Niramaya – Health Insurance Scheme for the Disabled

Niramaya is a Health Insurance Scheme for the welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities.


Objective

In order to enable and empower persons with developmental disability to live as independently and as fully as possible, health services and their access to persons with developmental disabilities assume a very significant role. In this context, the health insurance facility becomes important but presently such products are not easily available for persons with developmental disabilities. In such a situation, a health insurance scheme “Niramaya” is conceived with the following objectives.

  1. To provide affordable Health Insurance to persons with Autism, Cerebral Palsy, Mental Retardation & Multiple Disabilities.
  2. To encourage health services seeking behaviour among persons with developmental disability.
  3. To improve the general health condition & quality of life of persons with developmental disability
Scheme & its coverage

The scheme envisages to deliver comprehensive cover which will

  • Have a single premium across age band
  • Provide same coverage irrespective of the type of disability covered under the National Trust Act.
  • Insurance cover up to Rs.1.0 lakh.
  • All persons with developmental disabilities will be eligible and included and there will be no ‘selection’.

The scheme further envisages that there shall be

  • No exclusion of Pre-existing condition
  • Same cover as that for other persons
  • Services ranging from regular Medical Check up to Hospitalization, Therapy to Corrective Surgery, Transportation.
  • Conditions requiring repetitive medical intervention as an in-patient.
  • Pre & Post hospitalization expenses, subject to limits.
  • No pre-insurance medical tests.
  • Cashless hospitalization in empanelled hospitals, reimbursement of claims in case of OPD services and treatment through non-empanelled hospitals.
Premium for enrolment

• Rs. NIL for Below Poverty Level (BPL)
• Rs. 250/- whose monthly income is up to Rs.15, 000/-
• Rs. 500/- whose monthly income is above Rs. 15,000/-
• Payment should be made in the National Trust Account No: ………….at any Branch of State Bank of India or Account No: …….. at any Branch of Corporation Bank.

Documents required along with Application

• Disability Certificate (Xerox copy)
• Photo (passport size)
• Residence Proof (Xerox copy)
• Income Certificate (Xerox copy) &
• Payment voucher

Enrolment of Beneficiaries

Any eligible person can apply for enrolment under the Scheme and submit the Application to the nearest organization registered with the National Trust or to any other agencies specially entrusted in this regard by the National Trust. On successful enrolment and approval, Health ID No. / card will be issued to each beneficiary.

There will be a nominal processing fee as determined from time to time which shall be payable to the National Trust.

Premium & other charges

The insurance company shall be selected and premium shall be decided through a transparent process. The premium amount shall be paid by the National Trust in advance to the selected Insurance Company.

Stop Loss

In case of total claims exceeding the total premium amount, the Insurance Company will cover the risk up to 120% of the total premium amount i.e. the insurance company can have a stop loss at 120% of total premium amount. Similarly in case of claims falling short of total premium amount, the Insurance Company shall pay back 90% of the savings, after deducting 20% as administrative cost.

Implementation

The entire scheme may be implemented & monitored by the National Trust through registered organisation with the active participation of the Local Level Committees (LLC). The registered organisation shall liaise with the Insurance Company, health service providers, LLCs, State Nodal Agency Centres (SNAC) of the National Trust, State Govt. and all the stakeholders concerned for awareness generation, enrolment as well as for the speedy settlement of claims.

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