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Does health insurance cover disability?

Updated On Dec 28, 2022

As per reports, 3% of the Indian population is disabled in different ways. It is important to understand that having a mental or physical disability can become highly challenging especially when there is no financial protection at your bay. To overcome such health challenges, it is extremely important to have health insurance that can provide much-needed assistance to deal with such problems. As the coverage in a health insurance plan varies, so many of you must be wondering whether disability is covered in health insurance plans or not. The answer to this is yes, as there are government-sponsored health insurance plans for the disabled to cater to their healthcare needs especially.

Does health insurance cover disability?

What Exactly is Disability?

According to the Person with Disability Act of 1955, any individual who has a minimum of 40% disability is treated as a disabled person. In simple terms, disability can be either physical or mental or even both that limit an individual’s ability to carry out certain tasks. Based on this, disability is broadly classified into three different types:

  • Mental Disability: This is a health condition in which the mental being of an individual is affected. The mental imbalance leads to an individual’s inability in thinking. Some of the health issues that arise due to mental disability include schizophrenia, anxiety, bipolar disorders, depression, dementia, and a few more.
  • Accidental Disability: This type of disability arises when an individual suffers from injuries due to an accident that can lead to a permanent, temporary, or partial disability. This includes conditions where the injured person loses their arms, and legs, or is paralysed and loses the ability to see and hear. Please note that accidental disability is also offered as a rider benefit under a health insurance plan. 
  • Congenital Disability: On the other hand, Congenital Disability is when individuals are disabled right from their birth due to hereditary or other causes. A few health conditions that are categorized as Congenital Disabilities are cystic fibrosis, down syndrome, cleft lip, cerebral palsy, and more. 

Does Health Insurance Cover Disability?

Yes, there are health insurance plans that cover disability. However, as people with disability carry a high risk of falling ill, there are certain limitations to disability coverage in health insurance plans. There are not many health insurance plans that provide comprehensive coverage for persons with disability. Thankfully, there are two popular government-backed health insurance plans that provide substantial coverage for persons with disability. Listed below are the two health insurance plans that offer coverage for disability.

1. Niramaya Health Insurance

Backed by the government of India, the Niramaya Health Insurance provides comprehensive health insurance coverage for persons with a disability. The Niramaya Health Insurance provides coverage for disability health conditions such as autism, mental retardation, autism, and a few more. 

Some of the salient features of Niramaya Health Insurance include:

  • Provides health insurance coverage of up to Rs. 1 lakh
  • People who have a valid disability certificate as per the National Trust Act are eligible for availing the benefits of the Niramaya Health Insurance
  • All the medical expenses related to the hospitalisation and treatment of the disabled person is covered
  • For enrollment under this scheme, the guardian of the disabled person needs to visit the nearest RO as mentioned under the National Trust Act 
  • The Niramaya Health Insurance can be renewed 
  • For disabled individuals whose family has a monthly income lower than Rs. 15,000 then the premium amount that needs to be paid towards Niramaya Health Insurance is Rs. 250. On the other hand, if the monthly income exceeds Rs. 15,000 then the premium amount is Rs. 500. 

2. Swavalamban Health Insurance

The Swavalamban Health Insurance provides health insurance coverage to disabled individuals if their monthly family income is lower than Rs. 30,000. Under this government-sponsored plan for disabled people, coverage of up to Rs. 2 lahks is provided. 

Some of the features of Swavalamban Health Insurance are as follows:

  • The premium for Swavalamban Health Insurance is paid in one go
  • Provides medical coverage for all kinds of treatments
  • For Swavalamban Health Insurance, individuals must be between 18-65 years
  • The premium amount for the Swavalamban Health Insurance is Rs. 3100, out of which only 10% is paid by the disabled, and the rest 90% is borne by the government 

Apart from these government-sponsored health insurance plans for disabled people, many insurance companies like HDFC ERGO also offer specially designed health insurance plans for people with disability. 

Things to Consider While Buying Health Insurance Plans for Disabled People

There are certain things you need to keep in mind while buying health insurance plans for disabled people. Listed below are some of the key things to keep in mind:

  • Whenever you are buying a health insurance plan for disabled people, it is important that you declare their health conditions to the insurer in advance. In case you fail to do so, there are chances that your health insurance claim can get rejected.
  • Keep all the relevant documents such as disability certificates, income certificates, and others while buying health insurance plans for disabled people.
  • Consider the premium amount in mind before buying a health insurance plan. As it is on the basis of your income that you will be able to decide whether you can afford to pay the premium or not. 
  • Make sure to read all the terms and conditions related to disability when buying any health insurance plan and also check what is excluded from that particular plan. Also, consider your individual liabilities before buying any particular health insurance plan. 
  • You also need to be aware of the tax benefits that are offered under health insurance plans for disabled people. 

Take Away

So, in case you or your dear ones are disabled in any way, make sure to buy the above-listed health insurance plans for complete coverage. You must make sure to buy these plans at the earliest to start to enjoy the benefits offered under these plans.

Also read: Insurer's Gear Up To Deal With The Upcoming Covid Wave

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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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