Launched as a country-wide health insurance scheme in July 2003, the Universal Health Insurance Scheme (UHIS) is an extensively recognised government health insurance initiative that specifically targets low-income groups, particularly those who are the main breadwinners. This policy provides coverage for medical expenses and also includes personal accident cover.
What is the Universal Health Insurance Scheme (UHIS)?
The primary objective of the Universal Health Insurance Scheme is to enable improved access to free medical care, especially the vulnerable sections of society. Besides medical expenses, the scheme also provides benefits such as personal accident insurance coverage to the primary income earner and compensation to the family in case of death of the breadwinner.
What are the benefits of the Universal Health Insurance Scheme?
The Universal Health Insurance Scheme covers various expenses, including:
Room and boarding expenses of up to 0.5% of the sum insured, ICU room and boarding costs of up to 1% of the sum insured per day
Costs of surgeons, consultants, specialists, and medical practitioners up to 15% of the sum insured per injury or illness
Costs related to maternity are included in the coverage
For a regular delivery, an amount of up to ₹2,500 will be provided, while for a cesarean delivery, the coverage extends up to ₹5,000
There is a hospitalisation benefit of ₹30,000 for every family per policy, which includes maternity benefits
The policy also provides a personal accident cover of ₹25,000 if the insured or the family's breadwinner sustains an injury leading to death within 6 months of the incident.
In the unfortunate event of the death of the main income earner, the scheme offers compensation to the family members
A key feature of the Universal Health Insurance Scheme is that it can be purchased by both individuals and groups. However, if it is a group policy, the members cannot be part of more than one group health insurance scheme. The policy is issued in the name of the primary earner of the family and includes the names of all family members. In the case of a group policy, it is issued in the name of the group, institution, or association and includes the names of the members and their families.
Furthermore, the Universal Health Insurance Scheme provides disability compensation in case the primary policyholder or their spouse gets hospitalised due to an illness, accident, or disease. The insurer offers ₹50 as compensation from the fourth day of hospitalisation, after a waiting period of 3 days. This benefit can be availed for a maximum of 15 days.
What is the purpose of the Universal Health Insurance Scheme?
The Universal Health Insurance Scheme was launched nationwide in July 2003. The aim is to provide healthcare to the poorest sections of society, which is why it is open to both Below Poverty Line (BPL) and Above Poverty Line (APL) families. The premiums for the Universal Health Insurance Scheme vary for APL and BPL families. For APL families, the premium is calculated at ₹365 annually.
What is the eligibility criteria of the Universal Health Insurance Scheme?
The eligibility criteria for individuals and families to qualify for the Universal Health Insurance Scheme (UHIS) differ based on their income status, whether they fall below the poverty line or above it.
For individuals and families above the poverty line, those aged between 5 and 65 years are eligible for coverage under the scheme.
To qualify as an above-poverty-line (APL) family, their income should exceed the sum insured amount.
Children between the ages of 3 months and 5 years can be included in the policy if both parents are also covered.
Individuals and families below the poverty line can be covered if they are between the ages of 5 and 70. To be eligible, their income should be lower than the sum insured amount.
A certificate issued by an official, not below the rank of B.D.O/Tehsildar of the Revenue Department of the respective State Government, is required as proof of their income.
It is important to note that children aged between 3 months and 5 years can also be covered under the policy if both parents are covered.
In the event that an insured person is deleted from the policy after claiming benefits, the premium will not be refunded. The policy can only be renewed with mutual consent, and the insurance company may or may not provide a renewal notice. If the policy is cancelled, the insurance company will refund the amount on a pro-rata basis. However, any claims made within the terms and conditions of the policy will be covered by the insurance company.
As many government schemes may roll out changes or modifications, it is advisable to stay well-informed and up-to-date with details pertaining to the Universal Health Insurance scheme.
