What is the Niramaya Health Insurance Scheme?

What is Niramaya Health Insurance Scheme? The Niramaya Health Insurance Scheme is a government-backed plan for persons with disabilities, offering annual coverage of up to ₹1,00,000. It covers hospitalization, surgeries, therapies, preventive checkups, OPD, Dental, and AYUSH treatments, with no age limit. To qualify, applicants must hold a valid disability certificate under the Persons with Disabilities Act. Claims can be filed at both private and public hospitals through the reimbursement mode.

What if your ability to access essential healthcare depended not just on your health, but also on your disability? For many people with disabilities in India, this is a daily reality. From routine checkups to ongoing therapies or sudden hospital visits, healthcare costs can become overwhelming and often inaccessible.

To ease this burden, the Government of India introduced the Niramaya Health Insurance Scheme in 2015. 

In 2023-24 alone, 87,746 Divyangjan were enrolled under the scheme, with a total expenditure of ₹13.86 crore. The scheme is currently implemented through M/s. Oriental Insurance Co. Ltd and managed by Medi Assist TPA.

In this guide, we’ll break down everything you need to know about the scheme, how to qualify, the benefits it offers, and the steps to apply so that you can make the most of it.

Compare Niramaya and other health insurance plans today with Ditto. Get expert guidance and enroll hassle-free!

Niramaya Health Insurance Scheme: Key Features and Benefits

Before we dive into the key features, let’s understand what sets Niramaya apart from traditional health insurance. 

It’s tailor-made to support the unique healthcare needs of persons with disabilities, and there are no pre-insurance medical tests, making it more accessible to those who need it most.

Now, let’s dive into the benefits: 

1) Comprehensive Health Coverage

The Niramaya health insurance scheme covers a wide range of medical treatments

• Hospitalization: Costs for hospitalization are fully covered, ensuring that individuals can access necessary care without worrying about the expenses.
• Surgery: Surgical expenses to prevent further disability worsening for existing disabilities (including congenital conditions that cause disability). Pre- and post-surgery care are also included under the scheme. 

2) Regular Medical Checkups

Preventive healthcare is a key part of the Niramaya Scheme. The policy includes coverage for regular medical checkups, allowing individuals to monitor their health and catch potential issues early, which can lead to better long-term health outcomes.

3) Ongoing Therapies

For individuals requiring therapies like physiotherapy, occupational therapy, or speech therapy, the Niramaya Scheme provides financial coverage to ensure continuous care, aiding in improved quality of life and independence.

4) AYUSH Treatment

The scheme also supports alternative medical treatments under the AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) system, offering a holistic approach to healthcare.

5) Freedom to Choose Hospitals

Niramaya health insurance offers the flexibility to choose any hospital of your choice and file a reimbursement claim for your treatment later. 

6) No Age Limit

One of the most significant features of the Niramaya Health Insurance Scheme is that it has no age limit. Whether you're a young child or an older adult, the scheme offers health coverage for individuals with disabilities of all ages. This inclusive policy ensures that everyone, regardless of their age, has access to the necessary healthcare.

Here’s a coverage amount breakdown for your reference:

Section	Sub-Section	Detail	Sub Limit	Overall Limit of Section
I	Overall Limit of Hospitalization			55,000/-
	A	Corrective Surgeries for existing Disability including congenital disability (Under SECI(A)a maximum capping of Rs.15000/-For other than the corrective surgeries for Existing Disabilities, which is include in the overall limit of Rs.40,000/- of Sec I(A))	40,000/-
	B	Non-Surgical / Hospitalisation	15,000/-
*II	Overall Limit for Out Patient Department (OPD)			19,000/-
	A	OPD treatment including the medicines, pathology, diagnostic tests, etc.	15,000/-
	B	Dental Preventive Dentistry	4,000/-
**III	Ongoing Therapies to reduce impact of disability (Physiotherapy, occupational, speech therapy)			20,000/-
IV	Alternative Medicine-AYUSH			4,000/-
V	Transportation costs (Travel to and from medical centers)			2,000/-
OVERALL LIMIT OF THE COVERAGE FOR A PERSON: Rs. 1,00,000/-

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Note: Beneficiaries or their parents/caretakers can also enroll directly under the Niramaya Insurance Scheme through the National Trust website starting from 2023-24, provided they have the UDID Card number or UDID Enrolment number (along with a Disability certificate issued by a competent authority).

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If you’re unsure whether you’re eligible for Niramaya or want to look at other health insurance plans, book a free call with Ditto, and our advisors will help you out. 

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What are the Eligibility Criteria for the Niramaya Health Insurance Scheme?

The scheme is available to individuals with a disability as defined under the Persons with Disabilities Act, 1995. This includes a variety of conditions, such as autism, cerebral palsy, intellectual disability, and multiple disabilities.

Applicants must provide a disability certificate issued by a medical authority to confirm the type and extent of their disability.

How to Apply for the Niramaya Health Insurance Scheme?

Applying for the Niramaya Health Insurance Scheme is straightforward:

Step 1: Ensure Eligibility

The applicant must be a person with a disability as recognized under the Persons with Disabilities Act.

• Offline Application: Parents/guardians of the PwD can visit the nearest Registered Organization (RO) for assistance with the application and document verification.
• Online Application: The RO will fill out and submit the application form online on behalf of the beneficiary.

Step 2: Complete the Application Form

You need to provide documents such as:

• A disability certificate issued by a medical authority, confirming the disability
• Other identification documents, like proof of identity and address
• Passport-size photograph
• Income Certificate (to determine premium category: BPL or APL)
• Bank details (for claim settlement)

Step 3: Submit Required Documents

You need to provide documents such as:

• A disability certificate issued by a medical authority, confirming the disability
• Other identification documents, like proof of identity and address
• Passport-size photograph
• Income Certificate (to determine premium category: BPL or APL)
• Bank details (for claim settlement)

Step 4: Submit Application

Once the form is filled out and the documents are ready, submit your application to the designated insurance provider or the relevant authority managing the scheme.

Step 5: Wait for Confirmation

After processing, you will receive confirmation of your enrollment and the health ID card.

Note: For help, you can reach out to the helpline numbers provided on the official National Trust site. 

Premium Details

The National Trust arranges the premium and makes the payment to the insurance company.

However, applicants must pay a nominal enrolment or renewal fee each year. 

• For individuals below the poverty line (BPL), the enrolment fee is ₹250 and the renewal fee is ₹50. 
• For those above the poverty line (APL), the enrolment fee is ₹500 and the renewal fee is ₹250. 
• Persons with disabilities who are under the care of a legal guardian (other than natural parents) are exempt and can enrol or renew the scheme free of charge.

These fees are applicable annually, and the policy must be renewed before 31st March each year to maintain uninterrupted coverage. 

Renewal can be done online via the Niramaya website using Policy Period, Beneficiary ID, UDID, etc. The process is simple: RO verifies documents, and upon fee payment, the scheme is renewed for another year.

Did You Know? The IRDAI now mandates all health insurers to offer dedicated products for Persons with Disabilities (PWDs), individuals with mental illness, and those living with HIV/AIDS. Insurers cannot deny coverage solely based on disability, mental illness, or HIV status, and underwriting must be non-discriminatory. This directive flows from the Rights of Persons with Disabilities Act, 2016, the Mental Healthcare Act, 2017, and the HIV/AIDS Act, 2017. Therefore, health insurers are legally required to design inclusive policies that must include the minimum coverage features set by the IRDAI. Popular plans like Care Saksham, HDFC Equi Cover, and Star Special Care Gold have been introduced in response to this mandate.

How to File a Niramaya Health Insurance Claim?

Filing a claim under the Niramaya Health Insurance Scheme is a simple process that can be done online through the MediAssist portal or mobile app. Follow these steps to ensure smooth claim settlement:

1) Prepare Your Documents

Collect all relevant documents, including:

• Prescribed Claim Form (available on the MediAssist portal)
• Original bills, vouchers, and discharge summary from the hospital or treatment center
• Any other supporting medical documents

Note: Claims should preferably be submitted within 30 days of treatment or hospital discharge.

2) Log in to the MediAssist Portal or Mobile App

Go to the MediAssist website or download the MediAssist app from your phone’s app store. 

• Username: <Application_ID>@nationaltrust.com
• Password: Beneficiary’s Date of Birth in DD-MM-YYYY format

3) Submit your claim online

• Click on "Submit Claim"
• Fill in the required treatment and hospitalization details
• Click "Save and Next" to proceed through the form

4) Upload KYC and Supporting Documents

• On the third page, upload employee KYC documents (one-time activity)
• Upload scanned copies of all relevant documents, such as bills, payment receipts, hospital discharge summaries, doctor’s prescriptions, and diagnostic reports. 

Note: If you need help, their claim helpline is 040-68178569 / 71326135

5) MediAssist Support

• Phone: 040-68213648
• Toll-Free: 1800-572-9792
• Email: niramaya@mediassist.in

What are the Disabilities Covered in the Niramaya Health Insurance Scheme?

The Niramaya Health Insurance Scheme provides coverage for disabilities, as defined under the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation, and Multiple Disabilities Act, 1999.

The coverage is inclusive of both physical and mental disabilities, and the scheme is designed to provide medical support for a wide range of conditions related to disability.

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Conclusion

The Niramaya Health Insurance Scheme plays a vital role in making healthcare accessible for persons with disabilities by covering a broad range of treatments without age restrictions. With benefits like hospitalization, therapies, and OPD support, it eases the financial stress of ongoing medical care. However, applicants should carefully review eligibility and documentation requirements before applying.

If you’re unsure whether Niramaya is the right fit or want guidance on other health insurance options, speak to Ditto’s advisors. We can help you compare policies and choose the most suitable plan for your needs.

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