Launched in 2003, the Universal Health Insurance Scheme is a government-backed health insurance initiative by the Ministry of Health and Family Welfare. This scheme aims to make quality healthcare affordable and available for India’s economically weaker sections. Introduced under the Universal Health Assurance Mission (UHAM), the scheme offers coverage to both BPL and APL families.

With rising medical costs putting pressure on low-income households, UHIS aims to provide financial protection against hospitalisation expenses and other medical needs at minimal premiums. The scheme represents India’s commitment to providing healthcare to everyone. In essence, UHIS is a step toward creating a strong healthcare system where economic status does not determine the right to good health.

The UHIS is open to both BPL and APL families across India. This ensures that people from all economic backgrounds can access affordable healthcare coverage. Here is a detailed look at the eligibility criteria:

To enrol in the UHIS, certain documents are necessary to verify eligibility. This is especially required for families under the Below Poverty Line (BPL) category.

Applicants must submit a valid BPL Certificate as proof of their economic status. This certificate should be issued by a government authority, such as a Tehsildar or Block Development Officer
(BDO) from the Revenue Department of the respective state.

This is the official confirmation that the applicant qualifies for BPL benefits under the scheme and ensures that healthcare coverage reaches the families who need it most.

In addition to the BPL certificate, applicants must also submit a few essential documents while applying for the Universal Health Insurance Scheme India. These include:

• A valid ID proof, such as an Aadhaar card, PAN card, or Voter ID
• An address proof, like a recent utility bill, ration card, or passport
• Age proof for all insured members, which can be a birth certificate, school certificate, or 10th mark sheet
• Recent passport-size photographs of all family members to be insured

• Step 1: Contact a health insurance company or licensed agent that offers UHIS. You can reach out directly through the branch offices or via official representatives.
• Step 2: Get a pre-printed proposal form from the insurer or agent.
• Step 3: Carefully fill out the proposal form, ensuring that all personal, family, and income-related details are accurate.
• Step 4: Submit the completed form along with all required documents, such as ID proof, address proof, age proof, photographs, and BPL certificate (if applicable), to the insurer or agent.
• Step 5: Once verified, the insurer will provide premium details and a payment receipt through their computerised office system.
• Step 6: After payment and approval, the policy document will be issued to the applicant. It will be either handed over directly to the applicant or sent via post.

The scheme requires applicants to pay a nominal annual premium, with government subsidies available for BPL households.

Premiums of Universal Health Insurance Scheme for APL Families

For families above the poverty line, the premium amount varies based on the number of members covered under the policy:

• An individual needs to pay ₹365 per year.
• A family (up to 5 members), including the insured, spouse, and up to three dependent children, needs to pay ₹548 per year.
• A family (6–7 members), including the insured, spouse, up to three dependent children, and parents, needs to pay ₹730 per year.

Premiums of Universal Health Insurance Scheme for BPL Families

Also Read: Health Insurance Premium Calculator Online

Financial Protection

One of the main objectives of UHIS is to provide a shield to families from the financial stress of medical emergencies. By covering hospitalisation expenses and treatment costs, it helps economically weaker families get quality healthcare. They can get this without worrying about high medical bills.

Focus on Preventive Care

The scheme also takes care of preventive healthcare and encourages regular check-ups and awareness. This reduces the overall burden of diseases and promotes long-term well-being across communities.

Cashless Treatment Facility

UHIS policyholders can avail of cashless treatment at empanelled hospitals. You can get quick and easy access to care. The insurer will settle the medical bills directly with the hospital, allowing patients to focus on recovery rather than expenses.

Complete Coverage

The UHIS scheme’s wide protection includes personal accident cover for the insured. In case of an unfortunate event of the death of the insured due to an accident, the scheme pays a significant compensation to the family. This offers crucial financial support during difficult times.

Inclusion of Children

Children between 3 months and 5 years are covered along with their parents, making sure that the youngest members of the family have access to early and quality healthcare.

Also Read: Benefits of Health Insurance Plans in India

• Covers standard room and boarding costs up to 0.5% of the sum insured. For ICU stays, up to 1% of the sum is insured per day.
• Costs for surgeons, anaesthetists, consultants, specialists, nurses and other medical practitioners are covered up to 15% of the sum insured.
• Each family can get up to ₹30,000 per policy year, which includes maternity benefits.
• The UHIS covers ambulance expenses which include ground, water, and air transportation. This ensures timely medical support during emergencies.
• If the insured or the primary breadwinner suffers an injury resulting in death within six months of the mishap, a lump sum of ₹25,000 is paid to the family.
• The scheme provides coverage for normal deliveries up to ₹2,500 and cesarean deliveries up to ₹5,000.
• In case the insured or their spouse is hospitalised due to illness, disease, or accident, the insurer provides ₹50 per day starting from the fourth day, up to a maximum of 15 days, as disability compensation. A 30-day waiting period applies, and claims must be submitted under Section 1 of the policy.

Also read: How Much Health Insurance Do You Need?

• If any injuries or illnesses are caused by war, invasion, terrorism, or similar acts, they are excluded.
• Costs for spectacles, contact lenses, or hearing aids are not covered.
• Criminal intent or law violations related to death or injuries are excluded.
• Costs of vitamins or tonics are excluded unless prescribed as part of a medical treatment.
• Expenses incurred for dental care or surgery done for corrective, cosmetic, or aesthetic purposes are not covered in this scheme.
• Injuries or death due to alcohol or drug use, adventure sports, or operating an aircraft are not covered.
• Treatment for HIV/AIDS, venereal diseases, or congenital conditions is excluded.
• Death or injuries caused by nuclear weapons or radiation are not covered.
• Suicide attempts or self-inflicted harm-related deaths or injuries are excluded.

Understand Your Coverage

Before starting a claim, you must check the UHIS policy to understand the coverage, whether it includes hospitalisation expenses, pre- and post-hospitalisation care, maternity benefits, and other provisions. Ensure that your treatment falls under the covered services.

Contact Your Insurer

Confirm that your medical treatment is eligible and reach out to your insurer through their toll-free helpline or customer support. They will guide you on the claim procedure, required documents, and timelines.

File the Claim

Complete the claim form and submit it along with all necessary documents such as medical bills, invoices, prescriptions, and relevant reports. Having accurate and complete documentation will ensure smoother processing.

Verification Check

The insurer will verify the claim and supporting documents for authenticity and compliance with the policy terms.

Review or Verification

For higher-value claims or any discrepancies, the insurer may review medical records and conduct further investigations to confirm that the expenses are covered under the policy.

Claim Settlement

After verification and review, the insurer will settle the claim and send the amount directly to your bank account. The processing times depend on the insurer and the nature of the claim.

The UHIS is a significant step in India’s mission to make healthcare impartial and accessible to all. The scheme focuses on low-income and vulnerable families, helping make healthcare more accessible and affordable. It offers coverage for hospitalisation, maternity care and accidental injuries, ensuring financial protection during medical emergencies.

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