Insurance
Insurance Benefits The government-funded Niramaya scheme extends health insurance cover of Rs 100,000 to persons with autism, cerebral palsy, mental retardation and multiple disabilities, bringing a large section of disabled people into the healthcare system
According to the 2001 census, about 22 million people in India are disabled. The WHO reports a figure of 70 million in 2007, the largest national population of disabled people in the world. Every year thousands of people with disabilities need medical care but cannot afford it because of the high cost of treatment. Following the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act in 2000, under which children with mental disabilities were provided a legal guardian, the government has been under pressure from various organisations to allow people with these disabilities to be covered under life and health insurance schemes.
In 2008, the Government of India finally launched a health insurance scheme called Niramaya, for persons with autism, cerebral palsy, mental retardation and multiple disabilities. The scheme can serve a large section of people who so far have remained outside the scope of any medical insurance in the country.
The Niramaya scheme is disabled-friendly in form and conditions. It is implemented and monitored by the National Trust for Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities through a Third Party Nodal Agency (TPNA) with the active participation of the Local Level Committees (LLC). The TPNA will liaise with the insurance company, empanelled health service providers, LLCs, the National Trust, the state government and all the stakeholders concerned, to generate awareness about the scheme, to underwrite the risks, and to ensure speedy settlement of claims.
The main idea in introducing such a scheme is to enable persons with disability to have access to health services like any other person.The services covered by the insurance scheme include regular medical check-ups, hospitalisation, therapy, corrective surgery and transportation. With the availability of such health services at affordable costs, parents will be encouraged to take their children to health centres regularly, even for cases that are not serious. It will certainly improve the general health conditions of people with disability.
The annual premium for this health scheme is initially pegged at Rs 350 per annum. If an insured person with cerebral palsy, mental retardation, autism or multiple disabilities has an income of less than Rs 15,000 per month, the premium will be shared by the state government and the central government/National Trust.
The insurance cover for every person in the scheme is up to Rs 100,000.This is like a group insurance scheme.The insurance company has the right to stop entertaining any further claim any time in a year if the total amount of the claim exceeds the total premium amount.
The scheme aims to serve 100,000 people below the poverty line, with categorised disability in its first phase of implementation (two years) in 10 districts in 10 states: Central Delhi in Delhi, Chandigarh in Haryana, Jabalpur in Madhya Pradesh, Kaimur in Bihar, Agartala in the northeast, Rae Bareily in UP, Erode in Tamil Nadu, Ernakulam in Kerala, Ahmedabad in Gujarat and Bhageshwar in Uttarakhand.
There is no lower or upper age limit and a single premium applies across all age bands. Moreover, people may enter the scheme irrespective of the condition of their health. No medical tests are required prior to the contract with the insurance company, as is required for regular health insurance schemes. Pre- and post- hospitalisation expenses such as pathology, radiology, advanced diagnostic tests, post-operative monitoring and therapies etc are also included. All modes of authorised treatment – allopathic, homoeopathy, unani, ayurvedic, siddha etc -- are permitted. The scheme provides for cashless settlements in all listed hospitals and their branches all over India using smart or biometric cards provided by the authority. Treatment can also be availed of in hospitals other than those prescribed, but here payment is not cashless but will be reimbursed. Criteria for empanelled hospitals and nursing homes are also clarified. The National Trust will maintain the details of each beneficiary covered under the scheme, including their identification.
