Niramaya Health Insurance Scheme: Features, Benefits And Enrollment Process

Health Insurance

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

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

1. Overall limit of hospitalisation: Rs. 70,000
   1. Sub-section A (Corrective Surgeries for existing Disability including congenital disability)– Rs. 40,000
   2. Sub-section B (Non- Surgical/ Hospitalisation)– Rs. 15,000
   3. Sub-section C (Surgery to prevent further aggravation of disability)– Rs. 15,000
2. The overall limit for Out Patient Department (OPD): Rs. 14,500
   1. Sub-section A (OPD treatment including medicines, pathology, diagnostic tests, etc.)– Rs. 8000
   2. Sub-section B (Regular Medical check-up for non-ailing disabled)– Rs. 4,000
   3. Sub-section C (Dental Preventive Dentistry) – Rs. 2,500
3. Ongoing therapies to reduce impacts of disability and disability-related complications: Rs. 10,000
4. Alternative medicine: Rs. 4,500
5. Transportation costs: Rs. 1,000

Eligibility Criteria for Niramaya Health Insurance

1. 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).
2. 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:

Also Read: Janashree Bima Yojana: Eligibility, benefits & how to apply

Niramaya Health Insurance Enrolment Fees and Charges

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

1. Guardians of PwD will have to visit the nearest Registration Organisation for Niramaya renewal with the necessary documents.
2. The RO will check the validity of the documents. 
3. They will select the renewal link on the Niramaya website. 
4. 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. 
5. 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

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

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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.