Universal Health Insurance Scheme

The government is going to launch the Universal Health Coverage Scheme to provide health care to every family. According to this, all families will get the benefit of this scheme. The main reason for this scheme is to provide better health care. The government will provide UHC card to every family person.

An Overview:

In India Four publicly owned universal insurance suppliers have executed the Universal Health Insurance Scheme (UHIS) with the aim to improve people’s right to use health care specifically for people below or at the poverty line.

For the first course, this plan comes with a medicinal expenditure repayment of up to INR 30,000 for the hospitalization which the entire family can avail. For death cover produced by accident is up to INR 25,000/- would be provided to the chief earning person of the household.

The Universal Health Insurance Scheme (UHIS) in India to meet the requirements of the families under or at the poverty line. The Universal Health Insurance Scheme (UHIS) is accessible to Indians only for both Above Poverty Line (APL) and Below Poverty Line (BPL) people can have this scheme. This includes families or groups as well as individuals.

Summary:

The payment used to be INR 100/- and now it is changed to INR 200/- for a single person, INR 300/- with 5 members in a family and finally INR 400/- for 7 members in a family.

What Is Universal Health Insurance Scheme (UHIS)?

Universal Health Insurance Scheme i.e. UHIS is basically a government arrangement meant for delivering health insurance cover for the backward classes and poor of the nation. It has numerous unique features along with maternity insurance, general health insurance, death benefits, etc.

In the year 2003, the Ministry of Health & Family Welfare launched the Universal Health Insurance Scheme (UHIS) throughout the nation to cover medical expenditures of the backward classes of the society.

The arrangement was presented as a part of the ministry’s Universal Health Assurance Mission for individuals categorized under the Above Poverty Line (APL) and Below Poverty Line (BPL).

The essential goal of the plan is to improve access to free clinical consideration, particularly the defenseless segment of society. Aside from clinical costs, it additionally gives advantages, for example, individual mishap spread to the essential salary worker and pay to the family in the event of the death of the provider.

Salient Features of Universal Health Insurance Scheme

The salient features of the Universal Health Insurance Scheme are typically based on the element of whether the person or the family is above the poverty line (APL) or below the poverty line (BPL). The following features listed are for both APL & BPL.

Features for APL

The following features are for the Above Poverty Line category under the Universal Health Insurance Scheme for individuals or families.

  • The Scheme is allotted in the name of an Institution / Group / Association with the list of names of the members which also comprises their qualified family members, who will also be protected under the scheme.
  • It is accessible for families/bunches that contain in excess of 100 families. The qualified individuals for every one of these families under the protection will be secured. Hence, qualified individuals from various classifications won’t take into consideration protection inclusion under various gathering protection arrangements. Henceforth, it isn’t allowed for any anonymous gathering protection strategy to be given.
  • This Scheme offers cover in the form of the following:
  1. Hospitalization costs for any damages.
  2. Settlements for medical treatments
  3. Hospitalization costs for illnesses or diseases that may have been contracted.

Features for BPL

The following features are for the Below Poverty Line category by the Universal Health Insurance Scheme for individuals or families.

  • The Universal Health Insurance strategy will be accessible to the two Individuals just as in Group similarly as it is accessible for APL families.
  • Every part who is guaranteed is secured under one gathering strategy in particular, similarly for what it’s worth on account of APL families.
  • The Individual Policy will be given for the sake of the gaining leader of the family with subtleties of the Group strategy will be given for the sake of the Group/Association/Institution (called guaranteed) with a timetable of names of the individuals including his/her qualified relatives (called Insured people) shaping piece of the approach.

Who Are Eligible For The Universal Health Insurance Scheme (UHIS):

Who Are Eligible For The Universal Health Insurance Scheme (UHIS)

Here we have given the eligibility criteria for both Above Poverty Line (APL) and Below Poverty Line (BPL):

Above Poverty Line (APL) Eligibility for Universal Health insurance Scheme (UHIS):

The individuals who live above India’s countrywide chosen poverty threshold or people who have upper monthly income are called the Above Poverty Line (APL) family.

Age Eligibility:

This Universal Health Insurance Scheme (UHIS) scheme is accessible to individuals between 5 years to 65 years old. Children aged between 3 months to 5 years old will be protected under this scheme so long both the parents are protected at that point in time.

Summary:

No refund of the premium for removal of the Insured Person if the Insured Person is having recovered or made a claim in the Policy.

Below Poverty Line (BPL) Eligibility For Universal Health Insurance Scheme (UHIS):

Below Poverty Line (BPL) Eligibility For Universal Health insurance Scheme (UHIS)

The family’s earnings are likely to be a smaller amount than the countrywide chosen poverty threshold is falls under the Below Poverty Line (BPL) category. Documentation has to be issued by the office of a B.D.O. of the Revenue Department of particular State Govt. has to be attached as a proof to avail the scheme.

Age Eligibility:

This Universal Health Insurance Scheme (UHIS) scheme is accessible to individuals between 5 years to 70 years old. Children between 3 months to 5 years old will be protected only if both the parents are protected at that point in time.

The Premium for Universal Health Insurance Scheme (UHIS):

premium

The Premium for APL Families Under the Universal Health Insurance Scheme (UHIS):

  • The premium for a single Above Poverty Line (APL) Individual is INR 365 annually
  • The premium for Family members of 5 people or less, i.e. the spouse and maximum 3 children of the insured is INR 548/- annually
  • The premium for Family members over 5 people yet not more than 7 people i.e. the spouse, 3 children and the parents of the insured is INR 730/- annually

The Premium for BPL Families Under the Universal Health Insurance Scheme (UHIS):

  • The premium for a single BPL Individual is INR 300 annually. Where the insured share is INR 100/- and the Government of India (GOI) Subsidy is INR 200/-. So basically for the Below Poverty Line (BPL), the premium is only INR 100/-
  • The premium for Family members of 5 people or less, i.e. the spouse and maximum 3 children of the insured is INR 450/- annually. Where the insured share is INR 150/- and the Government of India (GOI) Subsidy is INR 300/-. So basically for Below Poverty Line (BPL), the premium is only INR 150/-
  • The premium for Family members over 5 people yet not more than 7 people i.e. the spouse, 3 children and the parents of the insured is INR 600/- annually.
  • Where the insured share is INR 200/- and the Government of India (GOI) Subsidy is INR 400/-. So basically for Below Poverty Line (BPL), the premium is only INR 200/-

Renewal of the Universal Health Insurance Scheme (UHIS):

The renewal of the Universal Health Insurance Scheme (UHIS) Policy is permissible through a mutual agreement. The insurance policy Company is not responsible to give a warning for the renewal and thus the insurance policy company can cancel the policy only by delivering a 30 days’ notice.

In such cases, the insurance policy company is bound to refund the premium to the insured person for the unexpired Insurance. The insurance policy company, however, shall remain responsible for any kind of claim that ascend preceding to the date of deletion.

FAQ:

Q. Is there a free look period in the Universal Health Insurance Scheme?

A. Yes, there is a 15 days free look period in the Universal Health Insurance Scheme

Q. Can the second child avail the maternity benefit under this scheme?

A. No. The maternity benefit is only for one child under the Scheme.

Q. What is TPA?

A. TPA means a “Third Party Administrator”, licensed by the IRDAI, and is involved, for remuneration or fee for the facility of health amenities.

Q. What are the maternity benefits covered under the Scheme?

A. Maternity Benefit i.e. expenditures acquired in Nursing Home/Hospital rising from or noticeable to Pregnancy, delivery including Caesarean Section and normal. This also comprises of medical expenditures acquired in respect of newborn children up to 3 months.

Q. What is the Claims Minimisation Clause?

A. Under the Claims Minimisation clause, the insured person will collaborate with the TPA or Corporation to cover the claims ratio through a fair treatment charge.

Q. What is a universal health insurance scheme?

A. Universal Health Insurance Scheme i.e. UHIS is basically a government arrangement meant for delivering health insurance cover for the backward classes and poor of the nation.

Q. Who is issuing a universal health insurance scheme?

A. In the year 2003, the Ministry of Health & Family Welfare launched the Universal Health Insurance Scheme (UHIS) throughout the nation

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