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Universal Health Insurance Scheme

Universal Health Insurance Scheme provides covers with the poorest sections of the societies for several healthcare expenses. Both individuals or groups can purchase this policy avail coverage related to room and boarding expenses, cost of Surgeon, Consultants, etc., maternity expenses, personal accident cover, etc. Premiums for APL families and BPL families differ under the Universal Health insurance Scheme.

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Universal Health Insurance Scheme

Universal Health Insurance Scheme (UHIS) is one of the most popular government health insurance schemes in India, that offers cover to low-income groups, mainly the sole breadwinner of the family. The policy offers cover for medical expenses and personal accident cover and provides compensation to the family members in the misfortunate event of death of the main income-earner of the family.

Launched on a countrywide basis in July 2003, the Universal Health Insurance Scheme has the objective of providing healthcare to the poorest sections of society. The scheme is launched as a part of the ministry's Universal Health Assurance Mission (UHAM) and is open to Below Poverty Line (BPL) as well as Above Poverty Line (APL) families.

Features of The Universal Health Insurance Scheme (UHIS)

Listed below are the features of the Universal Health Insurance Scheme:

  • The policy can be purchased by both individuals and groups
  • If it is a group policy, then the members cannot be a part of more than 1 group health insurance scheme
  • The scheme will be in the name of the primary earner of the family and will include the name of the family members
  • In case of group policy, it will be in the name of the group, institution, or association. The policy will contain the name of the member as well as their family.

Inclusions Under Universal Health Insurance Scheme (UHIS)

Universal Health Insurance Scheme (UHIS) covers you for the following expenses:

  • Room and boarding expenses for up to 0.5% of the sum insured
  • Room and boarding cost for ICU per day for up to 1% of the sum insured
  • Cost of Surgeon, Anaethetist, Consultants, Nursing, Specialists, Medical Practitioners for up to 15% of the sum insured per injury or illness
  • Maternity expenses for up to Rs. 2,500 for normal delivery, Rs. 5,000 for cesarean delivery
  • Hospitalisation benefit of Rs. 30,000 for every family per policy that also includes the maternity benefit as well
  • Personal accident cover if the insured or the breadwinner of the family sustains injury due to a mishap which lead to death within 6 months of the misfortunate event of Rs. 25,000.
  • Disability compensation in case the primary policyholder or the spouse gets hospitalised due to an illness, accident, or a disease. In this case, the insurer provides Rs. 50 from the fourth day as compensation, after a waiting period of 3 days of hospitalisation. The benefit can be availed up to a maximum of 15 days.

Exclusions Under Universal Health Insurance Scheme (UHIS)

Universal Health Insurance Scheme (UHIS) does not cover you for the expenses incurred on the following:

  • HIV/AIDS
  • War or warlike situation
  • Venereal or congenital diseases
  • Circumcision included only in case of accident or necessary treatment
  • Expenses related to hearing aids, spectacles, contact lenses, etc.
  • Expenses related to dental surgery, or cosmetic treatment
  • Suicide or attempt of suicide
  • Expenses related to vitamins, tonics, etc.
  • Injuries or death because of consumption of drugs or alcohol
  • Injuries or death due to breach of law with criminal intent

Eligibility For Universal Health Insurance Scheme (UHIS)

Eligibility for Universal Health Insurance Scheme (UHIS) varies for individuals or families that fall under Below Poverty Line and Above Poverty Line (APL).

Eligibility for Individuals and Families Above Poverty Line

People aged between 5 years and 65 years can be covered under the scheme. To be eligible for an APL family, the family’s income should be more than the sum insured amount. You can also include children if they are aged between 3 months and 5 years if both the parents are covered under the scheme too.

Eligibility for Individuals and Families Below Poverty Line

People aged between 5 years and 70 years can be covered under this policy. To be eligible, the family’s income should be less than the sum insured amount. One must have a certificate as proof thereof issued by an official, not below the rank of B.D.O/Tehsildar of Revenue Department of the concerned State Government and attach the same. Note that the children aged between 3 months and 5 years can also be covered under the policy provided both the parents are covered.

Premiums For Universal Health Insurance Scheme (UHIS)

Premiums for APL families and BPL families differ under the Universal Health insurance Scheme. Read below:

Premiums For APL Families

  • The premium is calculated at Rs. 365 annually
  • Families with not more than 5 members are required to pay a premium of Rs. 548 every year. The members should include the insured, spouse, and first 3 dependent children.
  • Families with more than 5 but less than 7 members including insured, spouse, and first three dependent children and parents shall pay Rs. 730 every year.

Points to Remember

  • In case of deletion of an insured person in the case, he/she has recovered a claim under the policy, the premium will not be refunded.
  • The policy can be renewed only with mutual consent. The health insurance company may or may not give any notice when the policy is due for renewal. Also, in case of policy cancellation, the insurance company will refund the amount on the prorata basis. However, any claims, if made as per the terms and conditions of the policy, shall be bored by the insurance company.

Period of Risk

Rate of Premium to be Charged

Up to 1 month

1/4th of the annual rate

Up to 3 month

1/3rd of the annual rate

Up to 6 month

1/2 of the annual rate

More than 6 months

Full annual rate

Premiums For BPL Families

To know about premiums for APL families, refer to the table below:

Coverage

Premium

Insured’s share

GOI subsidy

Individual

Rs. 300

Rs. 100

Rs. 200

Family with up to 5 members

Rs. 450

Rs. 150

Rs. 300

Family with up to 7 members

Rs. 600

Rs. 200

Rs. 400

Termination of Universal Health Insurance Scheme (UHIS)

The insured person or a family can anytime cancel their Universal Health Insurance Scheme. In this case, the insurance company shall refund the premium at its short period rate. Note that the premium will be refunded only if the insured has not made any claim up to the date of cancellation.

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