Key Features of the Scheme
- Health insurance cover of up to Rs. 1,00,000
- Provision of the same coverage for all types of disabilities.
- It covers OPD treatment. It covers medicines, pathology and diagnostic tests and regular medical checkup for non-ailing disabled
- It covers Dental Preventive Dentistry, Surgery to prevent further aggravation of disability, Corrective Surgeries for existing Disability including congenital disability
- Non- Surgical Hospitalization and Ongoing Therapies to reduce impact of disability and disability related complications are covered.
- Alternative Medicine and Transportation costs are included too.
- PwD has to have a valid disability certificate for availing benefits of the scheme.
- The scheme has to be renewed yearly.
- A Niramaya Health ID/Card will be given to the insured which should be used for claim process etc.
Eligibility Criteria for PwD
All PwDs who have at least one of the disabilities under the National Trust Act, 1999 with valid disability certificate are eligible to apply for the scheme.
Complete the Niramaya application form and upload it and relevant scanned documents as required after verification of originals. The form can be downloaded from here.
Pay the fees. For a PwD below poverty line, the enrolment fees is Rs. 250 and for a PwD above poverty line, it is Rs. 500. A PwD with a legal guardian (no natural parents) can get enrolled for free.
Benefits of the Scheme
- Pre-existing conditions are not excluded unlike most insurance schemes that have many conditions around pre-existing diseases and/or conditions.
- The insured can take treatment in any hospital.
- Pre-insurance medical tests are not required.
- Here is the benefit chart (revised in 2015)
Claims for settlement under Niramaya have to be submitted to the insurer. Relevant bills and invoices along with Niramaya documentation have to be submitted within 30 days of treatment or discharge from hospital. The claim form can be downloaded from here. The claim form can be submitted to the Third Party Administrator – Raksha TPA Pvt. Ltd. Here is a list with their branch details.
- Currently cashless hospitalization is suspended.
- It is not applicable in Jammu and Kashmir.
- In case of death of beneficiary, claim/compensation is not payable as it is a health insurance scheme and not a Life Insurance Scheme.
It is an affordable health insurance scheme for the disabled. It would be better if there were options for increasing the sum assured.