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Everything about Universal Health Plan in India

Team AckoFeb 19, 2025

India's vast population poses formidable challenges in delivering accessible and affordable healthcare. The Universal Health Plan represents a pivotal initiative addressing these hurdles by striving for equitable healthcare, regardless of socioeconomic disparities.

By offering comprehensive coverage, including for both individuals and groups, the plan aims to bridge gaps in healthcare accessibility. Through its inclusive approach and emphasis on family health, the Universal Health Plan aims to uplift the overall health and well-being of all Indians, fostering a healthier and more prosperous society. In this article, we delve into the various aspects of the Universal Health Plan in India, exploring its scope, implementation, and potential impact on the nation's healthcare landscape.

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Contents

What is a Universal Health Plan?
Scope and benefits of Universal Health Plan
Universal Health Plan (UHP) Eligibility Criteria
The Major Points To Keep In Mind
Objectives of The plan
- Inclusion Of Children:
Who should buy a Universal Health Insurance plan in India?
Features of the Universal Health Plan (UHP)
What is the claim process of Universal Health Insurance Plan?
Frequently Asked Questions (FAQs)
Complementing Healthcare with Financial Preparedness

What is a Universal Health Plan?

The Universal Health Plan’s primary objective is to make quality healthcare accessible to all citizens, especially the marginalised and underprivileged sections of society. The plan envisages a comprehensive health coverage system that leaves no Indian behind in times of medical need. These plans are also referred to as government health insurance schemes.

Scope and benefits of Universal Health Plan

The UHPI aims to provide a wide range of health services, including preventive, promotive, curative, and rehabilitative care. Some of the key benefits of the Universal Health Plan include:

Inclusive Coverage: The plan will cover medical expenses for all essential health services, ensuring that no one is left without access to healthcare.
Financial Protection: UHPI seeks to eliminate the financial burden of medical treatments by offering cashless and affordable services.
Reduced Out-of-Pocket Expenditure: With the Universal Health Plan, citizens won't have to bear the entire cost of medical treatments, reducing their out-of-pocket expenses.
Focus on Preventive Care: The initiative emphasises preventive healthcare measures to promote overall well-being and reduce the burden of disease.
Quality Healthcare: By providing standardised medical services, the plan aims to maintain high-quality healthcare across the country.

Universal Health Plan (UHP) Eligibility Criteria

The Universal Health Plan (UHP) in India aims to provide health insurance coverage to both Below Poverty Line (BPL) and Above Poverty Line (APL) families, ensuring that financial constraints do not hinder access to essential healthcare services. The eligibility criteria for enrollment into the UHP differ slightly for BPL and APL families.

The Major Points To Keep In Mind

For BPL families, individuals aged between 5 years and 70 years are eligible for coverage under the scheme. Additionally, children aged between 3 months and 5 years can also be covered along with their parents. To qualify, the family's income must be lower than the policy's sum insured or coverage amount. Furthermore, proof of belonging to the BPL category is required, which can be obtained from the Block Development Officer (BDO) of the Revenue Department or the local Tehsildar.

Similarly, APL families can also benefit from the benefits offered by the UHP. The eligibility criteria for APL families mirror those of BPL families. Adults aged between 5 and 70 years are eligible, along with children between 3 months and 5 years. To qualify for enrollment, the family's income must be below the policy's insured sum or coverage amount.

Objectives of The plan

The UHP aims to bridge the gap in healthcare accessibility by extending coverage to families across different economic strata. By covering both BPL and APL families, the plan ensures that a wider section of the population can access quality healthcare services without the fear of financial burden.

Inclusion Of Children:

Including children in the coverage ensures that the most vulnerable members of society are protected and have access to essential healthcare services from an early age. This proactive approach towards healthcare coverage promotes better health outcomes and contributes to the nation's overall well-being and development.

The UHP's eligibility criteria cater to both BPL and APL families, emphasising inclusivity and equity in healthcare access. By providing financial assistance and support, the UHP plays a crucial role in ensuring that all citizens, regardless of their economic status, have the opportunity to lead healthier lives.

Who should buy a Universal Health Insurance plan in India?

A universal health insurance plan is designed to provide coverage for a broad range of medical expenses, including hospitalisation, surgeries, treatments, and more. It is well-suited for various individuals and families, including:

Young Professionals and Entrepreneurs: For young professionals and entrepreneurs who are just starting their careers or businesses, a universal health insurance plan can offer a safety net against unexpected health issues. It provides coverage for hospitalisation and other medical expenses, ensuring that they can focus on their careers without worrying about the financial burden of healthcare costs.

Families with Children: Families with children often have higher healthcare expenses due to regular medical check-ups, vaccinations, and occasional illnesses. A universal health insurance plan can help parents manage these costs efficiently, ensuring the health and well-being of their children without straining their finances.

Senior Citizens: Senior citizens may find it challenging to get health insurance coverage due to their age and pre-existing health conditions. However, a universal health insurance plan may still be available to them. It can provide the much-needed financial support for medical treatments and hospitalisation during their golden years.

Self-Employed Individuals: As a self-employed individual, you are solely responsible for your healthcare expenses. A universal health insurance plan can be a wise investment, offering comprehensive coverage and reducing the financial burden of medical emergencies.

Employees without Adequate Employer Coverage: While many employers offer health insurance benefits, the coverage may not always be sufficient. Employees who feel that their employer's health insurance plan lacks adequate coverage can consider supplementing it with a universal health insurance plan.

Individuals with Pre-existing Conditions: People with pre-existing medical conditions might face difficulties in securing standard health insurance policies. In such cases, a universal health insurance plan may be a viable option, providing coverage for existing health issues along with future medical needs.

Features of the Universal Health Plan (UHP)

The Universal Health Plan (UHP) implemented by the Government of India encompasses several key features designed to extend healthcare coverage to individuals and groups across the nation, ensuring inclusivity and accessibility to essential medical services.

Comprehensive coverage

One prominent feature of the UHP is its comprehensive coverage, available to individuals and groups. This aspect ensures that both personal and collective healthcare needs are addressed under the scheme. Individuals can avail themselves of coverage for themselves and their families, while groups or institutions can also procure policies to cover their members.

The Structure

Another notable aspect of the UHP is its issuance structure. Policies are issued in the name of the primary earning member of the family. This ensures that the person responsible for the family's financial support is covered under the scheme, with the inclusion of all family members under the same policy. This streamlined approach simplifies administration and ensures that families can access healthcare services efficiently.

Broader Coverage

For Below Poverty Line (BPL) families, group policies are issued either in the name of the group or the institution procuring the coverage on behalf of the families. This arrangement facilitates broader coverage for economically disadvantaged groups and ensures that collective healthcare needs are met effectively.

Coverage For Families

Furthermore, the UHP emphasises individual and family-centric coverage. Policies are issued in the name of the primary member and their family, underscoring the importance of family health and well-being. By encompassing the entire family unit, the UHP promotes preventive healthcare practices and encourages regular health check-ups for all members.

No Multiple-Group Health Schemes

To prevent duplication and ensure efficient utilisation of resources, the UHP prohibits individuals from being insured under multiple group health schemes. This measure prevents overlap in coverage and ensures that beneficiaries receive the full benefits entitled to them under the UHP.

The Universal Health Plan by the Government of India is characterised by its inclusive coverage for individuals and groups, streamlined issuance structure, emphasis on family health, and measures to prevent duplication. These features collectively contribute to the UHP's goal of extending healthcare coverage to all segments of society, thereby fostering better health outcomes and promoting overall well-being.

What is the claim process of Universal Health Insurance Plan?

Here is a step-by-step claim process for this type of health plan.

Identifying Coverage Details: Once you have the policy documents, identify the specific coverage provided by your Universal Health Insurance plan. Understand the extent of coverage for hospitalisation expenses, pre and post-hospitalization care, and any other additional benefits.

Contacting the Insurer: In case of any queries or clarifications regarding your Universal Health Insurance policy, promptly contact the insurer's customer support. Many insurers offer multiple channels of communication, such as toll-free helplines, email, or online chat support.

Filing a Claim: When you or a covered family member incurs medical expenses, you must initiate the claim process. Filing a claim is the first step towards receiving reimbursement for the medical bills. Maintain accurate records of all medical expenses incurred. This includes hospital bills, pharmacy receipts, diagnostic test reports, and any other relevant documents.

Assessment and Verification: After receiving your claim, the insurer will assess the details provided and verify the authenticity of the documents submitted. This is a standard procedure to ensure legitimate claims and deter fraudulent activities.

Review Process: During the review process, the insurer's team evaluates the medical documents to confirm if the expenses are covered under the policy. They also check if the medical condition aligns with the policy's terms.

Investigation (if necessary): In some cases, insurers may conduct an investigation, especially if the claim involves significant expenses or seems suspicious. This investigation may include contacting the medical facility or the policy

Processing Time: The time taken for claim approval and reimbursement can vary among insurers. However, most reputable insurers strive to process claims within a reasonable timeframe to provide timely financial assistance.

Frequently Asked Questions (FAQs)

Here are some common questions about Universal Health Plans in India.

How will the Universal Health Plan impact private healthcare providers?

The Universal Health Plan seeks to collaborate with private healthcare providers to extend its reach and ensure quality healthcare services for all citizens. Private providers will play a significant role in delivering medical care under this initiative.

How can the Universal Health Plan address regional disparities in healthcare services?

Addressing regional disparities requires a focused approach on equitable distribution of healthcare resources and infrastructure development in underprivileged areas.

Is the Universal Health Plan sustainable in the long run?

The sustainability of the Universal Health Plan relies on effective resource allocation, public-private partnerships, and continuous monitoring and evaluation to ensure its long-term success.

How can citizens avail benefits under the Universal Health Plan?

The government is likely to establish a streamlined process for citizens to enrol and access benefits under the Universal Health Plan. Details on registration and utilisation of services will be provided by the authorities.

Will the Universal Health Plan cover pre-existing medical conditions?

The plan's specifics regarding coverage for pre-existing conditions are yet to be revealed. However, it aims to provide comprehensive coverage for essential healthcare needs.

Will the Universal Health Plan reduce the burden of out-of-pocket healthcare expenses?

Yes, the Universal Health Plan aims to reduce the financial burden on citizens by offering cashless and affordable healthcare services, thus reducing out-of-pocket expenditure.

Can citizens choose their preferred healthcare providers under the Universal Health Plan?

The details of the provider selection process are yet to be disclosed. However, efforts will likely be made to ensure citizens have options for healthcare services under the plan.

What role will technology play in the implementation of the Universal Health Plan?

Technology will play a significant role in the plan's implementation by streamlining patient records, facilitating coordination among healthcare providers, and enhancing overall efficiency.

Will the Universal Health Plan cover specialised medical treatments and surgeries?

The specifics of coverage for specialised treatments are yet to be disclosed. However, the plan aims to provide comprehensive medical services, which may include specialised treatments.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.

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