One of the fundamental rights of every citizen is to enjoy good health. The government of various first world countries have protected the health of its citizens by providing good medical care for free or very nominal cost.
The Universal Health Insurance Scheme was introduced by Ministry of health and family welfare as part of its proposed Universal Health Assurance Mission (UHAM). The present insurance reach is about 25% of the population.
The Universal Health Insurance Scheme was launched with effect from 14.7.2003 on a nationwide basis with an aim to provide health care to the poorest section of the society. The scheme is open to both BPL (Below Poverty Line) and APL (Above Poverty Line) families.
The Universal Health Insurance Scheme have been reformed to improve the access to the health care to the exclusive below poverty line families.
The Universal health insurance policy is available to both individuals as well as in a group.
The individual policy will be in the name of the earning head of the family with details of other insured members.
The Group policy will be issued in the name of the Group/Association/Institution with a schedule of names of the members including his/her eligible family members forming part of the policy.
Members covered in one group policy cannot be covered in any other group in the same health scheme.
Age Eligibility
People between the ages of 5 to 70 years can be enrolled in this health insurance scheme. Children between the age of 3 months to 5 years can be covered provided one or both the parents are covered simultaneously.
The policy coverage with respect to reimbursement of hospitalization expenses for illness / diseases suffered or injury sustained by the Insured Person. In the event of a claim, the expenses will be paid to the hospital or insured person subject to limits as mentioned in the below table:
| Hospital Benefits | Limits |
|---|---|
| Room, Boarding Expenses as provided by the Hospital / nursing home. If admitted in IC Unit | Up to 0.5% of Sum Insured per day Up to 1% of Sum Insured per day |
| Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses | Up to 15% of Sum Insured per illness / Injury |
| Anaesthesia, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Diagnostic Materials and X-ray Dialysis, Chemotherapy, Radiotherapy Cost of Pacemaker, Artificial Limbs & Cost of organs and similar expenses | |
| Maternity Benefit – ONE CHILD ONLY (With 12 months waiting period) | Rs.2,500/- for normal delivery and Rs.5,000/- for caesarean delivery |
Hospitalisation benefit INR 30,000 per family per policy inclusive of maternity benefit of INR 2500 for normal and INR 5,000 for caesarean delivery. Total expenses claim for any one illness is limit to INR 15,000 excluding maternity benefit.
If the earning head of the family or insured person shall sustain any bodily injury due to an accident caused by outward, violent and visible means, and if such injury results in death of the insured person within 6 calendar months of its occurrence then the Company shall pay INR 25,000.
If the earning head of the family is hospitalized due to an accident, illness or disease and has completed 3 months waiting period on the policy. The company shall pay INR 50 from the fourth day of hospitalization up to maximum of 15 days as per the policy.
| Coverage | Premium (INR) | Insured Share | Government of India Subsidy (INR) |
|---|---|---|---|
| Individual | 300 | 100 | 200 |
| Family of up to 5 members | 450 | 150 | 300 |
| Family of up to 7 members | 600 | 200 | 400 |
BPL family documentation proof to avail this health insurance: Certificate as proof of BPL issued by an official Tehsildar of revenue department of the concerned state government has to be attached.
Protection of policy holder’s interest: If any policy holder has any complaint then they can submit their complaint at the regional or head office of the company. This cell has been opened in compliance with IRDA’s regulations, 2002 to protect the interest of policy holders.
