The University of Rwanda Medical Insurance Scheme (MIS/UR) is the pioneer in the mutual health system in Rwanda since its creation in 2001. The initiative came from university staff and was approved by the university organs not only as the initiative in line with government priorities in the health domain, but also as their role to ensure healthcare and to reduce the burden of expensive health spending particularly to the vulnerable groups of students, lecturers and low income supporting staff of the university. From its establishment, the scheme registered a big success towards its mission and objectives and also it inspired the whole health system in Rwanda. The Scheme is designed to facilitate fair financing of health care costs through pooling and judicious utilization of financial risk protection and cost-burden sharing for university community, against high cost of health care through institution of prepaid mechanism, prior to their falling ill.