Niramaya Health Insurance Scheme

Niramaya Health Insurance Scheme is a pioneering initiative launched by the Ministry of Social Justice and Empowerment in India to meet the healthcare needs of persons with disabilities. The scheme aims to provide comprehensive and affordable health insurance coverage to persons with specific disabilities, including autism, cerebral palsy, mental retardation and multiple disabilities.

By offering financial support for medical treatment, therapy, and rehabilitation, the Niramaya scheme ensures that persons with disabilities can access quality healthcare services without facing exorbitant costs. This article explores the key features, benefits, and impact of the Niramaya Health Insurance Scheme in promoting inclusive healthcare for persons with disabilities.

Highlights of the Niramaya Health Insurance Scheme

Below mentioned are some of the major highlights of the Niramaya Health Insurance Scheme: 

Key Features of the Niramaya Health Insurance Scheme

The Niramaya Health Insurance Scheme aims to address the financial burden faced by individuals with specific disabilities and their families by providing them with accessible and affordable healthcare services. It offers a valuable safety net and helps improve access to medical treatment, therapy, and rehabilitation for persons with disabilities in India. Below mentioned are the Key Features of the Niramaya Health Insurance Scheme:

• Insurance Coverage: The scheme provides health insurance coverage up to INR 1 lakh (subject to change) per annum on a floater basis. The coverage includes medical expenses for hospitalization, therapy, rehabilitation, and pre-existing conditions. The exact coverage and benefits may vary depending on the insurance provider.
• Premium and Enrollment: The premium for the scheme is subsidized by the government, and the beneficiaries need to pay a nominal amount as their share. The enrollment process involves submitting relevant documents, including a disability certificate and proof of age, to the insurance provider.
• Empanelled Hospitals: The scheme has a network of empanelled hospitals and healthcare providers across India. Beneficiaries can receive cashless treatment at these empanelled hospitals for covered medical expenses.
• Renewal: The Niramaya Health Insurance Scheme's insurance coverage must be renewed annually. The beneficiaries need to ensure timely renewal to continue availing of the benefits.

Benefits of the Niramaya Health Insurance Scheme

The Niramaya Health Insurance Scheme is a comprehensive health insurance program for persons with disabilities (PwDs) in India. The scheme provides several benefits to its beneficiaries, including:

• Health coverage: Niramaya offers annual health insurance coverage of up to INR 1 lakh for individuals with disabilities. This coverage helps meet the costs of medical treatments, hospitalization, surgeries, and therapies.
• Wide coverage: Niramaya covers a broad range of disabilities, including blindness, low vision, hearing impairment, locomotor disabilities, mental illness, autism, cerebral palsy, and multiple disabilities. This inclusive approach ensures that individuals with diverse disabilities can benefit from the scheme.
• Pre-existing disease coverage: The scheme provides coverage for pre-existing disabilities, which is a significant advantage for individuals who may have disabilities before enrolling in the scheme. This ensures the continuity of healthcare services and supports individuals in managing their existing conditions.
• Rehabilitation services: Niramaya covers medical expenses and extends coverage to rehabilitation services. This includes the cost of assistive devices, prostheses, orthopaedic appliances, corrective surgeries, and therapies required for the well-being and functional improvement of persons with disabilities.
• Affordable premiums: The premiums under the Niramaya scheme are highly affordable, making it accessible to a wider range of individuals with disabilities. This allows individuals from economically disadvantaged backgrounds to avail themselves of health insurance benefits.
• Portability: The scheme offers portability, enabling beneficiaries to access medical services across a network of recognized hospitals and medical facilities throughout India. This feature especially benefits individuals needing to travel or relocate within the country.
• Easy enrollment: The Niramaya Health Insurance Scheme enrollment process is relatively straightforward. Beneficiaries need to provide relevant documents certifying their disability, and they can then enroll in the scheme through the designated authorities.

Eligibility of Niramaya Health Insurance Scheme

All PwDs with valid disability certificates and at least one of the disabilities listed in the National Trust Act of 1999 are eligible to apply for the scheme. To be eligible for the Niramaya Health Insurance Scheme in India, individuals must meet the following criteria:

• Disability Certification: The individual should possess a valid disability certificate from a competent medical authority. The disability should fall under any of the recognized categories, including blindness, low vision, hearing impairment, locomotor disabilities, mental illness, autism, cerebral palsy, and multiple disabilities.
• Age Limit: There is no upper age limit for enrollment in the scheme. Both children and adults with disabilities can apply for coverage.
• Residence: The scheme applies to residents of India only. The individual should be a citizen of India with valid proof of residence.
• Income Criteria: The Niramaya Health Insurance Scheme is designed to benefit individuals from economically disadvantaged backgrounds. As such, there is an income criteria to determine eligibility. To qualify for the scheme, the individual or their guardian must provide proof of an annual income of less than INR 3 lakhs (subject to state-specific variations).

Niramaya Health Insurance Scheme Revised Benefit Chart on Reimbursement Basis only applicable from April 2022

Niramaya Health Insurance Scheme Enrolment Process

Various state governments in India implement the Niramaya Health Insurance Scheme, and here is the enrollment process for the scheme:

• Gather Required Documents: Collect the necessary documents for enrollment. These commonly include:

1. Valid disability certificate
2. Proof of residence (such as an Aadhaar card, voter ID, or ration card)
3. Income certificate or proof of annual income (usually less than Rs. 3 lakhs)
4. Identity proof (such as an Aadhaar card, voter ID, or PAN card)
5. Passport-size photographs

• Visit the Enrollment Centre: Locate your nearby Niramaya Health Insurance Scheme enrollment center. This information can usually be found on the official website of the Niramaya Health Insurance Scheme.
• Fill out the Enrollment Form: Download it from the official website. Fill in the required details accurately and completely. The form typically includes personal information, disability details, income information, and contact details.
• Submit the Application: Submit the completed enrollment form and the supporting documents to the enrollment center. The officials at the center will review the application and verify the provided information.
• Application Fee: Pay the application fee as per your PWD category. We have mentioned the details below:

• Application Processing: The concerned authorities will process the enrollment application. This may involve verification of the disability certificate, income certificate, and other relevant documents. The processing time can vary, but it is typically a few weeks.
• Issuance of Health Insurance Card: Once the application is approved, a health insurance card will be issued to the eligible beneficiary. The card will contain relevant details such as the policy number, coverage amount, and validity period.
• Avail Health Insurance Benefits: The beneficiary can access the Niramaya Health Insurance Scheme benefits with the health insurance card. This includes reimbursement of medical expenses and coverage for rehabilitation services.

Niramaya Health Insurance Scheme Claim Process

Niramaya Health Scheme offers a simple and straightforward claim process where you can only opt for reimbursement claims. Below we have mentioned the claim process of the Niramaya Health Insurance Scheme in detail:

• Download the claim form from the website. 
• Fill in all details and attach the necessary bills with it. 
• Send it to the RAKSHA Health Insurance TPA for approval. 
• Submit the form within 30 days of treatment or discharge from the hospital. 

Contact persons of Raksha TPA (Oriental Insurance Co.)      
Ms Surbhi 8588844651

To avail of a cashless treatment in the hospital, you can buy a health insurance plan from any of the private health insurance companies in India such as:

• Care Health Insurance
• Star Health Insurance
• HDFC Ergo Health Insurance
• Aditya Birla Health Insurance
• ManipalCigna Health Insurance
• Niva Bupa Health Insurance
• Ayushman Bharat Yojana
• Government Health Insurance Schemes in India

Documents Required for Niramaya Health Insurance Scheme Claim Settlement

• UDID Card No./Enroll No. under UDID 
• Disability Certificate
• Copy of Niramaya card
• Original Prescription Documents
• All original bills of Medicine / Hospital / Therapy fee / Doctor fee / Conveyance etc.,
• Original Reports
• Complete bank details of Beneficiary: Name of Account Holder / Account No. / Bank Name / Branch (City & State) / IFSC Code

Niramaya Health Card Renewal Online Procedure

Below mentioned is the renewal process for Niramaya Health Insurance Scheme:

• Guardians of PwD must bring the required documentation while renewing their Niramaya Health Scheme to the nearest Registration Organization.
• The RO will verify the documents and their validity. 
• The RO will select the renewal link on the Niramaya website. 
• At this stage, beneficiaries must pay the renewal cost of INR 250 for non-BPL beneficiaries and INR 50 for BPL beneficiaries. However, no fees are associated with the renewal process for PwD with legal guardians. 
• The policy will be renewed for another year after successful payment. 

Niramaya Health Insurance Conclusion

The Niramaya Health Insurance Scheme was established under the National Trust Act of 1999 to provide health insurance to PwDs. The plan provides insurance coverage of up to INR 1 lakh, which must be renewed annually after the financial year. The beneficiary will have to pay an enrollment fee of Rs 250 for disabled coming below the poverty line. The fee is INR 500 for people with disabilities who are above the poverty line. For PWDs below and above the poverty line, the renewal health insurance premium is Rs 250 and Rs 500, respectively.