• Universal Health Insurance Scheme

    Health Insurance
    • Enjoy options to cover yourself, your spouse, kids and even your parents
    • Enjoy access to 10,000+ hospitals for cashless treatment
    • Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

    There are many people in India who still do not have access to proper healthcare services and are unable to purchase a proper health insurance policy It becomes even more difficult for an individual to purchase a health insurance policy if he/she belongs to the Above Poverty Line (APL) category and Below Poverty Line (BPL) category. Thus, in order to ensure that people belonging to APL and BPL categories do not miss out on their basic rights to proper healthcare services, the Government of India in the year 2003 introduced Universal Health Insurance Scheme (UHIS).

    If you sign up for this scheme provided you meet the eligibility criteria, you will receive a medical reimbursement of up to Rs.30,000 if you or a member of your family is hospitalised. In case of death of a family member, the main earning member will receive a death cover of Rs.25,000. If you are the earning member, your family will receive a sum of Rs.50 from the 4th day of being hospitalised up to 15 days along with the death cover in case of your death.

    UHIS has been revamped in order to meet the needs of people under both APL and BPL category. If you purchase this plan as an individual, then you will have to pay Rs.200 as monthly premiums. However, if you purchase this scheme as a floater plan, then you will have to pay Rs.300 as a monthly premium if you have a family has up to five members and Rs.400 if your family has up to seven members.

    Eligibility criteria for Universal Health Insurance Scheme

    APL Category

    • The family’s income is supposed to be over the cover amount in order to be eligible under the APL category.
    • The minimum entry age under this category is 5 years, while the maximum entry age is 65 years. Children between the age of 3 months and 5 years will be eligible to receive coverage as long as their parents are covered under the scheme.

    BPL Category

    • The family’s income is supposed to be less than the cover amount. The policyholder will have to obtain a certificate from an official whose rank should not be below the rank of Tehsildar or Block Development Officer Revenue Department of the concerned State Government stating that the policyholder belongs to the below poverty line category.
    • The minimum age of entry under this category is 5 years, while the maximum age of entry is 70 years. Children between the age of 3 months and 5 years will be eligible to receive coverage as long as their parents are covered under the scheme.

    Features of the Universal Health Insurance Scheme

    Some of the features of the Universal Health Insurance Scheme are:

    • The scheme can be purchased both individually and as a family plan.
    • The earning member of the family will be the policyholder. The scheme will also consist of the name of the other family members eligible to receive coverage.
    • If the scheme has been purchased as a group policy, it will be in the name of the Group/Institution/Association. The scheme will consist of the names of the members and their immediate family members eligible to receive benefits under this scheme.
    • Members in a group policy cannot be a part of another group under the same policy.

    Benefits under Universal Health Insurance Scheme

    Some of the benefits under Universal Health Insurance Scheme are:

    Hospital benefits Limits
    1. Room and boarding expenses as given by the nursing home or hospital
    2. Room and boarding expenses in case the patient is admitted to an ICU
    1. Up to 0.5% of sum insured per day.
    2. Up to 1% of the sum insured per day.
    Fees for surgeons, consultant, medical practitioner, anaesthetist, specialists Up to 15% of the sum insured for each injury or illness
    Charges related to anaesthesia, oxygen, blood, surgical appliances, medicines, drugs, X-ray, artificial limbs, chemotherapy, etc. Up to 15% of the sum insured for each injury or illness
    Maternity Benefit – For only one child (a waiting period of one year needs to be completed) Rs.2,500 in case of normal delivery, and Rs.5,000 in case of caesarian delivery.
    • Total medical expenses that will be covered per illness or injury will not exceed Rs.15,000 other than the Maternity Benefit.
    • The company’s liability with respect to all the claims including Maternity Benefit will not exceed more than Rs.30,000 per person or family.
    • The policy will also provide Maternity Benefit with the amount being Rs.2,500 in case of normal delivery and Rs.5,000 in case of caesarian delivery. However, the overall limit within which this benefit is available is Rs.30,000.
    • The benefits of this scheme are available only during the time when the policy is active.
    • The insured will receive a sum of Rs.25,000 if the earning head dies due an accident.
    • In case the earning member of the family is hospitalised due to an illness, accident, or disease provided that a waiting period of three months has been completed, the nominee shall receive a sum of Rs.50 for up to 15 days.
    • A grace period of 15 days will be provided during which if the policyholder fails to pay the premium, the policy will cease to exist.
    • A free-look period of 15 days will be provided during which if the policyholder does not agree with the terms and conditions of the scheme, he/she can return the policy back.

    Exclusions under Universal Health Insurance Scheme

    The policyholder will not be covered under the following circumstances:

    • Injury or death caused due to war, invasion, or act of terrorism.
    • Circumcision unless medically required.
    • The cost of a hearing aid, spectacles, contact lenses, etc.
    • Dental treatment or surgery unless medically required due to an injury or disease.
    • Congenital and venereal diseases.
    • HIV/AIDS.
    • Expenses related to vitamins and tonics unless medically required.
    • Injuries or death caused by nuclear weapons.
    • Cost of treatment arising due to miscarriage, abortion, or any pregnancy-related issues.
    • Naturopathy treatment.
    • Medical treatments which are not approved as established medical practices in India.
    • Death or injuries caused due to self-inflicted injuries, attempted suicide, or suicide.
    • Death or injuries caused under the influence of drugs or alcohol.
    • Death or injuries caused while taking part in an adventure sport or while operating an aircraft.
    • Death or injuries caused due to the result of breaching any law with a criminal intent.

    Hence, this scheme is a brilliant option for those who belong to the Above Poverty Level category and Below Poverty Level category. If you wish to avail a scheme which provides coverage to both you and your family members in case of hospitalisation, and saves you from worrying about the expenses, then UHIS is a brilliant option to go with.

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