Chris John

Expert

Published on: Sep 8, 2026

Universal Health Insurance Scheme (UHIS)

To enjoy and strive for good health is a fundamental right of every citizen. Therefore, the Government of India aims to provide proper medical care at a very nominal cost, or even free, to protect the health of its citizens. Under the Universal Health Assurance Mission (UHAM), the Universal Health Insurance Scheme (UHIS) was introduced by the Ministry of Health and Family Welfare. The scheme covers medical expenses, offers personal accident cover to the primary income-earner of a family, and provides compensation to families in case of the income-earner's demise. This scheme is available to both Above Poverty Line (APL) and Below Poverty Line (BPL) families. This article delves into the various essential aspects of the Universal Health Insurance Scheme (UHIS).

Eligibility

The eligibility for UHIS largely depends on whether the individual or family falls above or below the poverty line. The features for both categories are listed below.

Eligibility for APL

The family income determines eligibility for the scheme, with individuals aged 5 to 65 years eligible. Children aged 3 months to 5 years may also be covered, provided both parents are insured under the same scheme.

Eligibility for BPL

Families with income below a certain threshold are eligible, requiring a certificate from an official not below the rank of BDO/Tehsildar of the relevant state's Revenue Department. Individuals aged 5 to 70 years are eligible, with children and infants covering the same age as APL. Explore the CMHT Health Insurance Scheme for more options tailored to BPL families.

Salient Features

The features of UHIS vary based on whether the family or individual is APL or BPL.

Features for APL families/individuals

The UHIS is available for groups with more than 100 families. Eligible members within each family are insured under a single group policy. Unnamed group insurance policies are not issued.
The UHIS is issued in the name of a Group/Institution/Association, including a list of members and their eligible family members.
This scheme offers coverage in the form of:
- Reimbursements for medical treatments
- Hospitalization expenses for contracted diseases or illnesses
- Hospitalization expenses for any injuries

Features for BPL families/individuals

The UHIS can be availed by individuals and groups, similar to the APL scheme.
Each member insured is covered under one group insurance policy only.
An individual UHIS policy is issued in the name of the family's income-earner. For groups, the policy is in the group's name, including a list of their members and eligible family members.

UHIS Coverage and Benefits

The UHIS coverage and benefits differ for APL and BPL groups.

Coverage and Benefits for APL families/individuals

For any single illness, expenses are capped at INR 15,000, with the insurance company's total claim liability not exceeding INR 30,000 per individual or family during the insurance period.

The UHIS covers up to 0.5% of the sum insured per day for room expenses charged by the hospital/nursing home.
If admitted to ICU, up to 1% of the sum insured per day can be claimed.
Reimbursements for expert fees, including Surgeons, Anaesthetists, and Consultants, are available up to 15% of the sum insured per injury or illness.
Other expenses involving anaesthesia, blood, oxygen, surgical instruments, and more can be reimbursed up to 15% of the sum insured per injury or illness.

Coverage and Benefits for BPL families/individuals

For BPL families, UHIS offers healthcare or hospitalization benefits and Death through Accident benefits for the income-earner.

Hospitalization Coverage/Benefits

Hospitalization benefits similar to those for APL families are provided to BPL individuals or families.

Maternity Benefits

The UHIS provides INR 2,500 for women undergoing standard delivery and INR 5,000 for caesarean delivery, with a one-year waiting period from policy inception. Medical expenses incurred up to three months for a newborn are covered, but maternity benefits must stay within the INR 30,000 limit.

Accident Cover

The UHIS Policy offers INR 25,000 under certain conditions:

The insured is the family's income-earning head
The individual sustains bodily injury from an accident
The injury results in the insured's death within six months

Disability Compensations

For disability, the insurance company's liability is limited to INR 750 during the policy period. If the income-earning head or spouse is hospitalized due to an accident or illness, the family receives INR 50 per day from the fourth day of hospitalization up to a maximum of 15 days. A valid claim must be submitted under Section 1 of the policy with a three-day waiting period.

Premium Payment

Premium payment for the UHIS depends on whether the individual or family is APL or BPL. Rates for both groups are specified.

Above Poverty Line Individuals/Families

The individual premium is INR 365 per annum.
Families with up to five members (insured, spouse, and three dependent children) have a premium of INR 548 per annum.
Families with more than five members (including dependent parents) are charged INR 730 per annum.

Risk Period	Rate of Premium Amount
Up to 1 month	1/4 of the Annual Rate
Up to 3 months	1/2 of the Annual Rate
Up to 6 months	3/4 of the Annual Rate
More than 6 months	Full Annual Rate

Below Poverty Line Individuals/Families

The following are the premium amounts, insured's share, and government subsidy for BPL families and individuals:

Coverage	Premium	Insured's share	Subsidy
Individual	INR 300	INR 100	INR 200
Family with up to 5 Members	INR 450	INR 150	INR 300
Family with up to 7 Members	INR 600	INR 200	INR 400

Note: Premiums for the scheme may vary depending on factors such as Age, Location, GST, and other governing taxes.

Back to Learn

Frequently Asked Questions

Common questions about Universal Health Insurance Scheme.

A: The eligibility for the UHIS is based on whether an individual or family is above or below the poverty line. For Above Poverty Line (APL) families, the scheme can be availed by individuals between 5 to 65 years of age, and children/infants between 3 months to 5 years if both parents are covered. For Below Poverty Line (BPL) families, the scheme is available for individuals between 5 to 70 years of age, and children/infants between 3 months to 5 years if both parents are covered.

A: For APL families, the UHIS is accessible as a group policy covering at least 100 families. The scheme provides reimbursement for medical treatments, hospitalization expenses for diseases or illnesses, and injuries. All eligible members of a family are covered under a single group policy.

A: For APL families, the total expenses for a single illness are restricted to a maximum of INR 15,000, and the insurer's liability is capped at INR 30,000 per individual or family during the policy period. For BPL families, the scheme offers either healthcare or hospitalization benefits along with death through accident benefits for the income-earner.

A: The UHIS offers INR 2,500 for women who undergo a standard delivery and INR 5,000 for women who undergo a caesarean delivery, subject to a waiting period of 1 year from the policy inception. The amount also covers medical expenses for a newborn child up to 3 months, within the overall limit of INR 30,000.

A: The UHIS policy offers INR 25,000 to the insured if they are the income-earning head of the family and sustain bodily injury or death due to an accident within 6 months.

A: If the income-earning head of the family or their spouse is hospitalized due to an accident, disease, or illness, the family will receive a compensation of INR 50 per day from the 4th day of hospitalization, up to a maximum of 15 days, as per the policy period.

A: For APL individuals, the premium is INR 365 per annum. For families with up to 5 members, it is INR 548 per annum, and for families with more than 5 members, it is INR 730 per annum.

A: For BPL individuals, the premium is INR 300, with the insured paying INR 100 and the government subsidizing INR 200. For families with up to 5 members, the premium is INR 450 (insured's share: INR 150, subsidy: INR 300), and for families with up to 7 members, the premium is INR 600 (insured's share: INR 200, subsidy: INR 400).

A: Yes, for APL families, the scheme can be availed by individuals between 5 to 65 years of age, while for BPL families, the age range is 5 to 70 years.

A: For APL families, the UHIS covers expenses such as room charges (up to 0.5% of the sum insured per day), ICU charges (up to 1% of the sum insured per day), fees for surgeons, anesthetists, consultants, and specialists (up to 15% of the sum insured), as well as costs for anesthesia, blood, oxygen, operation theatre, surgical instruments, medicines, diagnostics, dialysis, chemotherapy, radiotherapy, pacemakers, and artificial limbs (up to 15% of the sum insured).