Swavlamban Health Insurance Scheme

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Swavlamban Health Insurance Scheme - Brief Overview

Swavlamban Health Insurance Scheme is a special health insurance plan that has been crafted keeping in mind the needs of persons with disabilities. Launched under the New India Assurance Company Limited under the guidance of the Ministry of Social Justice and Empowerment and the Department of Empowerment of Persons with Disabilities, the scheme was introduced on 2nd October 2016. Catering solely to Persons with Disabilities (PwD) the mission of the scheme is to improve the general health of PwD and thus improve the quality of their life.

With this scheme, the government aims to provide lost cost yet efficient health insurance plan that caters to people with special needs, that is for people who suffer from blindness, low vision, are leprosy-cured, loco-motor disability, hearing impairment, mental retardation and mental illness. 

Swavlamban Health Insurance Scheme - Best Features

  1. The premium for the Swavlamban Health Insurance Scheme is uniform throughout the country. For any PwD living across the country, the premium to be paid is INR 355 (10% of actual premium plus service tax)
  2. The scheme offers comprehensive coverage to the beneficiary and his family - spouse of the PwD and 2 children
  3. The scheme can be availed by PwD between the ages group of 18 to 65 years who have a family income of less than INR 3 lakhs annually
  4. In case a minor is PwD, the parent/ legal guardian can be covered under the scheme 
  5. It also offers a cover for a pre-existing ailment. An insurance cover up to INR 2 lakhs per year as a family floater option
  6. The enrolment, as well as the claim procedures, are very simple 
  7. Under the New India Assurance Company, a network of hospitals would be created. These hospitals would offer cashless treatment to the insured member
  8. A pre-policy medical examination is not required to avail of the scheme
  9. Pre, as well as the post-hospitalisation cover, is subject to sub-limits
  10. Policyholders can opt for cashless treatment at a network hospital
  11. The rest of the policy terms are as per the standard New India Flexi Floater Group Mediclaim Policy

Swavlamban Health Insurance Scheme - Coverage

  • Up to INR 10,000 per year for OPD cover for any corrective therapy for a PwD
  • OPD Cover of INR 3,000 per year for people with mental illness or retardation
  • Corrective Surgery for the treatment of existing impairment can be done but after the approval of the Insurer/ TPA.

Swavlamban Health Insurance Scheme - Plan Details 

  • Enrolment Procedure
    The following documents are required:
    • Duly filled and signed Proposal Form 
    • 2 Passport sized photographs of every member of the family who is being covered
    • ‘Person with Disability Certificate’, issued as per the Persons with Disability Act, 1995
    • Government Issued Valid Photo ID- Aadhaar Card/ Voter’s ID, Driver’s License
  • Premium Details
Sum InsuredCoversPlanPremium
INR 2 lakhsThe Person with Disabilities, Spouse and up to two childrenOPD and HospitalisationINR 3,100 (Plus 10% Service Charges) 
(10% of the premium is paid by the insured)

Swavlamban Health Insurance Scheme -  Exclusions

Under Swavlamban Health Insurance Scheme, the following people are excluded:

  • Autism
  • Cerebral Palsy
  • Multiple Disabilities

Swavlamban Health Insurance Scheme - Claim Process

As discussed above, under New India Assurance, there is a network of hospitals where cashless treatment is available for the insured person. In case the insured has to take treatment in a non-network hospital, approval from the TPA is required. If the hospitalisation was sought in an emergency then approval may not be required.

The pre-existing conditions of the insured are also covered under the scheme. Here also, if treatment is to be taken in a non-network hospital, an approval from the TPA is required.

When making a claim the “Person with Disability” Certificate, issued as per the Persons with Disability Act, 1995, is to be submitted with the TPA. 

The names of the authorised TPA and their contact numbers are given below:

Name of the TPAToll-Free Number
MD India Healthcare Services (TPA) Pvt. Ltd.

1800-233-1166

1800-233-4505

Raksha TPA Pvt Ltd1800-180-1444
Vidal Health TPA1800-425-8885
Medicare TPA1800 345 3339
Medi Assist India TPA Pvt. Ltd.1800 425 9449

 

Swavlamban Health Insurance Scheme - Redressal Process

In case someone is facing an issue with the policy or has any grievance related to a service, get in touch with the authorised official of New India Agency. If the concern still isn’t resolved, it can be escalated to the Department of Empowerment of PwD.

 

Swavlamban Health Insurance Scheme - Review 

In order to help persons with a disability, it is imperative that they have the ability to avail of healthcare facilities. Swavlamban Health Insurance Scheme can thus play a crucial role in empowering the PwDs and supporting them to be independent. A tailor-made plan, Swavlamban Health Insurance Scheme can help them live with dignity. 

This scheme by the government is surely a progressive step. In our country, there are many people who suffer from such disabilities, such a scheme when implemented and monitored correctly can bring a lot of positivity in the lives of the PwDs.

Frequently Asked Questions
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