The primary objective of the Niramaya scheme is to ensure that individuals with disabilities have access to necessary medical care and financial support for their healthcare needs. The scheme will be available in the entire country except J&K.
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Eligibility Criteria
1. Registered with the National Trust – To be eligible for the Niramaya scheme, the individual must be registered with the National Trust and have a disability as defined under the National Trust Act.
2. Income Criteria – There are no specific income criteria for the general category. However, special provisions and subsidised premiums are available for individuals from below poverty line families.
3. Documentation – Required documents typically include proof of disability, proof of age, identity proof, and income certificate (for BPL families). For those below the poverty line, the premium for this plan is set at ₹250, while it is ₹500 for those above the poverty line.
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Key Features
1. Coverage – The scheme offers health insurance coverage to persons with disabilities, specifically those registered under the National Trust Act. This includes individuals with autism, cerebral palsy, mental retardation, and multiple disabilities. The scheme provides insurance coverage of up to ₹1,00,000 which must be renewed annually after the financial year.
2. No Pre-Insurance Medical Tests – Beneficiaries are not required to undergo any pre-insurance medical tests to enrol in the scheme, making it accessible to a wider range of individuals.
3. Easy Enrollment Process – The enrollment process for the Niramaya scheme is straightforward. Beneficiaries can apply through registered organisations, NGOs, or directly through the official website of the National Trust. Here is the link of registered organisations.
4. Extensive Coverage – The scheme includes a wide range of medical services, such as Outpatient Department (OPD) treatments, regular check-ups for non-ailing disabled individuals, preventive dentistry, non-surgical hospitalisation, surgeries to prevent disability aggravation, treatment for congenital disabilities, ongoing therapies, and alternative medicine.
5. Eligibility Based on Disability Certificate – People with Disabilities (PwDs) holding a valid disability certificate under the National Trust Act are eligible for benefits under this scheme, ensuring coverage for genuine beneficiaries.
6. Pre and Post-Hospitalization Coverage – The Niramaya health insurance covers both pre-hospitalization and post-hospitalization expenses, providing comprehensive financial support for beneficiaries throughout their medical care journey. This ensures all aspects of their healthcare needs are addressed.
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Benefits and coverage details of the scheme
1. Hospitalisation Expenses – The scheme covers expenses incurred during hospitalisation, including room charges, doctor fees, nursing charges, and the cost of medical procedures.
2. Outpatient Care – It also includes coverage for outpatient consultations, diagnostic tests, and prescribed medications.
3. Therapies and Rehabilitation – A significant feature of the Niramaya scheme is its coverage for various therapies such as physiotherapy, occupational therapy, speech therapy, and other rehabilitative treatments necessary for individuals with disabilities.
4. Corrective Surgeries – The scheme provides financial assistance for corrective surgeries, which are often crucial for improving the quality of life for persons with disabilities.
5. Transportation – The scheme includes coverage for the transportation costs of the insured person to the healthcare facility, ensuring that access to medical care is not hindered by logistical challenges.
6. Freedom to Choose Hospitals – Beneficiaries have the freedom to select any hospital or healthcare centre for their medical treatment. They can then file a reimbursement claim, offering them flexibility and control over their healthcare choices.
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Here’s a table listing the sub-limits for various medical expenses under the plan:
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In conclusion, the Niramaya Health Insurance Scheme, established under the National Trust Act, 1999, aims to provide health insurance coverage for persons with disabilities (PwD). The scheme offers insurance coverage of up to ₹1 lakh, with an annual renewal requirement at the end of each financial year. Beneficiaries are required to pay an enrollment fee, set at ₹250 for persons with disabilities below the poverty line and ₹500 for those above the poverty line.
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During renewal, the health insurance premium stands at ₹250 and ₹500 for PwD below and above the poverty line, respectively. This initiative signifies a significant step towards enhancing healthcare accessibility for the underprivileged PwD community.
Noteworthy features, including uniform coverage for all disabilities, the freedom to choose healthcare providers, and a streamlined enrollment process, ensure accessibility and equality for beneficiaries. The focus on preventive and ongoing care, coupled with the scheme’s dedication to inclusivity and equal opportunities, is a significant step toward improving the well-being of individuals with developmental challenges.
Rohit Gyanchandani is Managing Director at Nandi Nivesh Private Limited
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Published: 06 Jun 2024, 09:38 AM IST