Universal Health Insurance Scheme

The Universal Health Insurance Scheme was introduced by the Ministry of Health and Family Welfare as part of its proposed UHAM i.e. Universal Health Assurance Mission. In 2003, the Scheme was launched in India with an objective to provide health care services to the needy and the poor sections of the society. The scheme is available to both the Below Poverty Line (BPL) and Non-BPL families. Currently, its insurance reach is close to 25% of the population.

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      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.

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