Niramaya Health Insurance Scheme

Brief Overview: Niramaya Health Insurance Scheme

The government of India regularly launches multiple schemes and initiatives to help common people to improve their quality of life and especially their health. Many such sections are also taken to offer monetary support to the disabled. But most of the time, due to lack of awareness most people are not able to avail the benefits. 

However, over the past few years more and more workplaces are evolving and welcoming people with disabilities. The category of PwD, Person with Disabilities, includes people who suffer from autism, mental retardation, multiple disabilities and cerebral palsy. Sadly in our country, most PwD has often been overlooked, however, with government support, there are many welfare activities and benefits policies that are being launched and can be extremely advantageous. 

Niramaya Health Insurance Scheme is a specific health insurance plan that offers financial stability to people who suffer a developmental disability. There are certain insurance companies that offer this health plan which helps the PwD to seek medical treatment. The premium of the plan for those below the poverty line is INR 250 and for those above the poverty line is INR 500. Irrespective of the type of disability, under the National Trust Act, 1999, the scheme offers the same coverage. 

Niramaya Health Insurance Scheme - Best Features 

1. This is an affordable health insurance plan for the welfare of people suffering from autism, mental retardation, multiple disabilities and cerebral palsy
2. Empowers people to seek healthcare services for their loved ones
3. Helps in improving the overall health condition of people who suffer a disability
4. The scheme is a single premium policy across different age groups
5. Insurance up to INR 1 lakh per beneficiary/nominee
6. The plan can opt for individuals who suffer from a developmental disability as stated by the National Trust
7. The scheme is available in the whole country with the exception of Jammu and Kashmir
8. Pre-existing conditions are not covered
9. No pre-policy medical tests are required
10. Treatment can be taken in any hospital

Niramaya Health Insurance Scheme - Coverage

1. Health Insurance Cover
   The Niramaya Health Insurance Scheme offers a health insurance cover of up to INR 1 lakh per beneficiary. 
2. Wide Coverage
   The scheme covers OPD treatment which includes medical check-ups, pathology, medicines, diagnostic tests, preventive dentistry, non-surgical hospitalisation, corrective surgeries, ongoing therapies and alternative medicines. The conditions that require repetitive medical invention and that require in-patient treatment are also covered in the scheme.
3. Transportation
   The medical transportation of the person with disabilities, PwD,  is covered up to a specific amount.

Niramaya Health Insurance Scheme - Plan Details 

• Eligibility Criteria
  • All registered Organisations under National Trust can Pay the registration fee of INR 1,000 and enrol people with disabilities
  • Any person with disabilities (PwD), listed by the National Trust 1999, has to produce a disability certificate and then apply for the scheme
• Enrolment Process
  • Any individual who is eligible for health insurance can apply for the registration. The application can be downloaded from the internet and then submitted to an organisation that is registered with the National Trust. Once the enrolment is done successfully and the application is approved, a Health ID card would be issued to the beneficiary/ beneficiaries. The E-card can be printed through https://thenationaltrust.gov.in/content/scheme/niramaya.php or https://www.thenationaltrust.gov.in/auth/niramaya-e-card.php 
  • The enrollment would have a small processing fee. This amount is decided by the National Trust. 
  • Fresh enrolments as well as existing enrolments begin from the date of enrolment and continue till the end of the financial year, which means up to March 31.  Post this a renewal fee would be applicable with a claim up to INR 1 lakh. 
  • Procedure:
    1. Parents/ Guardians of the PwD have to visit a Registered Organisation and fill in the Enrolment Form
    2. The RO would forward the application
    3. The Niramaya application is to be filled and the required documents are to be attached
    4. The form has to be filled on the portal of the National Trust
    5. The processing fee is to be paid
• Documents Required
  The following documents are to be submitted by the applicant along with the duly filled Enrolment Form
  • Government-issued Identification Card with Photograph
  • Certificate of Disability issued by District Hospital/ Government Authority
  • Proof of Address
  • Passport-sized photograph
  • Income certificate
  • Proof of payment of the applicable fee
  • Below Poverty Line Card, if applicable
  • Details of bank

Niramaya Health Insurance Scheme - Renewal Process 

As discussed earlier the Niramaya Scheme is valid till March 31 of the financial year in which the scheme is undertaken. In order to continue with the scheme, an application for renewal is to be submitted by the beneficiary 3 months before the date of expiry. The renewal process is given below:

• Guardians or parents of the PwD can visit the nearest Registered Organisation for the renewal. The following documents will be required:
  • Government-issued Identification Card with Photograph
  • Certificate of Disability issued by District Hospital/ Government Authority
  • Proof of Address
  • Below Poverty Line, BPL Card, if applicable
  • Income certificate
  • Legal Guardian Certificate, if applicable
• The Registered Organisation would verify the documents
• Once the application is approved, the official website can be visited and the “Renewal” can be processed
• After the application fee is paid, the Registered Organisation would be notified
• The Scheme would thus be renewed

Niramaya Health Insurance Scheme - Claim Process

The claim can be made through reimbursement. This means that you would have to pay for the treatment from your own pocket, then within 30 days of discharge or the treatment the listed documents are to be submitted. The form can be downloaded from the official website and then sent to the Insurance Company directly or the Third Party Administrator, which is associated with the Insurance Company. 

When making a claim, the following documents are to be submitted:

• Duly Filled Claim Form
• Copy of the Niramaya Card/ Health ID Number
• Disability Certificate
• Doctor’s Prescription
• All treatment-related bills
• All Investigative Reports and Tests
• Bank Details of Beneficiary

Niramaya Health Insurance Scheme - Review 

Under the National Trust Act, 1999, Niramaya Health Insurance Scheme has been launched to offer health insurance to persons with disabilities, PwD. The scheme offers an insurance cover up to INR 1 lakh and the scheme is to be renewed annually, at the end of the financial year. The beneficiary has to pay an enrolment fee which is-For Person with Disabilities, who are Below Poverty Line- INR 250. For Persons with Disabilities, who are Above Poverty Line the fee is INR 500. At the time of renewal, the health insurance premium is INR 250 and INR 500 for PwD who are below the poverty line and the ones above it respectively. 

Niramaya Health Insurance Scheme is a step in the right direction. This is an affordable health insurance plan that makes seeking treatment for the underprivileged PwD a lot easier.