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Health Insurance Policy For The Physically And Mentally Challenged People

Updated On Oct 29, 2020

When it comes to healthcare insurance for differently-abled people - Person with disabilities (PwDs), choices are currently quite limited in India. It gets even more limited in case of people with congenital or mental disabilities. In case of accidental disabilities, the situation is different as insurers tend to treat these cases at par with people without disabilities.

Policy For The Congenital And The Mental Disabilities.

For congenital and mental disabilities, currently there are two options, both provided by the Government of India:

  • Niramaya Health Insurance scheme
  • Swavalamban Health Insurance scheme 

Niramaya is a health insurance scheme provided by The National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities, Government of India.

This scheme is available for citizens of India residing anywhere except J&K (last updated 31-12-2019)

Features of Niramaya Health Insurance Scheme

Sum Insured Rs. 1 lakh for the PwD
Premium To be paid by the Trust to selected Insurance provider upon successful enrolment of PwD with the Trust
Period Coverage is provided till 31st March, that is end of financial year
Primary Person Insured PwD (as per National trust Act, 1999) with valid Identification card
Processing Fee Rs. 250 for PwD in Below Poverty Line (BPL) category
Rs. 500 for Non BPL
Free for PwD with Legal Guardian (other than natural parents) 

Other features:

  • No pre-insurance medical tests are necessary
  • Treatment can be availed at any hospital

Swavalamban is a group health insurance or family floater policy launched by the government in association with The New India Assurance Company that covers the individual or family up to a sum of Rs. 2 lakh. 

Features of Swavalamban Health Insurance Scheme

Sum Insured Rs. 2 lakh for the individual or family
Premium Currently the premium is subsidized by the government to the extent of 90%
Period Coverage is provided for 12 months from the date of issue of the policy
Age Band 0 to 65 years
Primary Person Insured PwD (as per Persons with Disabilities Act, 1995)
Family Insured Parents/legal guardians (for PwD < 18 years of age )
Spouse and 2 children, till they attain 18 years of age (PwD > 18 years of age)
Income limit The family earns less than or equal to 3 lacs(Rupees THREE LAKH)

It is essential to note that this policy offers Outpatient department (OPD) cover for persons with mental retardation and mental illness to the tune of Rs. 3000. When compared with the premium paid by the insured, which is 10% of the actual premium (around Rs. 350), there is a huge relief in terms of OPD costs.

The policy also covers hospitalization and pre-post operative care costs as well as recently inducted Ayurveda, Unani, Siddha, Homeopathy (AYUSH) care. 

In case of a disability, partial or permanent, arising of an unfortunate accident, the surviving individual is entitled to subsequent enrolment in healthcare insurance with private providers and is not restricted to government funded schemes. Those cases are usually considered at par with a person without any disability. However, sum insured, coverage and premium could be different from that of a regular policy, and this would be at the insurer’s discretion.


The Indian government launched the Ayushman Bharat scheme in 2018 to provide for eligible poor families without restriction for physical ability, age, gender etc. While this might be considered by many to assume that a sufficient coverage for PwD is provided by default, but being a family floater plan sometimes it may fall short of the needs of PwDs specifically. In order to better provide for differently abled people with care suited to their specific needs, currently the two schemes by the Government, mentioned above, are very helpful.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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