Universal Health Insurance Scheme – Features, Exclusions, Cover and Rates
As a part of the Ministry of Health and Family Welfare’s Universal Health Assurance Mission, the Universal Health Insurance Scheme (UHIS) was launched in 2003. This scheme was introduced with the motive of providing health care services to the Below Poverty Line (BPL) and non-BPL families. Thus, for individuals, who are looking for a comprehensive health insurance plan, the UHIS is an option worth considering.
Nevertheless, before enrolling in this scheme, you might want to consider some factors such as eligibility, coverage scope, etc. In this regard, you can go through the following piece.
Features of Universal Health Insurance Plan
- You can purchase this policy for yourself and your family.
- If bought individually, the scheme must be issued in the primary earner’s name and should include details of all family members.
- The group policies should be purchased in the group or institution’s name buying on behalf of the BPL families.
- Members cannot be insured under different health insurance schemes.
Coverage under Universal Health Scheme
1. Hospitalisation Cost
The scheme offers a medical reimbursement of Rs.30,000 to every family in case of hospitalisation due to illness or injury. The sum insured also includes a maternity benefit of Rs. 2,500 for normal and Rs. 5,000 for cesarean delivery. However, the maximum amount that one can claim for each illness is Rs. 15,000. Note that this does not include maternity benefits.
2. Personal Accident Coverage
In case a policyholder, who is the main earning member of the family, suffers serious injuries due to an unfortunate accident and dies within 6 months of the accident, his or her family will receive personal accident coverage. Under this cover, the family will get compensation of Rs. 25,000.
3. Benefits in Case of Disability
There might be instances when a policyholder is hospitalised due to an accident or illness, and the stay extends to more than 3 days. In such a case, the insurance company will provide compensation from the 4th day onwards till a maximum period of 15 days.
Also Read
Universal Health Insurance Scheme Exclusions
- Injuries or death resulting from wars, acts of terrorism, or invasion
- Expenses related to circumcision (except in the case of necessary treatment)
- Costs of hearing aids, spectacles, and contact lenses
- Dental surgery expenses or treatment costs for cosmetic, corrective, or aesthetic purposes
- Congenital or venereal diseases
- Cost of tonics/vitamins unless prescribed by a medical practitioner
- HIV/AIDS
- Injuries that are self-inflicted
- Suicide or attempted suicide
- Injuries or death owing to drug or alcohol influence
- Injuries or death resulting from adventure sports
Premium Rates for UHIS
1. For the BPL Category:
| Coverage | Premium Rate (Rs.) | Insured Share (Rs.) | Government Subsidy (Rs.) |
| Individual | 300 | 100 | 200 |
| A maximum of 5 family members | 450 | 150 | 300 |
| Up to 7 family members | 600 | 200 | 400 |
2. For Above Poverty Line (APL) Families:
| Coverage | Premium rates (Rs.) |
| Individuals | 365 |
| A maximum of 5 family members | 548 |
| Up to 7 family members | 730 |
Eligibility Criteria for Universal Health Insurance Scheme
1. For Below Poverty Line Families:
- The income of a family should not be more than the sum insured.
- Families must possess proof of a BPL certificate. They can collect this certificate from the local Tehsildar or BDO of the Revenue department.
- Individuals should be between 5 years to 70 years.
- Children between 3 months and 5 years are also eligible for this scheme if their parents are covered under it.
2. For Above Poverty Line Families:
- The Family’s income should not exceed the sum insured amount.
- They should be between 5 and 65 years.
- Insured parents’ children between 3 months and 5 years are also covered.
How to Enrol under the Universal Health Scheme?
To enrol under the UHIS, members might consider contacting their insurance provider. For a successful application, one should furnish necessary documents that state you are from a BPL family.
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Final Word
The current insurance reach of this scheme is close to 25% of the population. However, owing to its coverage scope and affordability, it is expected that more individuals, especially the ones belonging to BPL families, will find the Universal Health Insurance Scheme an ideal option. If you are planning to apply for this scheme, you might want to delve deeper and learn about its features, coverage, and more from the aforementioned section.
FAQs
Ans: Some of the hospital benefits available under this scheme are:
Per day hospital room charges
ICU costs (Per day)
Costs of surgeons, specialists, anaesthetists, medical practitioners, consultants, nursing
Costs of anaesthesia, oxygen, medicines, surgical appliances, blood, X-Ray, chemotherapy, etc.
Maternity coverage
Ans: In case a policyholder is admitted to a hospital for more than 3 days due to serious injuries from an accident, the UHIS offers disability compensation. This compensation is available only after 30 days waiting period for a span of 15 days.
Ans: No, the maternity benefit under the Universal Health insurance Scheme is only available for a single child. Further, beneficiaries can obtain benefits under this coverage only after a waiting period of 12 months from the date of enrolment under this scheme.
Ans: Yes, members obtaining individual policies for a tenure of more than a year can have a free look period of up to 15 days. The period starts from the commencement day of the policy. During this period, one can go through the terms and conditions of the scheme before making any decision.
Ans: Generally, individuals opting out of the policy benefits within the free-look period of 15 days can get a refund. However, beyond that period, no refunds are available if you cancel the Universal Health insurance policy.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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