Health Insurance for persons with Disabilities is a buzzword in Insurance sector. 

After the outbreak of the COVID-19 pandemic, Health Insurance became one of the priorities of every Individual.

Presently hardly anyone think of going for hospitalization without having his/her health Insurance. It becomes more important in case of persons with Disabilities.

As the advancement of the Healthcare sector along with treatment methods, the cost of any treatment is also risen up, and this is why the need for Health insurance became the priority of every individual. 

Its presence not only supports you financially but also to keep you calm and relaxed during those critical hours of hospitalization.

Health Insurance becomes much more critical in the case of persons with disabilities. 

As they require continuous health expenses due to their condition and most of Insurance companies do not cover treatment cost of this nature.  

Who are the Special  Needs Persons or Person with Disabilities

As per Investopedia, Special Need or Person with Disabilities refer to those youth who require continuous monitoring, special care, and attention by others even for performing their routine work.

They have a specific type of Disability either in the abnormal growth of their body part or in the slow development of their Mental state. 

In simple terms, we can say that they are not a normal human being in behavior or in body parts; that’s the reason they require continuous assistance or help from others.

What is the Challenge for persons with Disabilities

From an Insurance viewpoint, the requirement of Health insurance in these cases are a little bit different in comparison to normal seeking health Insurance.

That’s the reason many insurance companies do not cover the cost of treatment for these kinds of abnormalities under their regular insurance policies.

That’s why some Insurance companies had launched their special type of Health Insurance policies for covering the cost of treatment for persons with disabilities.

Apart from Insurance companies, the Government had also Launched some medical schemes for covering these persons with disabilities.

Available Health Insurance for Persons with Disabilities 

As mentioned above, apart from Insurance companies, Government also Launched some schemes for these persons with Disabilities in India.

Swavlamban Yojna

An Initiative of Central Government launched on October 02, 2015.

The aim was to cover the medical treatment cost of persons with Disabilities due to Autism, Mental retardation, Cerebral Palsy, Multiple disabilities on discounted Premium.

Insurance Company- The New India Assurance Company Limited

Third-Party Administrator(TPA)-Vidal Health Insurance TPA Services

Eligibility- The total Family income should be less than or equal to INR 3 Lacs.

Main Features- This was the Group Health Insurance Scheme on a Family Floater basis. 

Sum Insured- INR 2 Lacs. for an Individual or family

Total Premium- approx. 3500/- per annum (90% subsidy by Government, only 10% needs to pay)

Period of cover- 12 months from date of policy issuance

Age Band- 0-65 years

Primary Person Insured- Person with Disability.

Family Insured- In case of

-A person with Disability < 18 years – Parents/Legal Guardians

– A person with Disability > 18 years- Spouse and 02 Children(upto the age of 18 years)

Covered under Yojna-  

OPD cover for persons with mental retardation and mental illness: INR 3000 p.a. (only for the Disability for which disability certificate is issued from network hospitals)

Hospitalization must be for a minimum of 24 hours

• Pre-existing Diseases/medical conditions: Covered
• Pre and Post Hospitalization Expenses
• Room rent, ICU/ICCU/CCU expenses, Ambulance expense

Not Covered under Yojna-

• AYUSH(Ayurveda, Unani, Siddha, Homeopathy) for inpatient/outpatient care
• Naturopathy is not covered

Niramaya Health Insurance Scheme

 Niramaya Health Insurance Scheme was launched by the Government of India under the Department of Empowerment of Persons with Disabilities (Divyangjan).

   The aim was to cover the medical treatment cost of persons with Disabilities due to Autism, Mental retardation, Cerebral Palsy, Multiple disabilities. 

Coverage- Autism, Mental retardation, Cerebral Palsy, Multiple disabilities

Insurance Company- Oriental Insurance Company Limited

Third-Party Administrator(TPA)– Raksha TPA Private Ltd.

Sum Insured- INR 1 Lacs. for individuals or family, on a reimbursement basis only.

Geographical Limit- All India except Jammu & Kashmir

Covered under Scheme-

• Single premium across age band Provide same coverage irrespective of the type of disability covered under the National Trust Act
• Insurance cover up to INR 1,00,000/- Lac.
• All persons with disabilities under the National Trust Act with valid disability certificate will be eligible and included
• No pre-medical tests required
• Treatment can be taken from any hospital

i. Hospitalization Coverage limit – INR 70,000/-

• Corrective Surgeries for existing Disability including congenital disability INR 40,000/-
• Non- Surgical/ Hospitalization INR 15,000/-
• Surgery to prevent further aggravation of Disability INR 15,000/-

ii. Outpatient Department (OPD) Coverage limit – INR 14,500/-

• OPD treatment including the medicines, pathology, diagnostic tests, etc. INR 8,000/-
• Regular Medical checkup for non-ailing disabled INR 4,000/-
• Dental Preventive Dentistry INR 2,500/-

iii. Ongoing Therapies to reduce impact of Disability and Disability related complications INR 10,000/-

iv. Alternative Medicine INR 4,500/-

v. Transportation costs INR 1,000/-

Premium Chart-

Premium under this scheme will be charged as per below:-

• Below Poverty Line (BPL) -INR 250/-
• Non Below Poverty Line (Non BPL) -INR 500/-
• Person with Disabilities with Legal Guardian (other than natural parents) – Free

Period of cover-

Valid till March 31st of the financial year in which enrolment is undertaken. Beneficiaries are required to submit the renewal application three months prior to expiry to continue availing the scheme.

PRIVATE INSURANCE COMPANIES

Some Private Insurance companies also launched some policies to cover treatment cost of special needs or Person with Disabilities.

Star Health and Allied Insurance Company Limited

Policy Name- Star Special Care

Period of cover: 12 month from date of policy issuance

Sum Insured : INR 3,00,000/-

Covered  under policy : 

• Room Rent, ICU/ICCU/CCU
• Anesthesia, Blood, Oxygen Charges
• Emergency Ambulance Cover
• Post Hospitalization expenses cover up to 7% of Hospitalization expenses or actuals up to 60 days of discharge from the hospital

Diseases wise Limits

• Adeno Tonsilectomy INR 25,000/-
• Hospitalization for Treatment of Seizures INR 30,000/-
• Hospitalization for treatment of fractures requiring surgery Up to 20% of the sum insured.
• Botox injection- INR 5,000/- per sitting subject to a maximum of INR 20,000/- per policy period. (Payable when administered during inpatient hospitalization only)
• Behavioral Therapy,mPhysiotherapy, Occupational Therapy and Speech Therapy- Up to INR 1,500/-(These therapies can be taken as an outpatient also) 

Co-payment Condition- This policy is subject to co-payment of 20% of each and every claim amount for fresh as well as renewal policies.

Pre Existing Disease Cover(PED)- After 48 months of continuous running of the policy

Waiting Period- First 30 days for all treatment except accidental cases

                                                                        Premium Chart

Age-band (in years)                                                                                Gross Premium(in INR) 

         3-10                                                                                                              4,800

         11-20                                                                                                             5,325

         21-25                                                                                                            6,075

Note: Please check coverage and exclusions carefully before buy any Insurance coverage.

Tax Benefits for Health Insurance for persons with Disabilities

Health insurance policies for Persons with Disabilities disabilities can avail the tax benefits under section 80U and section 80DD of the income tax act. Under section 80U, an individual is entitled to receive a tax deduction of INR 50,000 for having 40% to 79% disability, if a person with above 80% disability can avail the tax deduction of INR 1,00,000.

On the other hand, as per section 80DD, the dependent disabled person’s family members can claim deductions. If his or her Disability is between 40% and 79%, the family member can receive deductions of INR 50,000 on the health insurance plan that covers the disabled. Whereas, for disabilities, more than 80%, INR 1,00,000 deduction can be availed.