Universal Health Insurance Scheme
The Universal Health Insurance Scheme covers medical expenses, provides a personal accident cover to the primary breadwinner of the family, and offers compensation to the family if the earning member passes away.
The Universal Health Insurance Scheme (UHIS) provides coverage for those with lesser incomes, particularly the family's primary breadwinner. The health insurance pays for medical expenses, personal accident insurance for the family's primary breadwinner, and death benefits for the family. Many rich and developing countries have health care programmes for the benefit of their underprivileged citizens on a global scale.
The National Health Insurance Plan in India aims to accomplish this and much more. Individuals between the ages of 5 and 70 years can take use of this scheme. Both individual and group health insurance are available under the Universal Health Insurance System where hospitalisation, accidents, and disability are all covered. Depending on the size of the family, the premium changes.
Universal Health Insurance Scheme Premium Rates
The premium rates of Universal Health Insurance are mentioned below -
1. For families below the poverty line:
Coverage | Premium Rate (Rs.) | Government Subsidy (Rs.) | Insured Share (Rs.) |
Individual | Rs.300 | Rs.200 | Rs.100 |
For family with up to 5 members | Rs.450 | Rs.300 | Rs.150 |
For family up to 7 members | Rs.600 | Rs.400 | Rs.200 |
2. For families above the poverty line:
Coverage | Premium Rate (Rs.) |
Individual | Rs.365 |
For family with up to 5 members | Rs.548 |
For family up to 7 members | Rs.730 |
Eligibility Criteria for Universal Health Insurance
The insured's eligibility for the UHIS depends on whether they fall within the BPL or APL category. The details are as follows:
The insured's eligibility for the UHIS depends on:
For below poverty line -
- If the parents are enrolled in the program, children between the ages of 3 months and 5 will also be covered.
- The income of the family should not exceed the amount of the insurance.
- Evidence of a certificate stating that the household is considered to be below the poverty line (BPL) from the local Tehsildar or BDO of the Revenue Department
- should fall somewhere between 5 and 70 years old
For above poverty line -
- The family's income must be more than the amount insured
- should fall somewhere between 5 and 65 years old
- If the parents are insured by the policy, children between the ages of three months and five years are also covered
Documents Required for Universal Health Insurance
A certificate attesting to your BPL status from a revenue department employee with a minimum rank of Tehsildar or B.D.O. from the relevant state government.
Benefits of Universal Health Insurance
The various benefits of Universal Health Insurance are mentioned below -
- Every family is entitled to a Rs.30,000 hospitalization benefit, which includes the aforementioned maternity benefit.
- The maximum amount of expenses that can be claimed, excluding maternity benefits, is Rs.15,000.
- Disability compensation - After a 3-day waiting period, the insurer will start paying Rs. 50 per day starting on the fourth day of hospitalization if the primary policyholder or spouse is admitted due to an illness, disease, or accident. The maximum is only 15 days per policy period, though.
- Personal accident cover - The insured will receive Rs.25,000 in the event that the main policyholder of the plan, the family's head, passes away. This applies when an accident causes harm to the insured or the family's primary breadwinner and if the injury results in death within six months of the accident.
Universal Health Insurance Scheme Hospital List
To obtain the exclusive list of hospitals that accept patients under the Universal Health Insurance Scheme, you must speak with the insurance provider.
GST rate of 18% applicable for all financial services effective July 1, 2017.
Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST
FAQs on Universal Health Insurance Scheme
- Is the Universal Health Insurance Scheme free to cancel at any time?
Yes, there is a 15-day free look period from the policy's start date to evaluate the terms and conditions for all individual policies, save for those with less than a year of tenure.
- What is a clause that minimizes claims?
In accordance with the provision, the insured will work with the Company or Third Party Administrator to reduce the claims ratio by implementing fair treatment fees.
- Can maternity benefits under this program be used for a second child?
No, the Universal Health Insurance Scheme only extends the benefit to one child. Additionally, there is a 12-month waiting period starting on the insurance policy's start date.
- Is the plan designed to treat patients using drug experimental therapy?
No, this program does not cover drug experimental therapy that is not based on recognized medical standards in India.
- Does the UHIS cover naturopathy?
No, naturopathy treatment is not covered by this program.
Disclaimer
Credit Card:
Credit Score:
Personal Loan:
Home Loan:
Fixed Deposit:
Copyright © 2025 BankBazaar.com.