Universal Health Insurance Scheme: Coverage, Benefits, Eligibility And More

Health Insurance

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

1. You can purchase this policy for yourself and your family. 
2. If bought individually, the scheme must be issued in the primary earner’s name and should include details of all family members. 
3. The group policies should be purchased in the group or institution’s name buying on behalf of the BPL families. 
4. 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 – https://navi.com/blog/arogya-sanjeevani-policy/ 

Universal Health Insurance Scheme Exclusions

1. Injuries or death resulting from wars, acts of terrorism, or invasion 
2. Expenses related to circumcision (except in the case of necessary treatment) 
3. Costs of hearing aids, spectacles, and contact lenses 
4. Dental surgery expenses or treatment costs for cosmetic, corrective, or aesthetic purposes 
5. Congenital or venereal diseases 
6. Cost of tonics/vitamins unless prescribed by a medical practitioner
7. HIV/AIDS 
8. Injuries that are self-inflicted 
9. Suicide or attempted suicide 
10. Injuries or death owing to drug or alcohol influence 
11. Injuries or death resulting from adventure sports 

Premium Rates for UHIS

For the BPL category:

For Above Poverty Line (APL) families:

Eligibility Criteria for Universal Health Insurance Scheme

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. 

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.

Alternatively, for comprehensive health benefits at affordable premium rates, you might want to consider the Navi health insurance policy offered by Navi. This insurance company offers health insurance plans at low premiums starting from Rs. 241 per month with support from over 10,000 hospitals all over India. Further, due to their technology-driven processes, you can expect a hassle-free application procedure. 

Download the Navi app today and purchase a plan in a few minutes. This Procedure is completely paperless and efficient. 

Also Read – https://navi.com/blog/gst-on-insurance-premium/ 

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. 

Frequently Asked Questions

Before you go…

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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.