Universal Health Insurance Scheme (UHIC): Coverage & Benefits

• The government launched the Universal Health Insurance Scheme in 2003 to provide affordable health insurance to the poor.
• The scheme offers a comprehensive cover to below and above-poverty-line families.
• Hospitalisation cover, maternity cover, disability cover, and personal accident cover are offered under the scheme.
• The premium starts at ₹300 and goes up to ₹730 depending on the type of family and number of insured members.

The economically weaker sections of society cannot afford comprehensive health insurance coverage. The premiums of health insurance plans can prove too costly for such families. However, they also need access to quality healthcare facilities. Keeping this in mind, the Indian government launched the Universal Health Insurance Scheme , which provides affordable health insurance for the poor.

The Universal Health Insurance Scheme (UHIS) is a government-sponsored scheme aimed at making health insurance accessible to all citizens, especially those who are underprivileged, economically vulnerable, and unable to afford medical expenses. It envisions comprehensive health insurance coverage which aims to cover the treatment cost of all Indians in times of medical need.

Known as a government health insurance scheme, UHIS was launched by the Ministry of Health and Family Welfare throughout the country in 2003 to provide healthcare services to the poorest people. The initiative was initially introduced as part of the Universal Health Assurance Mission (UHAM) of the Ministry of Health and Family Welfare for individuals categorised under the Below Poverty Line (BPL) and Above Poverty Line (APL).

The primary objective of the Universal Health Insurance Scheme is to improve access to healthcare services and free medical care to the weaker section of the economy. The government of India introduced the scheme with the following objectives:

Access to Healthcare

It aims to bridge the gap in medical accessibility and ensure to make quality healthcare is accessible to all citizens, regardless of their economic status.

Financial Protection

To provide universal health coverage in India , especially to the poor, in times of need and decrease out-of-pocket expenses for medical treatments and hospitalization.

Quality Care

To provide quality healthcare services and improve the overall standards of healthcare facilities nationwide. The scheme ensures that a wider population can get healthcare services without financial strain by covering both BPL and APL families. Also Read: Health Insurance 101: Guide on the Basics of Health Insurance

The features of the Universal Health Insurance Scheme (UHIS) in India typically include the following:

• The scheme comprises two categories: Below Poverty Line (BPL) Families and Above Poverty Line (APL) Families.
• The policy under the scheme can be purchased by both individuals and groups.
• For individual policy, the policy will be in the name of the primary earning member of the family. It shall contain the names of all the family members. For a group policy, it will be in the name of the association, institution, or group, and the policy will consist of the names of all the member of the group and their family
• In a group UHIS policy, the members of one policy cannot be a part of more than one group health insurance scheme .
• Universal Health Coverage in India includes healthcare expenses related to hospitalization, including medical procedures, room charges, surgeries, and associated services.
• UHIS offers subsidized premiums for families below the poverty line to ensure health insurance is accessible to them.
• The insurance providers have tie-ups with a wide range of network hospitals, including public and private hospitals, enabling the policyholders to get cashless treatments and services easily.

Some of the key benefits of UHIS include:

Comprehensive Coverage

Universal Health Insurance in India provides comprehensive coverage, including personal accident coverage, to the insured individual. The plans pay a lump sum amount on the death of the insured to their family.

Financial Protection

UHIS plans to provide much-needed financial protection to the family of the insured in the face of uncertainties due to the death of the breadwinner of the family. It eliminates the financial burden of the high treatment cost on the poor people who cannot afford the medical expenses.

Emphasis on preventive care

UHIS focuses on preventive healthcare measures for all the citizens of India and promotes overall well-being, thereby reducing the burden of diseases and illnesses.

Cashless treatments

UHIS plans enable the policyholders to get quality and standardised treatment and services without bearing the cost and getting it paid directly by their insurer.

No-Claim Bonus

UHIS offers a no-claim bonus of 10% at renewal for every claim-free policy year. Hence, if you have not made any claim in a year, you can get a 10% discount on your renewal premium for the plan.

Inclusion of children

Including children between the ages of 3 months to 5 years in the plan ensures that the most vulnerable members of society are protected and have access to quality healthcare from a very early age. Also Read: Health Insurance: Advantages, Disadvantages, and Important Considerations

The eligibility requirements for enrolment into the UHIS differ slightly for Below Poverty Line (BPL) and above-poverty-line (APL) families as detailed in the table below:

Universal Health Insurance typically provides a range of healthcare services, including but not limited to promotive, preventive, rehabilitation, and curative expenses. Here are some of the common inclusions of Universal Health Coverage in India :

Hospitalisation Expenses

It covers the cost of room rent, nursing expenses, ICU charges, etc., during hospitalisation, subject to the following maximum limits:

Maternity Cover

Universal Health Coverage in India includes maternity cover for one child subject to the maximum amount of ₹2,500 for normal delivery and ₹3000 for Caesarean delivery. However, the maternity cover is available after a waiting period of 12 months from the date of inception of the policy.

Personal Accident Cover

If the policyholder or the income earner of the family sustains injuries due to an accident or mishap and later suffers death within 6 months from the accident or mishap, then their family would receive ₹25,000 as personal accident cover benefit.

Preventive Health-Check-ups

UHIS also covers periodic health screenings and regular preventive health check-ups, including health risk assessments, basic blood check-ups, and cancer screening tests like mammography, Pap smear, etc., for the insured individuals up to a specified annual limit per insured.

Disability compensation

In the event of hospitalisation of the primary policyholder or his/her spouse due to an accident, disease, or illness, the insurer will pay the compensation of ₹50 after a waiting period of three days, from the fourth day of hospitalisation, up to a maximum limit of 15 days of hospitalisation per policy period.

Ambulance Cover

UHIS covers ambulance expenses, including water, air, and ground transportation.

Other benefits

Every family is entitled to a hospitalisation benefit of up to ₹30,000, which includes the maternity benefit. However, the maximum amount of expenses that can be claimed, excluding maternity benefits, is ₹15,000. Also Read: Medical Insurance: Compare Medical Insurance Plans in India

Universal Health Insurance in India does not cover certain events, commonly known as exclusions. Here are the common exclusions of Universal Health Coverage in India :

The cost of Universal Healthcare differs for BPL and APL families. It is detailed in the table below:

Universal Health Insurance Scheme is well-suited for everyone seeking affordable and comprehensive health insurance coverage . The following should consider buying a Universal Healthcare in India :

Young Entrepreneurs and Professionals

The earlier you buy health insurance, the better. For young entrepreneurs and professionals beginning their businesses or careers, a universal health insurance plan can provide financial protection against unexpected health issues and cover hospitalisation expenses without pinching your pocket early in your career.

Self-Employed Individuals

Not only for professionals and servicemen a Universal Health Insurance policy is also ideal for self-employed individuals, enabling them to get turn-around protection in the event of medical emergencies.

Parents

Individuals who have families with children should make investments in Universal Health Insurance plans as they often have higher healthcare expenses due to regular vaccinations, regular medical check-ups, and occasional illnesses. One plan can protect a family of up to 7 members by helping parents manage medical costs efficiently without straining their finances.

Senior Citizens

Universal Health Insurance plans are also suitable for senior citizens who may find getting health insurance challenging due to their pre-existing health conditions and age. UHIS offers health insurance plans to senior citizens up to age 65 (for APL) and 70 (for BPL), providing financial support for medical treatments after retirement.

People having Pre-existing Conditions

UHIS provides coverage for pre-existing medical conditions after the first two years from the policy's inception. Hence, Universal Healthcare Insurance can be viable for individuals with existing health issues.

Employees

While most employers provide health insurance coverage and benefits under relevant schemes, it may not always be sufficient in today’s rising medical cost. Employees who find their employer’s health insurance coverage inadequate can also consider supplementing it with a Universal Health Insurance plan.

Enrolling in Universal Healthcare in India is very simple and easy. You need to approach the concerned insurance provider whose Universal Health Insurance Plan you want to buy and can apply for it online or offline as offered and provided by them. You can connect to them on their helpline or visit their branch office to learn about the entire enrollment process at Universal Healthcare in India.

For BPL families, a Certificate of Proof that you fall under the BPL category must be submitted from an official, not below the rank of Tehsildar or B.D.O of the Revenue Department belonging to the respective state government for enrolling in Universal Healthcare in India.

Claiming a Universal Health Insurance Plan is very simple and quick. Here is the step-by-step guide to making a claim for a Universal Health Insurance Plan:

Identify the healthcare inclusion

Begin by checking Universal Health Coverage in India and identify the specific inclusion and extent of coverage for pre- and post-hospitalisation care, hospitalisation expenses, and additional benefits.

Reach your insurer

If the given medical treatment is covered in your plan, contact your insurer and understand the claim process. You can contact your insurer through toll-free numbers or customer support to get assistance with your queries and claim process.

File for a claim

Initiate the claim by filing the claim form and keep all medical bills and invoices for smooth claim settlement.

Verification of claim

The insurer's executives will verify your claim based on the claim form and documents/bills submitted and confirm the claim if all the documents are complete and authentic.

Review/Investigation

The insurer will also evaluate the medical documents to confirm if the claimed expenses are covered under the policy and check if the medical condition aligns with the terms of the policy. The insurer may also conduct investigations for claims of higher amounts or in case of suspicious claims.

Settlement

Once the verification and review are completed, the insurer will settle the claim by crediting the amount to your account. The time taken for claim approval and settlement can vary among insurers.

The Universal Health Insurance Scheme insurance provides tie-ups with a range of hospitals, including private and public hospitals, which provides cashless claims to the policyholders. You can contact your insurer to get the exclusive list of hospitals with which it has tie-ups to make cashless claim settlements under the Universal Health Insurance Scheme.

The Universal Health Insurance Scheme is a cost-effective way to avail of health insurance coverage . The premiums are low, while the coverage is comprehensive.You can also supplement the coverage of the UHIS with a super top-up health insurance plan. It will help you keep the premiums low while the coverage amount will increase. Plus, if you choose a comprehensive policy, you can enjoy a wider coverage scope and get financial assistance for different medical costs.So, choose a comprehensive health insurance scheme for complete financial security.