hospitals were to submit bills for the actual expenses along with their claims. Expenditures such as registration fees, bed charges, nursing, and boarding were not included in such claims. In addition, fees for surgeons, anaesthetists, doctors and consultants, as well as charges for anaesthesia, blood transfusion, oxygen, operation theatre use, surgical equipment, medicines and patient meals, were not a part of these reimbursement claims.
The Health Department has specifically prohibited government institutions from seeking reimbursement for medicines, consumables, surgical items and other supplies that are already being provided through regular government supplies, state budgetary allocations or National Health Mission (NHM) funding.
Patient Services Unaffected, Cashless Treatment to Continue
The revised reimbursement mechanism, however, will not affect patients receiving treatment under the scheme. Government hospitals and medical and dental colleges will continue to provide cashless treatment, with all medicines, surgical items, and other required consumables to be supplied to beneficiaries during treatment. The notification supersedes the earlier order issued on April 8, 2026, and has come into force with immediate effect following approval by the competent authority.
BJP Protests Alleged Weakening of Welfare Schemes
BJP MLAs led by Leader of Opposition Jai Ram Thakur on August 25 staged a protest outside the Himachal Assembly campus, accusing the Congress government of failing to provide basic healthcare facilities and deliberately weakening welfare schemes launched by the previous BJP government.
Addressing the media during the protest, Thakur said a government that could not provide adequate health facilities to people was "incompetent" and should be replaced. He alleged that although the Sukhu government was nearing four years in office, it had failed to introduce any major new public-welfare scheme and was instead attempting to shut down schemes initiated by the previous BJP government. (ANI)
(Except for the headline, this story has not been edited by Asianet Newsable English staff and is published from a syndicated feed.)