Money Planning with a Disability
Health Insurance and the Niramaya Scheme
How people with disabilities can get health insurance, including the National Trust's Niramaya scheme and government schemes such as Ayushman Bharat.
Health costs are often higher for people with disabilities, making health insurance especially important. But getting coverage has historically been difficult.
The challenge
Many private insurers were reluctant to cover people with disabilities or charged high premiums, often treating disabilities as pre-existing conditions. The RPwD Act requires the government to provide insurance schemes for employees with disabilities, and the insurance regulator, IRDAI, has directed insurers to offer products for people with disabilities and not to deny coverage purely on the grounds of disability.
Niramaya
The National Trust, a statutory body, runs Niramaya, a health insurance scheme for people with:
- Autism
- Cerebral palsy
- Intellectual disability
- Multiple disabilities
Key features:
- Coverage of up to 1 lakh rupees a year.
- No pre-medical tests and no exclusion for pre-existing conditions.
- Covers outpatient treatment, therapies such as speech and behavioural therapy, medicines and some hospitalisation costs.
- A small annual enrolment fee, with lower fees for low-income families.
It is one of the few schemes covering therapies that standard policies often exclude.
Ayushman Bharat
The government’s Ayushman Bharat PM-JAY scheme provides hospital coverage of up to 5 lakh rupees per family per year for eligible poorer families, and has been extended to all people aged 70 and above. Many families with members with disabilities qualify.
State and employer schemes
Some states run their own health schemes, and employer group policies usually cover all employees and often dependants, without individual medical tests.
Tips
- Use employer group insurance where available.
- Combine Niramaya or PM-JAY with a private top-up policy if affordable.
- Read the policy wording on therapies, devices and exclusions.
A family's daughter has autism and needs weekly speech and occupational therapy. Their private policy covers only hospitalisation. They enrol her in Niramaya, which reimburses therapy costs up to its annual limit, saving them tens of thousands of rupees a year.
Options have grown, including Niramaya, PM-JAY, employer group plans and products designed under IRDAI's directions. Coverage may still be limited, so it is worth comparing options.
- People with disabilities have historically struggled to get health insurance.
- IRDAI has directed insurers to offer products and not deny cover just because of disability.
- Niramaya covers autism, cerebral palsy, intellectual and multiple disabilities up to 1 lakh rupees, including therapies.
- Ayushman Bharat, state schemes and employer group plans are other options.
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