Universal Health Insurance Scheme: All You Need To Know

Understand the coverage and benefits offered under the Universal Health Insurance Scheme.
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3 min
08-May-2024

The Ministry of Health and Family Welfare introduced the Universal Health Insurance Scheme under the umbrella of the Universal Health Assurance Mission (UHAM). Launched in India in 2003, its primary aim is to extend healthcare services to disadvantaged segments of society. This inclusive scheme encompasses both Below Poverty Line (BPL) and Non-BPL families, ensuring access to essential medical care for all.

Universal Health Insurance Scheme: An overview

Scheme name

Universal Health Insurance Scheme (UHIS)

Launched in

July 2003

Objective

To provide healthcare facilities to the poorest section of the society.

Eligibility criteria

5 to 70 years

Scheme type

Applicable for individuals and groups


Also, read: Health insurance

What is Universal Health Insurance Scheme?

The Universal Health Insurance Scheme (UHIS) offers coverage to individuals with lower incomes, focusing on the main earner within the family. It includes medical expense coverage, personal accident insurance for the primary breadwinner, and death benefits for their family.

Features of Universal Health Insurance Scheme

Here are the characteristics of the Universal Health Insurance Scheme introduced by the Government of India:

  • The scheme is accessible to both individuals and groups.
  • Individual policies will be registered under the name of the primary earner in the family and will include the names of family members.
  • For group policies, the coverage will be registered under the name of the group, association, or institution, with individual members and their families listed.
  • Members covered under group policies are not permitted to enroll in multiple group health schemes.

Coverage for Universal Health Insurance Scheme

Given below are the coverage details under the scheme:

Daily charges for hospital room accommodation and boarding

0.5% of the sum insured

Intensive Care Unit (ICU) costs per day

1% of the sum insured

Cost of Doctors, Surgeon, Nursing, Anesthetist, Consultants, Specialists, Medicines, Oxygen, X-Ray, Blood, Surgical Appliances, Anesthesia, Chemotherapy, etc.

15% of the sum insured per Injury/illness

Hospitalisation benefit per policy for each family, inclusive of maternity benefits.

Rs. 30,000

Maximum expenses claim, excluding maternity benefits

Rs. 15,000

 

  • Personal Accident Cover: If the primary policyholder, who serves as the head of the family, passes away, the insured will receive Rs. 25,000. This applies if the insured, who is the family's breadwinner, suffers injuries due to an accident resulting in death within 6 months of the incident.
  • Disability compensation: The insured receives a payment of Rs. 50 if either the policyholder or their spouse is hospitalised due to illness or accident. This payment commences after a waiting period of 30 days, starting from the fourth day of hospitalisation, for a maximum of 15 days.

Read more: Chief Minister Ladli Behna Yojana

Eligibility criteria for Universal Health Insurance Scheme

Discussed below are the eligibility criteria for UHIS:

Eligibility criteria for BPL (Below Poverty Line) families:

Age eligibility for adults

5 to 70 years

Age eligibility for children

3 months to 5 years (with their parents registered under the scheme)

Family income

Lesser than the sum insured/ coverage under the scheme

 

Eligibility criteria for APL (Above Poverty Line) families:

Age eligibility for adults

5 to 70 years

Age eligibility for children

3 months to 5 years (with their parents registered under the scheme)

Family income

More than the sum insured/ coverage under the scheme

 

Premium for Universal Health Insurance Scheme

The premium rates of Universal Health Insurance are mentioned below:

Families Below Poverty Line (BPL)

Coverage

Premium Rate (in Rs.)

Government Subsidy (in Rs.)

Insured Share (in Rs.)

Individual

300

200

100

For family with up to 5 members

450

300

150

For family up to 7 members

600

400

200

 

 

Families Above Poverty Line (APL)

Coverage

Premium (in Rs.)

Individual

365

For family with up to 5 members

548

For family up to 7 members

730


The Universal Health Insurance Scheme strives to enhance healthcare affordability and accessibility for low-income populations vulnerable to financial strain. This governmental initiative endeavors to shield the most impoverished citizens from overwhelming healthcare costs by covering hospitalisation expenses and providing supplementary benefits such as personal accident coverage and preventive health screenings. Despite certain limitations, the scheme signifies progress towards universal health assurance and social protection for the marginalised segments of Indian society.

Frequently asked questions

What is the Universal Health Insurance Scheme (UHIS)?

The nationwide implementation of the Universal Health Insurance Scheme commenced in July 2003, aiming to extend healthcare coverage to the most economically disadvantaged members of society. The initiative was inclusive, catering to both Below Poverty Line (BPL) and Non-BPL households.

How to terminate the Universal Health Insurance Scheme (UHIS)?

An insured individual or family has the option to cancel their Universal Health Insurance Scheme at any time. In such instances, the insurance company will reimburse the premium based on a short period rate. It's important to note that the premium refund is applicable only if no claims have been made by the insured until the cancellation date.

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