Much of the problems are faced by the persons with disabilities in getting the health care and obtaining an easy access to it especially in developing countries like ours. Such persons are not employed much so they, mostly, are not covered under the employer sponsored medical insurance schemes. Due to their physical status, they generally experience greater risks of poor health and have higher medical expenditures. Disabled persons have to visit doctors more often and may have to stay longer in hospitals than those who are not disabled. So provisions either for life, medical or health insurance are of utmost necessity for the persons with disabilities to empower them to live independently. It can provide them an easy access to an otherwise expensive medical treatment. In the absence of such facilities, sometimes the only way out left for them is to collect money through donations in order to get themselves treated in case of major
health problems like heart ailment, kidney failure etc. The same was the condition here few years back when insurance facilities for the persons with disabilities were altogether missing from the Indian scenario. According to the 2001 census, about 22 million people in India are disabled. According to another survey by W.H.O in 2007, India has the largest number of disabled population in the world i.e. around 70 million. After much pressure from the parents, families and various organizations, the Ministry of Social Justice and Empowerment has recently launched “Nirmaya”, an insurance scheme for the persons with disabilities on 6th March 2008.It is also in consonance with commitment made to the United Nations by ratifying the UN Convention on the Rights of Disabled People in 2007. The insurance scheme named Niramaya, now serves those who have, till now, remained outside the purview of insurance facilities already present in the country. It is a health Insurance Scheme for the welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities.
The National Trust for Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities is entrusted with the job of monitoring the scheme through a Third party Nodal Agency(TPNA) along with the participation of Local Level Committees(LLC). Liaison is done with the insurance companies, empanelled health services providers, LLCs, the National Trust, the state governments so that awareness of the scheme is brought about along with underwriting the risks and claim settlement.
Aims and objectives of Niramaya Health Insurance Scheme:
1.Persons with Autism, Cerebral Palsy, Mental Retardation & Multiple
Disabilities to be provided with affordable health insurance.
2. To encourage them to seek health services.
3. To help them have a better quality of life and general health.
The aim was to serve more than 100,000 people living below poverty line all over the country except in the state of J&K. But at present it has also been made available in J&K with the help of some insurance companies. The scheme applies across all age bands, irrespective of conditions of their health. No prior medical tests are required to get this health insurance. Almost all hospitalization expenses such as pathology, radiology, advanced diagnostic tests, post-operative monitoring and therapies etc are covered. The patient can get treated in all modes of authorised treatment – allopathic, homoeopathy, unani, ayurvedic, siddha etc. Cashless settlements are provided in all listed hospitals and their branches all over India using smart or biometric cards provided by the authority. Criteria for empanelled hospitals and nursing homes are also clarified.
The annual premium for this health scheme is initially pegged at Rs 250. If the income of the person availing this scheme is less than Rs 15,000 per month, the premium will be shared by the state government and the central government/National Trust. The insurance cover for every person in the scheme is up to Rs 100,000.The insurance company has the right to stop entertaining any further claim any time in a year if the total amount of the claim exceeds the total premium amount. So the clients need to be aware and must act responsibly while incurring expenditure trying to curtail it upto the “essential level” only. To avail the scheme, one needs to contact the disability cell of the state social welfare ministry/related institutions/the National Trust/related NGOs. Enrolment form/applications are sent by the NGOs under Niramaya to the National Trust either by post or electronically. On successful enrolment and approval, health card is issued to each beneficiary.