Patients to bear the cost of MRI, CT scans, medicines, diagnostic tests and several treatment-related expenses as revised Himcare guidelines come into effect.
Kangra, June 28
Patients availing treatment under the Himcare health insurance scheme at Dr. Rajendra Prasad Government Medical College (RPGMC), Tanda, are set to face significant changes following the issuance of a new government notification that limits the scope of reimbursable medical expenses.
Under the revised guidelines, several services that were previously covered or reimbursed under the scheme have been excluded from claim eligibility. Hospital authorities have confirmed that reimbursement of medicine expenses has been discontinued, while a number of diagnostic tests and treatment-related charges will now have to be paid directly by patients.
According to the notification, government hospitals will now be allowed to submit claims based only on the actual expenditure incurred or the prescribed package rate, whichever is lower. Hospitals will also be required to furnish detailed expenditure records and supporting bills while filing claims.
The revised provisions specifically exclude several common healthcare expenses from reimbursement. These include registration fees, general ward bed charges, nursing and boarding charges, fees of surgeons, anesthetists and physicians, anesthesia costs, blood transfusion charges, oxygen expenses, operation theatre charges and surgical equipment costs.
In a major setback for beneficiaries, expenses related to medicines, diagnostic investigations and radiology services have also been excluded. This includes X-rays, MRI scans, CT scans, pathology tests and other laboratory examinations, which patients will now have to pay for out of their own pockets.
The notification further states that consultation fees, investigations and medicines incurred before admission and up to 15 days after discharge will no longer be covered under the scheme. Earlier, admitted patients were entitled to receive medicines free of cost for up to 15 days after discharge. That benefit has now been withdrawn.
Officials have also clarified that consumable items and treatment-related materials already available in government hospitals under state-funded budgets will not be eligible for reimbursement.
Among the major diagnostic procedures affected by the decision are MRI scans costing around ₹2,750, CT scans ranging between ₹880 and ₹1,320, and angiography procedures costing approximately ₹550. Patients will now have to bear these expenses themselves.
However, the notification provides relief in one area, stating that the cost of surgical implants will continue to remain eligible for payment under the scheme.
The changes are expected to impact a large number of Himcare beneficiaries who rely on government hospitals for affordable healthcare services across Himachal Pradesh.
