Getting health insurance for individuals with physical disabilities is extremely difficult. To some extent, insurance companies provide insurance, but health insurance is often not available afterward. Recognizing this difficulty, the Government of India has launched the Nirmaya Health Insurance Scheme in association with the National Trust Act, 1999.
This scheme is designed for people with physical disabilities, cerebral palsy, autism, and mental retardation. The Nirmaya Health Insurance Scheme is an affordable health insurance plan for persons with disabilities.
Policy bazaar insurance Schemes 2025: Features,Apply & Benefits
Niramaya Health Insurance Overview and Presenter Introduction
It also offers holistic and comprehensive coverage. We’ll dive into the details in this video, so stay tuned until the end. Before we start, let me introduce myself. My name is Gurleen Kaur Tikku, and I’m a certified financial planner. I bring you videos every week to make your personal financial life easier and happier, as our company’s tagline is “Creating a Wealth of Happiness.” A quick reminder: if you haven’t subscribed to our channel yet, please do so to get the right information at the right time.
Objective and Coverage Area Niramaya Health Insurance
Let’s talk about the Nirmaya Health Insurance Scheme. As I mentioned, this is an initiative by the Government of India in association with the National Trust Act, 1999, launched for the welfare of people with autism, mental retardation, cerebral palsy, and multiple disabilities. The objective of this scheme is to provide necessary health insurance, which is often unavailable to these individuals. This policy is valid across India, except in the state of Jammu and Kashmir.
Eligibility Criteria of Niramaya Health Insurance
Now, let’s discuss the eligibility criteria. First, to avail of this policy, an individual must be registered under the National Trust Act. If someone has a disability, they need to be registered under this act to be eligible for the scheme. Second, there is no income criterion for this scheme. For those below the poverty line, the premium is ₹250, and for those above the poverty line, the premium is ₹500 for a coverage of ₹1 lakh, which is renewed annually.
Coverage Details and Enrollment Process
The coverage is provided for individuals with autism, cerebral palsy, mental retardation, or multiple disabilities. Second, no pre-insurance medical tests are required, meaning no physical check-up is needed before enrolling in the policy, making it easier to join. Third, the enrollment process is quite simple. You can avail of this policy through certain registered organizations or NGOs, which are listed as points of sale on the National Trust website.
Accessing the Scheme and Extensive Coverage
You can refer to the list of registered organizations on their website, and I’ll also attach the link in the description box. Next, the plan offers extensive coverage, meaning it provides holistic coverage. This includes OPD (outpatient department) expenses, regular check-ups, preventive dentistry, non-surgical hospitalizations, surgeries to prevent disability aggravation, treatment for congenital disabilities, ongoing therapies, and alternative medicines—all covered under this package.
Detailed Coverage Breakdown
Let’s dive deeper into the coverage details. Here’s a table outlining the limits and scope of coverage:
- The overall limit for hospitalization is ₹55,000.
- For corrective surgeries to address congenital disabilities, ₹40,000 is covered.
- For non-surgical hospitalization in a year, ₹15,000 is provided.
- For OPD expenses, including medicines, pathology, and diagnostic tests, the sub-limit is ₹19,000.
Additional Coverage and Benefits
So, in total, you get ₹55,000 for hospitalization and ₹19,000 for OPD. Next, for ongoing therapies to prevent disability aggravation, ₹20,000 is covered. Alternative medicines and transportation costs (from home to hospital) are also covered up to ₹20,000. All of this is provided under the ₹1 lakh coverage, at a cost of ₹500 (or ₹250 for below poverty line individuals). To be eligible, you need a Persons with Disability (PwD) certificate from the National Trust to ensure benefits reach genuine beneficiaries.
Comprehensive Package and Flexibility
Pre- and post-hospitalization expenses are also covered within the sub-limits. Overall, this is a complete package covering OPD, hospitalization, corrective surgeries, diagnostic tests, alternative medicines, and transportation costs up to ₹1 lakh. Beneficiaries also have the freedom to choose their preferred hospital. These benefits are provided on a reimbursement basis.
Scheme Purpose and Outreach
Although this scheme is not very popular, it has been designed to support individuals who cannot access insurance due to certain conditions. I’m sure this video will reach those who need this policy and help them enroll. For more details, you can visit the National Trust Act website to raise queries or check further information.