There are 4 public sector general insurance providers who have implemented impanelledUniversal Health Insurance Scheme with the intention to enhance people’s access to health care especially for families at or below the poverty line. This not only includes individuals but groups or families. For starters this scheme comes with a medical expense reimbursement of up to Rs.30,000 for hospitalization which is floated amongst the entire family, along with death cover caused by accident for Rs.25,000 which would be given to the main earning member of the family and also a compensation for the loss of the earning member with Rs.50/given to the family for a up to 15 days. The Universal Health Insurance Scheme (UHIS) is revamped to serve the purpose of meeting the needs of families falling under the poverty line. The premium used to be Rs.100 and has now been changed to Rs. 200 for an individual, Rs.300 with family members of five and finally Rs.400 for a family of 7, with no compromise on the benefits.
APL (Above Poverty Line) Features:
- The scheme provides coverage in the form of medical treatment reimbursements for Hospitalisation expenses for illness/diseases that have been contracted or any sort of injury that has been sustained by the insured individual. Under the circumstance that any claim becoming admissible under policy, the insurer through TPA (Third Party Administrator) will pay to the Hospital/ Nursing Home or Insured individual the amount of such expenses which is again subject to limits as would fall under different heads and are reasonably and incurred through necessity in respect to the place in India by or on behalf of such Insured Person but not exceeding Sum Insured (all claims in aggregate) for that person as stated in the Schedule in any one period of insurance.
- The UNIVERSAL HEALTH INSURANCE POLICY for groups is available for families or groups that consist of more than 100 families. Each of the families insured is covered of all eligible members i.e. insured persons under a single group policy only. This means that different categories of eligible members are not be allowed for coverage under different group policies. Hence, it is not allowed for any unnamed group policy to be issued.
- This scheme is issued in the name of the Group/Association/Institution with a simple list of names of the members which includes his/her eligible family members who are insured forming the policy.
BPL (Below Poverty Line) Features:
- The UNIVERSAL HEALTH INSURANCE policy will be available to both Individuals as well as in Group just as it is available for APL families.
- The Individual Policy will be issued in the name of the earning head of a family with details of insured family members. The Group policy will be issued in the name of the Group/Association/Institution (called insured) with a schedule of names of the members including his/her eligible family members (called Insured persons) forming part of the policy.
- Each member who is insured is covered under one group policy only, just as it is in the case of APL families.
The eligibility requirements of this scheme
APL (Above Poverty Line) Eligibility:
The family’s income is expected to be over the amount, making them eligible to be an APL family.
Age Eligibility: This insurance scheme is available to people between the ages of 5 to 65 years. Children who are aged between the age of 3 months and 5 years can be covered as long as both parents are covered at the time.
BPL (Below Poverty Line) Eligibility:
The family’s income is expected to be less than the amount, making them eligible to be a BPL family. A certificate as proof thereof issued by an official, not below the rank of B.D.O. / Tehsildar of the Revenue Department of the concerned State Government has to be attached.
Age Eligibility: This insurance scheme is available to people between the ages of 5 to 70 years. Children who are aged between the age of 3 months and 5 years can be covered as long as both parents are covered at the time.