Niramaya Health Insurance Scheme: How To Apply, Eligibility & Other Details

The Niramaya Health Insurance Scheme, initiated by the Department of Empowerment of Persons with Disabilities, Ministry of Social Justice & Empowerment, offers comprehensive health coverage for individuals with autism, cerebral palsy, mental retardation, and multiple disabilities. With a fixed premium regardless of age, the scheme provides equal healthcare support, and financial assistance on a reimbursement basis, and covers various medical services without the need for pre-insurance medical tests.

Details of Niramaya Health Insurance Scheme

The Niramaya Health Insurance Scheme, launched by the Department of Empowerment of Persons with Disabilities, offers comprehensive coverage:

• Affordable: Fixed premium regardless of age.
• Equal Coverage: All disabilities receive the same healthcare support.
• Financial Assistance: Reimbursement-based insurance cover.
• Wide Range of Services: Covers checkups, hospitalizations, therapies, surgeries, and transportation.
• No Medical Tests: Immediate coverage without pre-insurance tests.
• Hospital Flexibility: Choose any hospital without restrictions.

Benefits of the Niramaya Health Insurance Scheme

The Niramaya Health Insurance Scheme offers a wide range of benefits to individuals with disabilities. It provides health insurance coverage of up to ₹1,00,000 for various medical expenses, including outpatient department (OPD) treatments such as medicines, pathology, and diagnostic tests.

The scheme also includes regular medical checkups for non-ailing individuals with disabilities and preventive dentistry services. Moreover, it covers surgeries to prevent disability worsening or for existing disabilities, as well as non-surgical treatments and related stays.

Ongoing therapies for managing disability and complications, alternative medicine options, and reimbursement for transportation costs related to medical care are also included in the scheme’s benefits.

Eligibility & Application Process

All the disabled person who have at least one of the disabilities under the National Trust Act, 1999 with valid disability certificates.

Enrolment process for Niramaya Health Insurance Scheme

1. Parents/guardian of the PwD will visit the nearest Registered Organization (RO) for Niramaya enrolment with required documents.
2. RO will fill up the Niramaya application form online and upload the scanned documents as required after verification of the originals.
3. On successful enrolment and approval, Health ID No. /card will be issued to each beneficiary or can be downloaded by the beneficiary online or through RO.

Niramaya Health Insurance Renewal Process

Beneficiaries are expected to renew the scheme three months prior to expiry to continue availing the scheme.

• For APL category (family income above ₹15,000/- per month):

1. The parent/guardian of the beneficiary can renew the scheme online by logging on to the Niramaya website.
2. Provide the information
   • Policy Period
   • Beneficiary ID:
   • UDID No /Enrollment No.:
   • Date of birth:
   • Type (UDID No /Enrollment No.)
3. Submit and proceed

The parent/guardian of the beneficiary can renew the scheme online by logging on to the Niramaya website

• For APL (family income upto ₹ 15,000/- per month)/BPL:

1. The parent/guardian of the beneficiary will have to revisit the RO for renewal with the required documents-
   • BPL card (in case of BPL category) .
   • Income certificate (self attested) of the parent/ guardian competent authority as issued by the State (in case of APL category-family income upto ₹15,000/- per month).
   • Address Proof (in case of change of address).

Scheme Claim Process

All claims for settlement under Niramaya have to be submitted to the canters of the insurance provider in the prescribed Claim Form along with relevant vouchers / bills, etc. (preferably within 30 days of treatment) or discharge from hospital.

1. Beneficiaries need to download the claim form from https://www.rakshatpa.com/WebPortal under “Downloads” menu.
2. Submit the filled claim form along with complete supporting documents (medical bills, prescription, hospitalization report, discharge card etc.) and submit it to the regional centres of the insurance provider.
3. The insurance provider will verify the documents and transfer the approved claim to the given bank account as per Insurance Regulatory and Development Authority (IRDA) guidelines.

Documents Required For Niramaya Health Insurance Scheme

For Enrollment Process:

1. Disability certificate issued from the District Hospital or appropriate Government authority(Self-attested).
2. Below Poverty Level or BPL card (in case of beneficiary belongs to BPL category).
3. Address Proof.
4. Proof of payment.
5. Income certificate (Self attested)of the parent/ guardian competent authority as issued by the State(in case of beneficiary belongs to APL category).

For Niramaya Health Insurance Claim Process:

1. Copy of Niramaya card or mention Health ID Card number.
2. Self-attested copy of Disability Certificate.
3. All original prescription papers given by the doctor.
4. All original bills of Hospital / Medicine / Doctor fee / Therapy fee / Conveyance etc.
5. All reports in original.

Complete bank details of Beneficiary :

1. Name of Account Holder.
2. Account No. / Bank Name / Branch / (City & State).
3. Bank account IFSC Code.