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What is the Universal Health Insurance Scheme (UHIS)? How to Enroll In Universal Health

Published on Sept 15, 2020. EST READ TIME: 5 MIN   

The global pandemic has taught us the importance of health insurance. If your company doesn’t provide you with an adequate health insurance plan, you can always buy a comprehensive health cover for yourself. But unfortunately, a sizable part of our population can’t even think of buying an insurance plan. Then the accountability lies with the government to look after their health cover needs. The Universal Health Insurance Scheme was a welcome step taken in that direction. Read on to learn more about the eligibility criteria, the various features, and benefits of this scheme.

What is the Universal Health Insurance Scheme (UHIS)?

While medical advancements are making our lives easier, the cost of treatment is simultaneously on the rise and people who struggle to fulfil basic requirements of food, shelter, and clothing can hardly afford quality healthcare. Therefore, it becomes the duty of every responsible government to provide not just better healthcare infrastructure, but also health cover to its citizens, especially to those who are underprivileged. In its bid to that, the Government of India introduced a project known as the Universal Health Insurance Scheme (UHIS) in 2003. It is a government health insurance scheme that provides coverage for lower-income groups so that they can afford the medical expenses. Besides, paying for medical bills, it also provides personal accident cover and compensates a family in case of death of the breadwinner.

Features of Universal Health Insurance Scheme (UHIS)?

  • The policy for health insurance can be bought bothindividually or as a group.

  • If bought by an individual, the policy will be in the name of the earning member of the family and will have details of other insured members.

  • If the policy is purchased as a group, it will be in the name of the group, institution or association. The policy will have the names of all family members.

  • Members covered in one group policy cannot be part of another group under the same policy.

Benefits & Coverage of Universal Health Insurance Scheme

With an aim to provide healthcare access to the poorest sections of the society, the UHIS comes with the following benefits:

  • Cost of hospitalisation: In case of hospitalisation due to an illness or injury, the insurer will provide medical reimbursement of INR 30,000. This sum insured includes maternity benefit of INR 2500 for normal and INR 5000 for a caesarean delivery. However, the maximum amount that can be claimed per illness is INR 15000 and this is excluding maternity benefit.

  • Personal accident coverage: If the earning head of the family, who is the policyholder of the scheme, sustains injuries due to an accident and unfortunately dieswithin 6 months of the accident, the family will get a compensation amount of INR 25,000.

  • Disability benefit: Under this benefit, if the policyholder or any family member is admitted to the hospital due to any illness or accident and the hospital stay extends to more than 3 days, then the insurance company will pay INR 50 per day as compensation from the 4th day onwards. However, this is applicable maximum up to 15 days.

Exclusions

The policyholder will not be covered under the following conditions:

  • Disease, injuries or death caused due to war, an act of terrorism, or invasion

  • Circumcision, unless it is a necessary treatment

  • Expenses related to spectacles, hearing aids, and contact lenses

  • Dental surgery or treatment for corrective, cosmetic or aesthetic purposes

  • Venereal or congenital diseases

  • Cost of vitamins or tonics, unless prescribed by a medical practitioner

  • HIV/AIDS

  • Self-inflicted injuries

  • Suicide/attempted suicide

  • Injuries or death from the influence of alcohol or drugs

  • Injuries or death while participating in adventure sports

Eligibility Criteria for Universal Health Insurance Scheme (UHIS)

  • People between the ages of 5 to 70 years are eligible for this policy for health insurance . Children between 3 months and 5 years can be covered if either of the parents are covered under the scheme.

  • Income of the family should not be more than the sum insured amount.

  • To get enrolled for Universal Health Insurance Scheme, the applicant has to provide a proof of certificate from the local tehsildar or Block Divisional Officer (BDO) of the Revenue Department certifying that the family falls in the Below Poverty Line (BPL) category.

Conclusion

Medical expenses are skyrocketing and not everyone can keep up these rising costs. To make healthcare accessible to one and all, the Government of India launched the Universal Health Insurance Scheme for those belonging to Below Poverty Line (BPL) and Above Poverty Line (APL) categories. The insurance scheme provides reimbursement in case of hospitalisation, personal accident or disability and with a reasonable premium.

This  blog is written by Dr. Kavita Ganesh 
Asst. Vice President, Health & Accident Product Underwriting

About The Expert :   Dr. Kavita Ganesh holds over 15 years of work experience in health insurance industry. She highly recommends buying health insurance for securing finances in case of a medical emergency. Looking at the current pandemic situation, she enforces the idea of having a higher sum insured for covering the entire family.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.


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