Universal Health Insurance Scheme (UHIS)

Understand the Universal Health Insurance Scheme (UHIS)

As medical costs continue spiralling upward, quality access to health services is one of today's greatest challenges. Most countries, however, target a future whereby everyone can access health care regardless of their socio-economic status. One such initiative in India is the Universal Health Insurance Scheme (UHIS), which aims to provide affordable healthcare and pave the way for universal health coverage.

This comprehensive guide will cover UHIS insurance, its features, eligibility criteria, impact on healthcare access, and more. 

What is the Universal Health Insurance Scheme (UHIS)?

The Universal Health Insurance Scheme is an initiative introduced by the government to protect people financially against medical costs. It attempts to reduce the financial burden on individuals by providing health insurance coverage to vulnerable and economically weaker sections of the population.

With rising healthcare costs, even the simplest treatment becomes out of reach for most people, especially the low-income group. Therefore, by offering UHIS, the government aims to provide access to quality healthcare for all economic groups without the high-cost implications. 

Additionally, UHIS insurance aligns with global movements toward universal healthcare, which calls for all individuals to have access to the required healthcare services when needed without suffering financial hardship.

Key Features of the UHIS Scheme

Some of the key features of the UHIS scheme include the following:

• Treatment Expenses Coverage: The scheme covers hospitalization bills, diagnostic services, pre- and post-hospitalization costs, and, in some cases, outpatient consultations.
• Low Premium: Health insurance coverage available under UHIS comes with a low premium amount. For individuals, the premium starts at just ₹100 and goes up to ₹200 for covering a family with seven members. 
• Cashless Treatment: UHIS enables the beneficiary to undergo treatment at network hospitals without making advance payments for medical services, as the costs are directly settled with the insurer.
• Preventive Health Check-ups: The Universal Health Insurance Scheme covers routine preventive health check-ups for insured individuals up to a certain annual limit, including basic blood work, health risk assessments, and cancer screening tests, aiding early illness detection.
• Flexibility in Plan Design: The Universal Health Insurance Scheme can be customized to a certain extent based on the specific needs of individuals or families, providing a tailored approach to health insurance.

Eligibility for the Universal Health Insurance Scheme (UHIS)

The following are the eligibility criteria for the UHIS insurance scheme:

• Income Group: The family income should not be more than the amount insured.
• Residency: Applicant needs to be a Permanent Resident of India. 
• Family Size: The scheme incorporates the head and spouse, two or more offspring below 18 years of age, and extends potential coverage even to elderly parents.
• Age Limits: Individuals aged between 5 years and 70 years are eligible for this scheme. Additionally, children aged between 3 months and 5 years can gain coverage along with their parents.   

The Role of the UHIS Provider Portal

In the digital age, efficiency is paramount, especially when accessing government services. The UHIS provider portal, an online platform designed for ease of access and streamlined service delivery, simplifies the process of applying for, managing, and accessing benefits under the Universal Health Insurance Scheme.

Key Functions of the UHIS Provider Portal

• Registration and Enrolment: It is relatively easy to enrol in the Universal Health Insurance Scheme on the portal. This allows applicants to apply electronically with the required documents and paperwork, saving time and breaking administrative barriers.
• Claim Processing: The portal also makes it convenient to process claims quickly. Beneficiaries can submit medical bills and request reimbursements or cashless treatment authorizations directly with the insurance provider.
• Provider Access: It also allows hospitals and healthcare providers to check the eligibility of beneficiaries, process payments, and maintain records. This way, there is a smooth interaction between the provider, the insurance company, and the insured party.
• Monitoring and Tracking: Users can monitor the status of their insurance claims, coverage details, and premiums. This transparency ensures that beneficiaries are well-informed and reduces the chances of disputes or delays in service delivery.

Why is Universal Health Insurance Important?

The concept of universal health coverage has been gaining traction globally. Countries such as Canada, the United Kingdom, and Thailand offer various forms of public health insurance to ensure every citizen has access to healthcare. 
In India, the need for a universal insurance policy covering medical costs is even more pressing due to the large and diverse population, with significant disparities in healthcare access.

Advantages of Universal Health Insurance

1. Economic Security: Health care costs can devastate poverty-stricken households. A universal health insurance program ensures that the family does not have to choose between health and economic security.
2. Improved Access to Healthcare Services: With universal health coverage, individuals can seek medical attention at the right time, avoiding complications arising from delayed treatment due to financial constraints.
3. Promotes Preventive Healthcare: By removing financial barriers to accessing healthcare, the scheme encourages people to undergo regular health check-ups and preventive care, reducing society's overall healthcare burden.
4. Improved Health Conditions: Universal access to healthcare means that more people get early treatment for diseases, resulting in better health outcomes and a decrease in mortality rates.
5. Reducing Health Inequities: The Universal Health Insurance Scheme helps bridge the gap between the rich and the poor, providing equitable access to healthcare for all.

Universal Health Insurance Scheme and Its Impact in India

In India, universal health coverage has been a long-standing goal for policymakers. The Universal Health Insurance Scheme is one step towards achieving this goal. Here's how:

• Increased Enrollment in Health Insurance: The Universal Health Insurance Scheme will cover low-income families and increase enrollments. It will increase the covered population, especially in rural areas, to a huge extent.
• Government Support for Vulnerable Groups: This scheme ensures that marginalized groups, such as women, children, and the elderly, are not left out of the healthcare system. The government may provide subsidies or financial support to make insurance affordable for these groups.
• Strengthening Healthcare Infrastructure: There is an increasing demand for quality healthcare services because of a higher enrollment of people into health insurance. This encourages the improvement and expansion of the medical infrastructure in India.
• Economic Growth and Productivity: Healthy people are always more productive, and the removal of financial burdens due to the expenses related to healthcare allows families to use their resources more effectively. In the long run, this may contribute to better economic growth. 

UHIS is an innovative attempt toward universal health coverage in India. It will allow access to health services in a manner that is not only affordable but also equitable. This makes getting coverage and managing claims less cumbersome to achieve a step towards a healthier and more prosperous nation.