Niramaya Health Insurance Scheme: Features, Benefits and Enrollment Process
Niramaya Health Insurance scheme was conceived to provide affordable health insurance to people with disabilities, such as Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities. This health insurance scheme is floated by The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities, which comes under the Department of Empowerment of Persons with Disabilities of the Ministry of Social Justice and Empowerment. People diagnosed with such disabilities can enrol in Niramaya Health Card to get maximum coverage of Rs.1 lakh.
Features and Benefits of Niramaya Health Insurance Scheme
- This scheme offers health insurance cover up to Rs.1 lakh. Note that this is on a reimbursement basis only.
- There are several facilities under this health plan. Some of them include OPD treatment, a regular medical check-up for non-ailing disabled, dental preventive dentistry, non-surgical hospitalisation, surgeries to avoid disability aggravation, treatment for congenital disability, ongoing therapies, alternative medicine, and more.
- This scheme also covers transportation costs.
- Beneficiaries do not require pre-insurance medical tests to obtain benefits from this scheme.
- Individuals from any part of India can enrol under this scheme.
- It offers comprehensive coverage, which will have a single premium across age bands.
- Individuals can get similar coverage irrespective of the type of disability under the National Trust Act.
- Persons with Disabilities (PwDs) with a valid disability certificate under the National Trust Act are eligible for benefits under this scheme.
- Beneficiaries can get treatment from any hospital and raise a claim accordingly.
- This scheme covers pre as well as post hospitalisation expenses. But note that there are limits with regard to the extent of coverage.
Also Read: Pradhan Mantri Jan Arogya Yojana: Eligibility, benefits & coverage
How to Apply for Niramaya Health Card Online
In order to get Niramaya Health Card, you need to apply online. Follow these steps to enrol for Niramaya e card:
- Visit the Official Website of thenationaltrust.gov.in
Once you are there, on the left-hand side (under the ‘Scheme’ section), click on Niramaya. You will get all the scheme-related details there.
- Click on Download
After checking Niramaya Health Insurance scheme details, click on the “Download” tab. You will have four options to choose from – Download Enrolment Form, Download Renewal Application Form, Download Claim Form, and Raksha TPA Pvt Ltd. Center List.
- Select Download Enrolment Form
Out of the four options, click on ‘Download Enrolment Form’. Keep all the required details mentioned in the form handy.
- Submit the Form
Submit the form to your nearest RO. The RO will take care of the rest, including filling up the Niramaya application form online and uploading the scanned documents as required after verification of originals. Once done, the RO will Submit the duly filled in form on the National Trust portal and pay the application fees.
Once the process is completed, the National Trust reviews the application form and the documents. If there’s any incorrect information that entails re-submission, the RO give 15 days time to re-submit it. Once everything is verified, e-Niramaya Card. The health ID card is uploaded online and can be downloaded with an application ID number.
Cost of Facilities under Niramaya Health Insurance
- Overall limit of hospitalisation: Rs. 70,000
- Sub-section A (Corrective Surgeries for existing Disability including congenital disability)– Rs. 40,000
- Sub-section B (Non- Surgical/ Hospitalisation)– Rs. 15,000
- Sub-section C (Surgery to prevent further aggravation of disability)– Rs. 15,000
- The overall limit for Out Patient Department (OPD): Rs. 14,500
- Sub-section A (OPD treatment including medicines, pathology, diagnostic tests, etc.)– Rs. 8000
- Sub-section B (Regular Medical check-up for non-ailing disabled)– Rs. 4,000
- Sub-section C (Dental Preventive Dentistry) – Rs. 2,500
- Ongoing therapies to reduce impacts of disability and disability-related complications: Rs. 10,000
- Alternative medicine: Rs. 4,500
- Transportation costs: Rs. 1,000
Eligibility Criteria for Niramaya Health Insurance
- All Registered Organisations (ROs) must pay Rs.1,000 as registration fees to get registration under the Niramaya Health Insurance Scheme of the National Trust for further enrolling the Persons with Disabilities (PwDs).
- PwDs must have at least one disability under the National Trust Act, 1999, along with a valid disability certificate to apply for this scheme.
Documents Required for Niramaya Health Insurance Application Online
Here are the documents required for the Niramaya Health Insurance application form:
| BPL (Below Poverty Line) | Self-attested Disability certificate BPL card Address Proof |
| Non-BPL | Self-attested Income certificate of the parent/guardian competent authority as issued by the State Address proof Self-attested Disability certificate |
| PwD with Legal Guardian | Disability certificate(self-attested) issued from the District Hospital or appropriate Government authority Address proof Legal Guardian Certificate issued from the Local Level Committee constituted under section 13 of The National Trust Act, 1999 |
Also Read: Janashree Bima Yojana: Eligibility, benefits & how to apply
Niramaya Health Insurance Enrolment Fees and Charges
| BPL | Rs.250 |
| Non-BPL | Rs.500 |
| PWD with Legal Guardian | Free |
Niramaya Health Insurance Claim Process
- Download the claim form from the website.
- Fill in all details and attach the necessary bills with it.
- Send it to the Third Party Authorisation (TPA) for approval.
- Submit the form within 30 days of treatment or discharge from the hospital.
Note that under this scheme, you can only opt for reimbursement claims.
However, if you prefer cashless claims on your health insurance plan, you might want to consider the health insurance offered by Navi. Navi’s paperless process allows you to raise claims via your mobile phone without any hassle. Download the Navi app and get comprehensive health coverage benefits up to Rs. 1 Crore.
Niramaya Health Card Renewal Online Procedure
- Guardians of PwD will have to visit the nearest Registration Organisation for Niramaya renewal with the necessary documents.
- The RO will check the validity of the documents.
- They will select the renewal link on the Niramaya website.
- Beneficiaries need to pay the renewal fee at this point, which is Rs.50 for BPL, and Rs. 250 for non-BPL. That said, the renewal process for PwD with legal guardians does not involve any charges.
- After successful payment, the policy will be renewed for another year.
How to Download Niramaya Health Card Online
Step 1: Visit the official website of The National Trust
Step 2: Click on Niramaya under the “Schemes” section
Step 3: Go to “Download” and download the application form
Step 4: Visit your nearest RO and submit the form after paying the necessary fees
Step 5: Once the enrolment procedure is completed, you will be issued the Niramaya Card. You will also be notified that the e-Niramaya card is available for download
Step 6: Visit the Niramaya section on the National Trust website again
Step 7: Click on the Niramaya E-Card of the Beneficiary
Step 8: Provide your application number to download the Niramaya e-card online
How to Check Niramaya Health Card Status Online
You can check Niramaya Health Card status by visiting the official portal of The National Trust. Go to “Niramaya” under the “Schemes” section. Click on Download e-Niramaya of the Beneficiary and provide your application number to check the status of your e-Card.
Niramaya Health Insurance Scheme Revised Benefit Chart
| Section | Sub-Section | Detail | Sub-Limit | Overall Limit of Section |
| I | Overall Limit of Hospitalisation | |||
| A | Corrective Surgeries for existing Disabilities including congenital disability | Rs.40,000 | Rs.55,000 | |
| B | Non-surgical Hospitalisation | Rs.15,000 | ||
| ii | Overall Limit for OutPatient Department (OPD) | Rs.19,000 | ||
| A | OPD treatment includes regular medical checkups, medicines, pathology, diagnostic tests, etc. | Rs.15,000 | Rs.19,000 | |
| B | Dental Preventive Dentistry | Rs. 4,000 | ||
| iii | Ongoing Therapies to reduce the impact of disability and disability-related complications | Rs.20,000 | ||
| iv | Alternative Medicine | Rs.4,000 | ||
| v | Transportation Costs | Rs.5,000 |
Also read: Aam Aadmi Bima Yojana: Process, claims & how to apply?
Final Word
Now that you know everything about the Niramaya insurance enrollment online process and other vital details, you might find it easier to apply for this scheme and obtain benefits. As of July 2021, around 75 applicants had received Niramaya health insurance cards. This figure is estimated to go up in the near future due to this scheme’s comprehensive coverage and affordability.
FAQs on Niramaya Health Insurance Scheme
Ans: This insurance scheme is valid for one financial year, after which it needs renewal. Further, beneficiaries might consider submitting the Niramaya insurance renewal online application before three months of the policy expiry date to continue reaping the benefits of this scheme.
Ans: Along with the duly filled application form, one has to submit the following documents for a successful enrolment:
Income and disability certificate.
a) BPL card.
b) Address proof.
c) Passport-size photograph.
d) Bank receipt of application fees.
e) Details of the bank for claim settlement.
Ans: Furnish the following documents during the Niramaya health insurance claim process:
1. Doctor’s prescription
2. Hospital, medicine, doctor consultation bills and other receipts
3. Original hospital reports.
4. Complete bank details of a beneficiary
5. Self-attested disability certificate
6. Niramaya e- card copy
Ans: If individuals with physical disabilities are facing any issues while availing of the benefits of the Niramaya Health Insurance Scheme, they can feel free to contact the Dakshina Kannada District Legal Services Authority. The DKDLSA will provide support to resolve the issue.
Ans: In the case of the Niramaya health insurance scheme, the selection of insurance companies and the computation of premiums are carried out in a transparent manner. The National Trust pays the premium amount to the insurance company in advance.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
Health Insurance Knowledge Base
Does Niramaya insurance scheme provide cashless claim facilities? Or is it via reimbursement only?
Though Niramaya health care is beneficial for many, especially the less-privileged, I think it’s time to increase the cover amount
Niramaya scheme is the probably best scheme for people with disabilities. Thanks to the state Govt. for introducing this scheme.
How to renew Niramaya policy? Can anyone help?
Can I get covered under Niramaya scheme even if I don’t have e Niramaya card?
Can I pay monthly premiums for Niramaya health insurance? What other government insurance schemes I can look into other than Niramaya?