What is Niramaya Health Insurance Scheme

About Niramaya Health Insurance Scheme

The Niramaya Health Insurance Scheme was started by the Government of India’s Department of Empowerment of Persons with Disabilities under the Ministry of Social Justice & Empowerment.

This scheme helps people with Autism, Cerebral Palsy, Mental Retardation, and Multiple Disabilities by offering affordable health insurance. It covers medical expenses up to ?1,00,000 per year. To continue getting benefits, the insurance must be renewed every year after the financial year ends.

Note: This scheme is not applicable in J&K.

Coverage of Niramaya Health Insurance Scheme

Niramaya Scheme Benefits

The Niramaya Health Insurance Scheme helps people with disabilities get the medical care they need. Below are the main benefits explained in simple words:

1. Health Insurance Coverage

This scheme gives financial help up to ?1,00,000 per year for medical needs. It covers doctor visits, hospital stays, treatments, and tests, so people with disabilities can get the right care without worrying about money.

2. Outpatient Department (OPD) Treatment

This means people can visit a hospital or clinic for checkups, medicines, tests, and doctor consultations without staying in the hospital. It helps in regular monitoring and early detection of health issues.

3. Regular Medical Checkups

People with disabilities who are not sick can still get regular checkups. These checkups help doctors find any health problems early, making it easier to manage and stay healthy.

4. Dental Care

The scheme also takes care of dental health. It includes regular dental checkups, cavity treatments, cleaning, and other preventive care to keep teeth healthy.

5. Surgery for Disability Management

If a person needs surgery to stop their disability from getting worse or to manage a condition they were born with, this scheme helps pay for it. This ensures they get the right medical treatment without worrying about the cost.

6. Non-Surgical Treatments and Hospitalization

Some medical conditions do not need surgery but still require hospital care. The scheme pays for medicines, treatments, and hospital stays needed to help people recover.

7. Ongoing Therapies

Many disabilities need regular therapy, such as physiotherapy, speech therapy, or occupational therapy. The scheme helps pay for these therapies so people can move better, communicate well, and do daily activities more easily.

8. Alternative Medicine Treatments

The scheme also covers alternative treatments like Ayurveda, Homeopathy, and Unani medicine. This gives people more options to choose from for their treatment.

9. Travel Costs for Medical Care

Many people with disabilities need to visit hospitals regularly, which can be expensive. The scheme pays for travel costs so they can reach hospitals and clinics without money problems.

Who Can Apply for Niramaya Health Insurance?

Individuals with disabilities can apply for the Niramaya Health Insurance Scheme if they have a disability certificate for any of the disabilities mentioned in the National Trust Act of 1999.

To qualify and get free medical benefits, the person must have the following documents:

• Disability certificate: Proof that they have a disability.
• Age proof: A document showing their date of birth.
• Identity proof: Any ID like an Aadhaar card or voter ID.
• Income certificate: Needed only for families below the poverty line (BPL).

These documents help confirm eligibility and allow the person to receive cashless medical treatment under the scheme.

How to Apply for the Niramaya Health Insurance Scheme?

You can apply for Niramaya Health Insurance online or offline by following these simple steps.

1. How to Apply Online

• Visit the official website: Click here.
• Fill out the form with the required details.
• Upload all necessary documents (disability certificate, age proof, ID proof, etc.).
• Submit the application, and your request will be processed.

2. How to Apply Offline

• Go to the official website: Click here.
• Find the "Schemes" section and click on the Niramaya scheme.
• Look for the "Download Enrolment Form" button and download the form.
• Fill out the form and attach all the required documents.
• Visit your nearest Regional Office (RO). They will verify your documents and upload them online for you.
• The RO office will submit your form to the National Trust along with the application fee.
• Once verified, you will receive your Niramaya e-card.
• Download your Niramaya health card from the official website using your application ID number.

By following these steps, you can easily apply and get medical benefits under the Niramaya Health Insurance Scheme.

Documents Needed to Apply for Niramaya Health Insurance

To apply for the Niramaya Health Insurance Scheme, you need to submit some important documents. The documents and fees depend on your family's income.

For BPL (Below Poverty Line) Families (Fee: ?250)

• Disability certificate (self-attested) from the District Hospital or Government authority
• BPL card (proof of being below the poverty line)
• Address proof (Aadhaar, Ration card, etc.)
• Proof of paymentProof of payment (receipt of ?250)

For APL (Above Poverty Line) Families - Income up to ?15,000 per month (Fee: ?250)

• Disability certificate (self-attested) from the District Hospital or Government authority
• Address proof (Aadhaar, Ration card, etc.)
• Proof of payment (receipt of ?250)
• Income certificate (self-attested) from a State-authorized officer to prove family income

For APL (Above Poverty Line) Families - Income above ?15,000 per month (Fee: ?500)

• Disability certificate (self-attested) from the State-authorized officer
• Address proof (Aadhaar, Ration card, etc.)
• Proof of payment (receipt of ?500)

Niramaya Health Insurance Scheme Renewal Process

You need to renew your Niramaya Health Insurance every year to keep it active. Follow these simple steps:

Step 1: Provide Required Details Online

The parent or guardian of the person with a disability must log in to the Niramaya website and enter the following details:

• Policy Period (the current insurance time)
• Beneficiary ID (the unique ID of the insured person)
• UDID Number/Enrollment Number (disability ID)
• Date of Birth of the beneficiary

Step 2: Document Verification

The Regional Office (RO) will check the documents to make sure they are valid.

Step 3: Pay the Renewal Fee

After verification, the parent/guardian pays the renewal fee online.

Step 4: Renewal Confirmation

Once the payment is received, the RO or beneficiary will get a confirmation on the website, and the insurance will be renewed for another year.

Documents Needed to Renew Niramaya Health Insurance

To renew Niramaya Health Insurance, you need to submit some documents. The required documents and fees depend on your family's income.

For BPL (Below Poverty Line) Families (No Renewal Fee)

• BPL card
• Address proof (only if the address has changed)

For APL (Above Poverty Line) Families - Income up to ?15,000 per month (Renewal Fee: ?250)

• Address proof (only if the address has changed)
• Income certificate (self-attested, issued by a government authority)
• Proof of payment (receipt of ?250)

For APL (Above Poverty Line) Families - Income above ?15,000 per month (Renewal Fee: ?500)

• Proof of payment (receipt of ?500)
• Address proof (only if the address has changed)

Niramaya Scheme Claim Process

If you want to get money back for your medical expenses under the Niramaya Health Insurance Scheme, you need to submit a claim to the insurance provider. It is best to submit the claim within 30 days after treatment or leaving the hospital.

Step 1: Download the Claim Form

Go to the website: https://www.rakshatpa.com/WebPortal. Click on the “Downloads” menu and download the Claim Form.

Step 2: Fill and Submit the Form

Fill out the Claim Form with the required details. Attach all supporting documents, including:

• Medical bills and receipts
• Doctor’s prescription
• Hospitalization report
• Discharge summary from the hospital

Submit the filled form and documents to the nearest insurance provider center.

Step 3: Claim Processing and Payment

The insurance provider will check all the documents. Once verified, the approved claim amount will be transferred to the given bank account as per the Insurance Regulatory and Development Authority (IRDA) rules.

Documents Required for Claim Process

• Original medical reports (test results, scan reports, etc.).
• All original bills for hospital charges, medicines, doctor fees, therapy fees, and travel expenses.
• Doctor’s original prescription for medicines and treatments.
• A self-attested copy of the Disability Certificate (signed by the beneficiary or guardian).
• Copy of the Niramaya Health Card or mention the Health ID Card number.
• Bank account details of the beneficiary, including:
  • Name of account holder
  • Bank account number
  • Bank name and branch (City & State)
  • Bank IFSC code

Conclusion

The Ministry of Social Justice and Empowerment started the Niramaya Health Insurance Scheme to help people with disabilities get medical care. This scheme makes it easier for them to get treatment and therapy across India. It is a great step towards better healthcare for people with disabilities and their families.