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Nirmaya is a health insurance scheme which is specially designed for people with special needs. Read futher to know more!

Nirmaya is a health insurance scheme which is specially designed for people with special needs. Read futher to know more!

Balwant Jain

15 Jul 2010

Taking into account the overwhelming response to my article captioned

Benefits for Special Needs People in DNA on June 15, 2010 having mention of insurance scheme Niramaya administered by The National Trust, and subsequent requests for the details of the scheme, I am giving the details of Niramaya in this article.


Niramaya is the insurance scheme specifically designed for the Special needs people who are suffering from Autism, Cerebral Palsy, Mental Retardation, multiple disabilities (sclerosis) and other similar diseases. The scheme has turned out be a real boon for the family of these people who have been financially burdened with medical costs. Around 85,000 people registered under this scheme are availing the benefit of this novel group health insurance scheme. The number is still very small considering the number of people who need to benefit, and this is due to very low awareness about this scheme in general public. Thus I felt it is important that all of us contribute in our own ways to create awareness about the scheme.


Salient Features:


This scheme covers existing disease without any medical check up and no premedical check up is required for enrolling under this scheme. This scheme is unique in the sense that there is no upper or lower age limits for enrollment. The other unique feature about this scheme is that the premium charged for coverage under this scheme is uniform across all the age groups.


What it covers:


The Niramaya scheme covers overall medical expenses upto Rs. One lac within separate sub limits, besides many other expenses, which are normally not covered under regular health insurance plans like OPD treatment, regular medical check up, corrective surgery for existing disability etc. in addition to the regular expenses on hospitalization. This scheme also covers expenses incurred for transportation of the patient as well as cost of alternative medicines.


The sub limits within overall cover of Rs. One lac are given below:


Nature of expense

Overall Limit or sub limit (Rs.)

Corrective Surgeries

Rs. 50,000

Preventive Surgery to prevent aggravation

Rs. 15,000

Post operation care and therapies for six months

Rs. 15,000

Domiciliary Hospitalization reimbursement

Rs. 20,000

Out Patient Treatment reimbursement

Rs. 15,000



The sub limits within the overall cover for Rs. 15,000 for OPD are as given below:

Nature of expense

Overall Limit or sub limit (Rs.)

OPD Treatment including pathology and diagnostic test

Rs. 10,000

Regular Medical check up for non ailing disabled

Rs. 5,000

Ongoing therapies to reduce the of disability and its complications

Rs. 7500

Dental Preventive Dentistry

Rs. 7,500

Transportation

Rs. 1,500

Alternative Medicines

Rs. 2,000


How to get covered


The scheme is administered by The National Trust (www.thenationaltrust.in) in collaboration with ICICI Lombard General Insurance Company Limited. The applications for this insurance scheme are accepted through registered organization which are primarily trusts and NGOs. (The area wise list of registered organizations and the enrollment forms are available on the website of the National Trust mentioned above). The applicant is required to submit the fully filled in enrollment form to the trust along with the proof of payment of applicable fee. The families Below Poverty Line (BPL) need to submit the copy of BPL card as there is no fee payable in such cases. In case they do not have BPL card, they can obtain copy of income certificate from the authority which is competent to issue the BPL card.


The enrollment can be done throughout the year but the process of covering the patients under this scheme has two cut off periods. People enrolled from 1st September to 28th February under first phase are covered from 2nd April and those enrolled from 1st March to 31st August in second phase are covered from 2nd October. The registered organization furnishes the details to The National Trust. The details received from the NGOs are forwarded to ICICI Lombard who in turn issues the health card, which are forwarded to the concerned registered organization through which the respective applications had come.


The application for renewal should be done well in advance accompanied with payment of proof of appropriate fee. The fee is required to be directly deposited into the account of The National Trust.


Medical screening is not insisted for enrollment under the scheme. Every beneficiary is issued a Smart/biometric cards once he/she is covered which enables him in accessing the services in empaneled hospitals.


The costs involved:


A family having income of less than Rs. 15,000 per month needs to make a payment of Rs. 250 annually for the person inflicted. Families having income of more than Rs. 15,000 per month are also eligible but the insurance premium payable would be Rs. 500 for the patient. For the BPL families, this scheme is provided free of cost as the cost is borne by the Government. .


Earlier Niramaya like other regular health insurance plans used to offer cashless facilities which have been discontinued w.e.f. 11th March 2010 and now only offers reimbursement facilities for expenses incurred. The cashless facility will be resumed once the deficit is covered.


This way we see that Niramaya can bring ray of life to the lives of special needs people with its novel features, nominal premiums and above all the genuine intentions.


I request you to take the message across amidst your family members and acquaintances and who knows you become harbinger of lighting up a person's life whose life is special for all of us.

Not only this you will be lending a helping hand to The National Trust to save on the publicity costs which is around 40% of the overall costs , including servicing cost of this insurance scheme.