• Health Insurance Coverage for the Disabled in India

    Health Insurance
    • Enjoy options to cover yourself, your spouse, kids and even your parents
    • Enjoy access to 10,000+ hospitals for cashless treatment
    • Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

    India is country where health insurance penetration is still low compared to other developed and developing nations in the world. Though we have a long way to go in terms of implementing universal health cover for all citizens, people are gaining awareness about the importance of health insurance day by day. Health insurance penetration levels could be worse when it comes to coverage for persons with disabilities (PwDs). Health insurance plans for the disabled are already in practice under many forms.

    The general perception among people is that disabled people cannot get access to any kind of health insurance coverage. While there are many roadblocks for the disabled in getting access to health insurance, it is not completely impossible. The government is also doing its part when it comes to providing insurance coverage for people with disabilities. Let us see in detail about the different forms of insurance that are available for people who have different kinds of disabilities.

    Swavlamban Health Insurance Scheme

    This is an affordable health insurance scheme designed specifically for PwDs. This plan was launched by renowned public-sector general insurer New India Assurance Ltd. in collaboration with the ‘Trust Fund for Empowerment of Persons with Disabilities’. This scheme was primarily developed with the intention of improving the quality of life of a disabled person. With the comprehensive health insurance coverage under this scheme, PwDs can live independently without compromising on their dignity.

    One of the main eligibility criteria for this scheme is that the overall family income of the PwD must be less than Rs.3 lakh per year. Some of the key features of this policy can be listed as follows:

    • This health insurance coverage is available for a PwD between the age of 18 years and 65 years.
    • The maximum sum insured amount available under this scheme is Rs.2 lakh, which can be utilized on a family floater basis.
    • The family floater cover is available for the primary insured, his/her spouse, and two dependent children.
    • Beneficiaries can get access to both hospitalisation coverage and OPD coverage under this scheme.
    • This scheme also provides cashless treatment (up to the sum insured limit) through the network hospitals associated with New India Assurance.

    Niramaya Health Insurance Scheme

    This is another government-backed scheme specifically designed for PwDs. This scheme was developed to provide affordable health insurance access to persons with multiple disabilities, autism, cerebral palsy, mental retardation, etc. The main focus of this scheme is to reduce the impact of disability and improve the quality of life for PwDs. One of the highlights of this scheme is that it comes with an affordable premium that remains the same across all age bands.

    Some of the key features of this scheme can be listed as follows:

    • The maximum benefit that can be availed under this policy is Rs.1 lakh.
    • In that total sum insured amount, Rs.70,000 is allocated is for inpatient hospitalisation expenses.
    • The remainder is allocated for other expenses such as outpatient treatment expenses, ongoing therapies, transportation costs, and alternative medicine treatments.
    • Eligible beneficiaries can also make claims for pre-existing conditions, pre-hospitalisation expenses, post-hospitalisation expenses, routine medical checkup, etc.

    Health Insurance Options Among Private Insurers

    While it may be slightly difficult for PwDs to enroll themselves in health insurance plans offered by private insurers, it is not entirely impossible. The type of insurance available for a person is likely to vary from one to another depending upon the severity of the condition. Most health insurance policies do not provide any coverage for people with permanent total disabilities or severe mental disabilities. However, conditions like amputated limbs, learning disabilities, speech disabilities, etc. are generally covered by health insurers.

    PwDs applying for health insurance must declare their disabilities and existing conditions to the insurance company. The insurer may ask for some extra medical tests to assess the condition of the applicant. It is also necessary for applicants to provide certificates issued by their physicians. Once all the necessary evaluations are done, the applications of PwDs will be accepted by insurance companies. In certain cases, the insurer may accept the application with an extra loading on premium charges.

    Congenital Disability vs. Accidental Disability

    Unlike accidental disabilities, congenital disabilities arise out of birth defects and related complications. PwDs who suffer from congenital disabilities are often categorized as high-risk applicants when they apply for a health insurance plan with a private insurer. Most private health insurers do not provide coverage for people with congenital disabilities mainly because of their high-risk nature. Even if accepted, they have to pay an exorbitant loading over the base premium charges.

    This may not be the case for those who are disabled due to accidents. In most cases, people who suffer from accidental disabilities are treated as normal applicants without any need for additional medical tests or higher premiums. At the time of signing up for a policy, all accidental disabilities must be declared by the applicant in advance. Once the insurer verifies all the details, the PwD can subscribe to a health insurance policy without any restrictive clauses or additional premium.

    Tax Relief Available for PwDs

    Income tax relief for PwDs is provided under Section 80U and 80DD of the Income Tax Act. For premiums paid on health insurance policies, a person with severe disability (80% and above) can get deduction for up to Rs.1 lakh. A person with disability between 40% and 79% can get tax relief for up to Rs.50,000. People supporting disabled family members can get tax deductions for up to Rs.1 lakh (80% or more disability) on premiums paid for health insurance policies.

    Conclusion

    The health insurance sector in India is still in its growth phase. When it comes to health insurance for PwDs, the overall reach in India is even lower. Government-backed schemes launched recently are changing the dynamics of the health insurance industry in India. With the proper implementation of these schemes, the current gap in the market can be resolved and the quality of life can be improved for PwDs.

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