Universal Health Insurance Scheme
asshwin D'silvaThe Universal Health Insurance Scheme (UHIS) is a medical insurance scheme from the Government of India for Indian citizens, primarily for those on or below the poverty line. However, individuals and families both above poverty line (APL) and below poverty line (BPL) can avail it. It covers medical expenses, has personal accident cover for a family’s primary breadwinner, and provides death benefit to the family if the earning member passes away.
Features
- Policy given in the name of the family’s primary earning member and lists all family members.
- Group policies given in the name of the group or institution or association; the policy lists names of the primary member and their family. Members cannot be part of more than one group policy.
- Medical expense reimbursement of up to ₹30,000, which floats for the entire family.
- Accidental death benefit of ₹25,000.
- Compensation of ₹50 for up to 15 days in case of loss of life of the earning family member.
Benefits
- Total expenses for single illness covered up to ₹15,000. Total expenses during the period of insurance not more than sum insured of ₹30,000.
- Hospitalisation cover of up to 0.5% of sum insured per day, covering room, boarding, etc.
- ICU expenses of up to 1% of sum insured per day.
- Surgeon, anesthesiologist, doctor, consultant, specialist, procedures like X-ray, dialysis, chemotherapy, radiotherapy, pacemaker costs, artificial limbs, and nursing expenses of up to 15% of sum insured for each illness/injury.
Additional BPL Benefits
- Maternity benefits of ₹2500 (normal delivery) and ₹5000 (caesarean delivery) for delivery of a single child. This coverage includes medical expenses of a newborn child up to three months. There is a waiting period of 12 months before this benefit becomes applicable.
- ₹25,000 personal accident cover for the earning member, should the said person sustain an accident and die within six months.
- ₹750 disability compensation for earning head/ spouse if they are hospitalised due to accident or illness. This is paid out after a waiting period of three days, in ₹50 installments for a maximum of 15 days.
Premium rates
| BPL Families | APL Families |
| Individual: ₹300, of which the individual has to pay ₹100, while the government subsidizes ₹200 | Individual: ₹365 |
| Up to five family members: ₹450 (150 from family + 300 government subsidy) | Up to five family members: ₹548 |
| Up to seven family members: ₹600 (250 from family + 400 government subsidy) | Up to seven family members: ₹730 |
Eligibility Criteria
| BPL Families | APL Families |
| Family’s income should not be more than the sum insured amount. | Family’s income should exceed the sum insured amount. |
| BPL category Proof of Certificate from local Tehsildar or BDO at the Revenue Department of respective state | |
| Age range: 5 to 70 years; children between 3 months and 5 years covered if parents are covered under the scheme. | Age range: 5 to 65 years; children between 3 months and 5 years covered if parents are covered under the scheme. |
