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.

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.

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.

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

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.

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

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.

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.

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.

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.