Universal Health Insurance Scheme (UHIS)

UHIS, in its full form, is a Universal Health Insurance Scheme that aims to provide affordable health coverage to a broader population segment. With the raging pandemic, the demand for comprehensive health coverage has increased.

However, many people can’t afford it, so the government created the Universal Health Insurance Scheme (UHIS). This article will explain UHIS in detail, including its benefits, eligibility criteria, and application process.

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What is the UHIS?
Features & Benefits
What is Covered & Not Covered?
Premium for UHIS
Eligibility Criteria
How to Register for UHIS?
Required Documents
Hospital List Under UHIS
Frequently Asked Questions

What is the Universal Health Insurance Scheme (UHIS)?

The Universal Health Insurance Scheme was inaugurated in 2003 to provide medical coverage to lower-income groups. It also provides accident coverage and compensation in case the breadwinner dies.

The scheme was designed to ensure that even the most vulnerable sections of society have access to essential healthcare services. In addition to providing medical coverage, UHIS includes provisions for accident coverage and offers financial support in the event of an accident.

Features of the Universal Health Insurance Scheme

The UHIS differs based on whether the individual or the group falls Above or Below the Poverty Line:

UHIS Features for Above Poverty Line (APL)

This scheme can be availed by both individuals and families who earn above a stipulated amount. The group will need to comprise more than 100 families. All members shall be covered under a single group policy. Lastly, an individual cannot be part of multiple such policies.

The UHIS is issued in the name of a group/institution/association along with a list of names of its members who shall be insured under the policy.

The Universal Health Scheme offers the following as a part of the coverage:

Reimbursements for medical treatments.
Hospitalisation expenses for diseases or illnesses that may have been contracted.
Hospitalisation expenses for any injuries.

UHIS Features for Below Poverty Line (BPL)

This can be availed by both individuals as well as groups identical to the APL format. Every member secured under a group can be a part of one group only.

The individual UHIS policy is to be issued to the breadwinner of their family. For groups, insurance is issued on the group's name with a list of names of all members.

Benefits of the Universal Health Insurance Scheme

The benefits of UHIS are also variable depending on whether the individual/group/association is below the Poverty Line:

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.

Accident Cover to the Breadwinner

Suppose the insured, who is also the breadwinner for his or her family, suffers an accident due to outward, violent and visible injuries and passes away within six months from the injury. In such a case, the company is to pay the family a sum of Rs.25,000.

Disability Compensation for the Breadwinner

A maximum of Rs.750 is to be paid if the breadwinner is ill or hospitalised. The company must pay Rs.50 from the fourth day onwards to a maximum of 15 days.

What is Covered Under the Universal Health Insurance Scheme?

The Universal Health Insurance Scheme (UHIS) offers a range of coverage to protect lower-income families from financial burdens due to medical expenses. The key coverages under UHIS include:

Hospitalisation Expenses: Coverage for medical expenses incurred during hospitalisation due to illness or injury, including room charges, nursing and ICU charges.
Medical Practitioner Fees: Fees for surgeons, anaesthetists, consultants, and specialists are covered under the scheme.
Medical Expenses: Costs related to anaesthesia, blood, oxygen, operation theatre (OT) charges, surgical appliances, drugs, and diagnostic materials are included.
Advanced Treatments: Dialysis, chemotherapy, radiotherapy, the cost of pacemakers, and artificial limbs are covered up to a specified limit.
Maternity Benefits: Coverage of Rs. 2,500 for normal delivery and Rs. 5,000 for caesarean delivery. Medical expenses for the newborn up to Rs. 30,000 for the first three months.
Accident Coverage: Compensation for accidental death or disability, providing financial support to the insured or their family.
Coverage for Dependents: The scheme extends benefits to the insured's spouse, dependent children, and dependent parents based on the family plan selected.

The UHIS aims to provide comprehensive healthcare coverage to lower-income groups, ensuring they have access to essential medical services without significant financial strain.

Know about: Pre-Post Hospitalization Expenses in Health Insurance

What is Not Covered Under the Universal Health Scheme?

The insured will not be covered in the case of:

Disease, injuries, or death caused due to war or terrorism.
Circumcision without medical grounds.
Hearing aids or vision aids like spectacles and lenses.
Cosmetic, dental or corrective procedures.
Venereal or congenital diseases.
Self-inflicted injuries.
Suicide/attempted suicide.
HIV/AIDS.
Injuries or death from the influence of alcohol, drugs, or adventure sports.

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?

To enrol yourself for UHIS, visit a concerned insurance provider to help you apply for the scheme.

If you wish to apply for BPL benefits, you will need a certificate issued from an official like a BDO, tehsildar, etc., as proof of your income. Providing the Universal Health Insurance Scheme documents is crucial for easy enrollment.

This is mainly for BPL families to avail themselves of medical benefits; however, APL families can also avail themselves of this help at nominal costs. The maternity benefits add a perk to this scheme.

Documents Required for Universal Health Insurance Scheme Registration

All that is required to apply for the Universal Health Insurance Scheme are the following documents:

A Certificate of Proof proving your status as a member of the Below Poverty Line (BPL) social group.
The certificate should be provided by The State Revenue Department's Tehsildar or B.D.O.

Universal Health Insurance Scheme Hospital List

You must contact the insurance provider, as they have an exclusive roster of medical facilities that accept patients under the Universal Health Insurance Plan. These hospitals and clinics provide treatment to UHIS members in collaboration with the insurance.

Ensure you visit one of these network hospitals to avoid paying for services yourself. A long list of hospitals nationwide that have agreed to provide inpatient care under this program should be available to your insurer.

The goal of the Universal Health Insurance Plan is to increase the accessibility and affordability of healthcare for low-income and vulnerable groups. This government program covers hospitalisation costs and provides other advantages, such as personal accident insurance and preventive health check-ups, to protect the poorest citizens from catastrophic health bills.

FAQs about Universal Health Insurance Scheme

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What are the conditions for availing of the hospital benefits?

There are a few conditions to meet if you want medical compensation:

All claims under the policy are to be paid in INR.
All medical services are to be availed in India.
TPA will pay the insured person or the hospital directly.

Do I get a refund if I cancel the policy during the relief period?

Yes, you can opt to cancel the policy provided there has been no claim made in that period.

Can a maternity claim be made on the second child?

No, a maternity claim can only be made on the first child.

Is Naturopathy treatment included in the UHIS coverage?

No, UHIS does not cover Naturopathy treatment. Note the coverage before availing of the treatment to avoid paying for it yourself.

Does the scheme cover experimental drug therapies?

No, experimental drug therapies not based on established medical practices in India are excluded from coverage.

How can someone enrol in the Universal Health Insurance Scheme?

To enrol in UHIS, contact the relevant insurance provider, who will assist you with the application process.

Who is eligible to buy this Universal Health Insurance scheme?

People and their families between three months and sixty-five are eligible for coverage under the Universal Health Insurance Scheme (UHIS). As long as insurance is uninterrupted, the insured may continue to renew his policy after turning 65.

Who is eligible for coverage under the Universal Health Insurance Scheme?

A family consisting of the policyholder and the following persons may be insured under this policy:

Dependent Parents
Dependent Children (up to three)
Spouse

Is there any health insurance for people below the poverty line?

Yes, the 2003-launched Universal Health Insurance program is available for purchase for the Above Poverty Line (APL) and Below Poverty Line (BPL). Institutions and other groups can buy the policy as group insurance.

When was the Universal Health Insurance Scheme (UHIS) introduced?

The Universal Health Insurance Scheme (UHIS) was introduced in 2003 to provide health coverage to India's impoverished and destitute.

Is it possible for a second child to receive maternity benefits under this system?

No, the Universal Health Insurance Scheme only benefits a single child. In addition, a 12-month waiting period begins on the day the insurance policy was issued.

Is there an opportunity to try the Universal Health Insurance Scheme for free?

Yes, all individual policies have a 30-days free look-up period from the policy's start date to examine the terms and conditions, except for those with a duration of less than a year.

What is the Claims Minimisation Clause?

According to the condition, the insured will work with the company or third-party administrator to control the claims ratio by imposing fair treatment charges.

Know about:

Can a person cancel the Universal Health Insurance Scheme for free at any time?

Yes, cancellations are free after enrolling in the program. It should be noted that all policies, except those with less than a year of tenure, have a 30-day free look period from the policy's commencement date to review the terms and conditions.