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Health Insurance Plan for Disabled Individual

Updated On Jul 12, 2021

Various health insurance schemes have been initiated by the Government of India to help out the individuals having some kind of disability in order to offer them some relaxation and relief with respect to their health insurance plans. However, the thing here to notice is that these schemes offer coverage for just basic healthcare treatment and for any other intense health treatment no additional coverage is provided.

Some of the private insurance companies also offer important health coverage to differently abled individuals. However, these insurance plans are generally very costly. To state in simple words, an individual with a disability has only a few insurance benefits at their disposal.

Health Insurance Plan for Disabled Individual

Who All are Considered to be Differently-Abled?

Individuals, who are suffering from any of the listed below conditions are said to be differently-abled:

  • Accidental Disability: This disability condition is caused because of an accident. Individuals suffering from broken or impaired limbs are offered coverage under accidental disability. Moreover, individuals having complete or partial blindness caused because of an accident are offered coverage under accidental disability.
  • Congenital Disability: It is a particular health condition, where an individual is affected right from their birth. These commonly include cystic fibrosis, heart conditions, cerebral palsy, fragile X syndrome, spina bifida, etc.
  • Mental Disability: These are the disabilities that are associated with mental illness or disorder. It offers coverage to individuals with behavioural distress, psychiatric disorder or mental impairment.
    People with mental and congenital disability fall under the category of high risk. Hence, such people are not eligible to avail total coverage of critical illness plans. However, people having accidental disabilities are eligible to get coverage for health insurance.

Health Insurance Plans by Government for Specially-Abled People

Although, there aren’t any customized or specific critical illness insurance plans available for individuals with disability, the Indian government offers certain health insurance options to provide certain assistance to specially-abled people.

  1. Nirmalya Health Insurance: This health insurance plan introduced by the government is specifically designed for people having mental disabilities. Under this health insurance plan, the policyholder is entitled to get coverage of up to Rs 1 Lakh for treatment including pre-hospitalisation expenses and post-hospitalisation expenses.
    In case, the monthly income of the family is less than Rs. 15,000, then the policy buyer is required to pay just Rs. 250 as fixed premium amount. However, in case the family's monthly income is more than Rs. 15,000, then the amount of premium paid is Rs. 500.
  2. Swavalamban Health Insurance: It is also a health insurance plan sponsored by the Government of India, which is customized in order to meet the needs of individuals with disabilities.
    This health cover has been designed carefully to ensure that the policyholder is able to pay the premium amount in a single go and can avail insurance benefits for the purpose of medical treatment anytime. Also, please remember that this health insurance plan can be availed by only those disabled people having family income of less than Rs. 30,000.

Note: Remember that eligibility for insurance coverage is based upon the risk scale of the insurance buyer. However, risk rate is not the sole criteria, there are several other factors too that can pose an impact on eligibility of a specially-abled person.

Factors that Determine Health Insurance Plan Eligibility

Some of the key factors are explained below:

  • Family Earnings: It is one of the most important factors that is considered while determining the eligibility of a specially-abled individual for a health insurance cover. Based upon the overall family income, the insurance company offers a suitable insurance plan to a person. Also, along with the eligibility, in many cases, the premium is also decided based upon one’s family earning.
  • Existing Health Condition: An insurance company prior to offering health insurance cover to individuals with disability checks their current health status. To minimize the associated risk, the insurance provider goes through the health status of previous 2 months of differently abled individuals. If during the time of policy issuance, an individual suffers from chronic issues, then there is a high probability of insurance companies rejecting the eligibility of such individuals.
  • Premium Paying Capacity: Each insurance plan has its own share of premium. The insurance company checks the bank accounts and statements personally of an individual and determines if they are eligible to receive health coverage or not.

In a Nutshell

Individuals suffering from disabilities deserve to get all kinds of support and health care in order to lead a relaxed life. With the continuous efforts by the government and growing awareness, such people can easily overcome all the hurdles thrown at them by life. Also, having a health insurance plan guarantees financial safety as it permits them to take proper care of their health without worrying about costly health treatments. 

Also Read: Health Insurance Policy for Disabled Person

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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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