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Universal Health Insurance Scheme (UHIS)

What is the Universal Health Insurance Scheme (UHIS)?

Features of the Universal Health Insurance Scheme

Benefits of the Universal Health Insurance Scheme

Benefits of Universal Health Insurance Scheme for Above Poverty Line

The Universal Health Scheme coverage for APL members includes:

Benefit Description
Maximum Cap on Single Illness Claim The maximum cap on the claim for a single illness is Rs. 15,000.
Room Tariff and Boarding Expenses UHIS shall cover 0.5% of the total sum insured on room tariff and boarding expenses as billed by the medical institution.
Intensive Care Unit (ICU) Coverage If an individual is admitted into the Intensive Care Unit (ICU), up to 1% of the insured sum can be claimed.
Medical Practitioner and Nursing Expenses A total of 15% per illness can be claimed for costs like a surgeon, anaesthetist, medical practitioner, consultants, specialists’ fees, and nursing expenses.
Coverage for Surgical and Diagnostic Costs Costs like anaesthesia, blood, oxygen, OT charges, surgical appliances, medicines, diagnostic material & X-ray, dialysis, chemotherapy, radiotherapy, pacemakers, and artificial limbs are covered up to 15% of the sum insured per injury or illness.

Below are the benefits of the Universal Health Insurance Scheme for BPL:

Benefit Name Description
Health Care or Hospitalisation Families falling under the BPL category can opt for health care or hospitalisation benefits under UHIS.
Compensation at Death of Breadwinner Compensation is available through UHIS for families if the breadwinner passes away.

Hospitalisation Benefits

Below are the hospitalisation benefits under the Universal Health Insurance Scheme:

Benefit Description
Limit on Total Expenses for a Single Illness The total expenses incurred for any single illness shall be less than Rs. 15,000.
Reimbursement of Room Tariff and Boarding Expenses 0.5% of the total sum insured on room tariff and boarding expenses billed by the hospital is up for reimbursement.
ICU Daily Withdrawal Limit If admitted to the ICU, up to 1% of the sum can be withdrawn per day.
Coverage for Other Medical Expenses The cost of other medical expenses like surgeon, anaesthetist, medical practitioner, consultants, specialists fees, and nursing expenses, along with charges like anaesthesia, blood, oxygen, OT charges, surgical appliances, drugs, diagnostic material & X-ray, dialysis, chemotherapy, radiotherapy, cost of a pacemaker, artificial limbs are covered up to 15% similar to the APL category.
Maternity Benefits Rs. 2,500 for normal delivery and Rs. 5,000 for caesarean delivery for the birth of a single child can be claimed. This amount also covers the medical expenses of the child for the first three months. However, this benefit is also within the overall sum of Rs. 30,000.

What is Covered Under the Universal Health Insurance Scheme?

What is Not Covered Under the Universal Health Scheme?

What is the Premium for the Universal Health Insurance Scheme?

Universal Health Insurance Scheme premium is different for APL and BPL:

Premium

Description

UHIS Premium for Above Poverty Line

  • The premium for individuals is Rs.365 per annum.

  • For families not more than five people with one spouse and three dependable children, the premium is Rs.548/- per annum.

  • For families with more than five but less than seven members, including the insured, spouse, first three dependent children and dependent parents, the premium is Rs.730/- per annum.

UHIS Premium for Below Poverty Line

  • For individuals, the premium is Rs. 300, out of which the insured bears Rs.100/- and the government subsidies Rs.200/-.

  • For families of not more than five people with one spouse and three dependable children, the premium is Rs. 450/- per annum. Out of this sum, Rs.150/- is borne by the individual, and Rs.300/- is a government subsidy.

  • For families with more than five but less than seven members, including the insured, spouse, first three dependent children and dependent parents, the premium is Rs. 600/- per annum, out of which Rs. 200/- is paid by the individual and the rest is subsidised by the government.

Who is Eligible for the Universal Health Insurance Scheme?

The eligibility is based on the fact that the individual is Above or Below the Poverty Line. The table below shows a detailed account of the eligibility criteria:

Eligibility 

Description

Eligibility for APL

The total income of the family is expected to be over a stipulated amount. Individuals can opt for this scheme coverage for members aged between 5 and 65 years. Children and infants too are covered from the age of 3 months to 5 years as long as the plan covers their parents.

Eligibility for BPL

A family's income must be less than a stipulated amount to make them eligible for this scheme. A certificate issued from an official like a BDO, tehsildar, etc., is also to be submitted. The age bracket is 5 to 70 years. Children from the age of 3 months to 5 years are also a part of this scheme till their parents are also covered.

How to Register for a Universal Health Insurance Scheme?

Documents Required for Universal Health Insurance Scheme Registration

Universal Health Insurance Scheme Hospital List

FAQs about Universal Health Insurance Scheme