Health Insurance for Disabilities in India

Introduction

From Hiccup Horrendous of How to Train Your Dragon, Professor X from the X-Men franchise, Dr Greggory House from House M.D. to Dr Shaun Murphy from The Good Doctor - representations of mental and physical disabilities across the screen have been getting the spotlight for a long time now.

As protagonists with different abilities gain ground, the expectation from the crowd is that they start looking at everyone as equals. Well, in this respect, the endeavours are still a work in progress and only time can say when society will turn to look at everyone as equals.

However, as far as the financial aspect of society is concerned, instrumental actions are being taken to ensure that differently-abled individuals have an equal opportunity to stay stable. One of the crucial indicators of these endeavours is the availability of health insurance plans for the disabled in India and across the globe. Such policies aim to solidify the ground for the disabled by offering financial security to cater to them during times of medical distress.

Considering how crucial health insurance plans for the differently abled are becoming, it’s time we take a look at the details of the same to see if they are at all worth the hype.

What are the different kinds of disabilities?

As per the Persons with Disability (Equal Opportunities, Protection of Rights and Full Participation) Act, 1955, India considers those individuals as

• Disabled, those who have a minimum of 40% impairment
• Severely disabled - those who have multiple disabilities with at least 80% impairment.

And here are the 3 important categories of disabilities -

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A. Congenital disabilities

Congenital disabilities are brought forth by genetic conditions, exist from birth, or are brought forth by environmental factors. Such disabilities include -

• Down’s Syndrome
• Cerebral Palsy
• Deaf and Dumb
• Blindness

B. Mental disabilities

These disabilities are brought forth by psychological ailments that often affect the decision-making power, mental balance, behaviour, and mood of an individual. These include the following ailments -

• Schizophrenia
• Dementia
• Depression
• Anxiety, etc.

C. Physical disabilities

Such disabilities are a result of an accident or congenital (eg: polio) leading to temporary, partial, or total disability. Such disabilities may affect the arms, legs, eyesight (Blindness), or hearing loss (Deaf) of an individual or may cause paralysis.

Any such disabilities bring forth a huge financial burden on the individual because they have to dedicate their life’s savings and funds towards their treatment. Needless to say, such a financial dip has a dire impact on their continued lifestyle and that of their dependents. And this is where the best health insurance plans for the disabled come into play. However, such plans are not without its drawbacks.

Things to remember when availing of health insurance plans for the disabled in India

Exclusions by the disability health insurance plan

1. Pre-Existing Conditions: Some policies might cover pre-existing conditions after a waiting period or might be completely excluded.
2. Certain Medical Treatments: Some specific medical treatments or procedures such as experimental or unproven treatments, cosmetic procedures, elective surgeries, or alternative therapies.
3. Self-Inflicted Injuries: Injuries or disabilities resulting from intentional self-harm or dangerous activities.
4. Injuries Due to Substance Abuse: Disabilities arising from substance abuse or drug-related incidents.
5. War and Terrorism: Disabilities or injuries resulting from war, acts of terrorism, or civil unrest.
6. Hazardous Activities: Disabilities incurred while engaging in hazardous activities like extreme sports, professional racing, or other high-risk endeavours.
7. Certain Age-Related Conditions: Some policies might exclude coverage for age-related disabilities or conditions.
8. Unapproved Providers or Facilities: Treatments that are not approved by the insurance company.
9. Pregnancy and Childbirth: Disabilities related to pregnancy and childbirth (depends on the type of disability insurance).
10. Mental Health Conditions: Limitations or exclusions related to mental health conditions or psychiatric treatments.
11. Congenital Conditions: Disabilities present since birth.
12. Specific Illnesses: Certain illnesses such as HIV/AIDS or certain chronic illnesses.

(High-risk profiles like heart ailments, BP etc may not be covered. This might vary from one policy to the other; hence, please refer to policy wordings for further details.)

Remember exclusions can vary from one insurance provider and policy to another. So, make sure to read the health insurance policy documents carefully and send queries to your insurance company about any confusion regarding the same.

2. Tax benefits under disability insurance India

In the case of health insurance plans for the disabled, tax benefits can be availed under Section 80U and Section 80DD and can be collected by the policyholder and the dependents. Here is a look into the capping limit of the tax benefits under these 2 sections -

3. Take into account the premium for health insurance plans for the disabled

When it comes to health insurance for disabilities, you must take into account the estimated premium. Considering that you find multiple health insurance plans, you can always opt for the health insurance comparison tool and use it for free to find a plan that doesn’t set you on a financial back foot.

4. Submission of relevant documentation before availing of the plan

Understand this - health insurance for the disabled comes with a condition: health insurance providers always factor in the % of disability before calculating the premium of a plan and the maximum coverage that one can avail.

And this disability percentage can only be verified by the insurers and/or the TPAs (Third Party Administrators) over valid disability certificates. Apart from this, certain insurers also require the mandatory submission of income proof, proposal forms, and more. Sans the submission of these relevant documents, no insurer will be willing to give out a health insurance policy for the disabled.

5. Complete declaration of medical details is mandatory

Along with the specifications of one’s disabilities, it is important to declare any pre-existing conditions too.

All of these are instrumental in determining the calculation of premiums because, with certain pre-existing diseases, health insurers put a certain loading charge on the base premium amount. So, you might be looking at a slightly upped premium. However, if you fail to declare all medical complications to your insurer, a later exposure of the same may lead to a claim rejection or a complete cancellation of your existing health insurance plan.

What are the best Government-Sponsored Health Insurance Policies for Disabled Individuals?

However, as you can see, the coverage amount across such health insurance plans is nominal and might fall short of meeting all prices involved in medical procedures and treatments. Subsequently, you must find a plan from the best health insurance providers that offer ample coverage. So, are such health insurance for disabilities available across the insurance market?

Let’s find out!

What are the best Private Health Insurance Policies for Disabled Individuals?

Note: For Care Plus and Optima Restore the % of disability should be 50%. However, the issuance of the policy depends on past medical records and the UW team.

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Conclusion

Health insurance for disabilities is a premium perk considering how it bridges the financial gap created in the case of the interruption in one’s source of income, the need for funds to ensure continued medical care, etc. However, whether such disability insurance is best with a health policy or a term insurance plan is up for discussion with subject experts.