Universal Health Insurance Scheme (UHIC): Check Coverage & Benefits

What is Universal Health Insurance Scheme?

The Universal Health Insurance Scheme offers coverage for all medical expenses, including personal accident cover to the primary breadwinner of the family. In this scheme, compensation is also provided if the earning member of the family passes away. Both BPL (Below Poverty Line) and APL (Above Poverty Line) families can apply for this scheme.

Universal Health Insurance Scheme (UHIS) Eligibility Criteria:

People in India who fall under the category of Below Poverty Line (BPL) or the Above Poverty Line (APL) are eligible to get health insurance under UHIS. Check out the details below:

Eligibility Criteria for Below Poverty Line (BPL) Families:

Eligible age for Adults- 5 years to 70 years
Children who are 3 months to 5 years are also covered with their parents under the scheme
Family’s Income- Lesser than the policy sum insured/coverage amount
Proof of BPL Certificate- It can be taken from the BDO of the Revenue Department or local Tehsildar

Eligibility Criteria for APL Families:

Eligible age for Adults- 5 years to 70 years
Children who are 3 months to 5 years are also covered with their parents under the scheme
Family’s Income- Lesser than the policy sum insured/coverage amount

Features of the Universal Health Insurance Scheme (UHIS)

Mentioned below are some of the features of the Universal Health Insurance Scheme by the Government of India:

Coverage in this scheme is available to both the individuals and the groups
The scheme is issued in the name of the primary earning member of the family and includes the name of all the family members

Hospital Benefits	Criteria
Hospital room rent and boarding charges on a daily basis	0.5% of the SI
Intensive Care Unit ( ICU) Costs Per Day	1% of the SI
Cost of Doctors, Surgeon, Nursing, Anesthetist, Consultants, Specialists	15% of the SI per Injury/ illness
Cost of Medicines, Oxygen, X-Ray, Blood, Surgical Appliances, Anesthesia, Chemotherapy, etc.	15% of the SI per Injury/ illness
Maternity Cover ( Single Child Only)	Normal Delivery- Rs 2,500 Cesarean- Rs 3000 12 Months Waiting Period)

All the group policies to be issued in the name of the group, or the institution that is buying it for the BPL families.
Universal health insurance scheme will be issued in the name of the member and their family
The members cannot be insured under multiple group health schemes

Benefits and Coverage of the Universal Health Insurance Scheme:

The main objective of this health insurance scheme is to provide financial coverage to meet the cost of healthcare services. The insured members are paid for medical expenses incurred during hospitalization for any illness, disease, or injury sustained by the insured person. Other benefits offered under the UHIS are given below:

Other benefits:

Every family gets Rs 30, 000 as hospitalization benefit that includes maternity benefit i.e. child delivery expenses as well
Maximum claim expenses are restricted to Rs 15, 000 ( exclusive of maternity benefits)

Personal Accident Cover:

Universal health insurance scheme provides compensation of Rs 25,000 to the insured in case of the death of the head of the family (the main policyholder of the scheme). This is in the case where the main income earner of the family of the policyholder sustains injury due to a mishap that leads to death within 6 months of the incident.

Disability Compensation:

An amount of Rs 50 is paid to the insured in case the policyholder or the spouse is hospitalized due to an illness or an accident. This is provided after 30 days of the waiting period i.e. from the fourth day of the hospitalization for a maximum of 15 days.

How to Enroll under the Universal Health Insurance Scheme?

To enroll under this scheme you need to speak to the insurance company who will help in applying for the scheme.

Documents required

To apply for Universal Health Insurance Scheme you only need to furnish a Certificate of Proof that you belong to the Below Poverty Line (BPL) Section of the society. This certificate should be taken from either Tehsildar or B.D.O of the State Revenue Department.

FAQS

Q1. Who is eligible to buy this Universal Health Insurance scheme?

Universal Health Insurance Scheme (UHIS) offers coverage to people and their families between the age group of 3 months and 65 years. Insured may renew his Policy beyond the age of 65 years provided there is no break in Insurance.
Q2. Who can be covered under the Universal Health Insurance Scheme?
Under this policy a family comprising the policyholder and the members as given below can be insured:
- Spouse
- Dependent Parents
- Dependent Children (maximum three)
Q3. Can I avail Installment Facility under the Universal Health Insurance scheme?

No, you cannot avail of Installment Facility under the Universal Health Insurance scheme.
Q4. Is there any health insurance for Below the Poverty line people?

Yes, for both the Below Poverty line (BPL) and Above Poverty Line (APL) you can buy the Universal Health Insurance scheme that was launched in 2003. The policy can be purchased as group insurance by institutions and other groups.
Q5. When was the Universal Health Insurance Scheme (UHIS) launched?

Universal Health Insurance Scheme (UHIS) was launched in 2003 to ensure health cover to the poor and deprived people in India.
Q6. Can maternity benefits be availed for the second child under this scheme?

No. The benefit is extended only to one child under the Universal Health Insurance Scheme. Also, there is a waiting period of 12 months from the date of inception of the insurance policy.
Q7. Is personal accident cover provided under the UHIS?

Yes, personal accident cover is provided under the Universal Health Insurance Scheme (UHIS).
Q8. Is Naturopathy treatment covered under the Universal Health Insurance Scheme?

No. Naturopathy treatment is not covered under this scheme.

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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in