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Health insurance plans for disabled people in India

Team AckoJun 28, 2022

In a census conducted in 2011, it was found that there were more than 2.5 crore people with disabilities (PwDs) in India. If you or your family member is a person with a disability (PwD), it can be helpful to know about health insurance for disabled people in India. The following article presents the related details.

Health Insurance for Disabled

What is a disability?

A disability can be defined as a physical or mental impairment that hinders one’s ability to accomplish day-to-day tasks. As per the Persons with Disability Act of 1955, an individual having a minimum of 40% bodily impairment is considered as disabled. However, if a person displays more than one disability or has 80% bodily impairment, they are considered severely disabled. 

Categorisation of disabilities in health insurance

Under health insurance for disabled in India, disabilities are usually categorised into the following three types.

1. Congenital disability

This type of disability is present from birth and is usually hereditary or caused by environmental stimulants. Examples of congenital disabilities include cleft lip, cleft palate, spina bifida, etc. Initially, congenital diseases were considered a universal exclusion in health insurance. However, as per the amended regulations of the Insurance Regulatory and Development Authority of India (IRDAI) in 2016, only external congenital defects are excluded. 

2. Accidental disability

Disabilities resulting from accidental injuries are termed as accidental disabilities. Based on the impact, they are classified into three types, total, partial and temporary disability. Accidental disabilities include the loss of limbs, hearing, eyesight, total or partial paralysis, etc. 

3. Mental disability

Disabilities under this category include mental disorders that affect the thinking, mood and behaviour of a person. Examples of this include autism, schizophrenia, depression, etc. According to the National Mental Health Survey of 2016, around 14% of the adult Indian population is in need of mental health interventions. Fortunately, under the Mental Healthcare Act of 2017, insurers are instructed to treat mental illnesses on par with physical illnesses.

Health insurance options for disabled persons

Individuals with congenital or mental disorders are usually considered as high-risk from a health insurance perspective. Thus, they may receive only partial coverage under most health insurance plans. Fortunately, there are Government health insurance policies like Nirmaya and Swavlamban Health Insurance that can offer substantial coverage. 

You can search online to find comprehensive health insurance for disabled individuals. Alternatively, you can opt for the two available Government health insurance plans. Medical emergencies are unpredictable and can be financially draining. Thus, it is better to be covered under a health insurance policy, than to not have one and panic in time of need.

Important factors to consider while buying health insurance for disabled individuals

Consider the following factors irrespective of whether you are availing government or private health insurance for disabled persons.

1. Share accurate information

While applying for a health insurance policy, make sure to input your exact disabilities and other preexisting conditions. Your insurer reserves the right to decline a medical claim if it is found out that the information you provided is inaccurate.

2. Submit medical reports

While buying health insurance for disabled individuals you may be required to submit your previous medical history. This is to help your insurer assess the extent of your disability and check if you have any preexisting health conditions, as it can affect premium calculation. So, keep your medical records handy when trying to buy health insurance.

3. Policy premium

After a health insurance policy is approved by an insurer, the policy premium will be determined. It is usually calculated based on your age, type of disability, the medical history of your family, pre-existing conditions in health insurance, etc. Also, it is important to note that you will have to pay the premium along with an 18% GST.

What is the eligibility criteria for availing health insurance for PwDs?

These are the criteria that insurers usually consider to determine your eligibility for buying health insurance.

  • Extent of disability

Health insurers usually check your extent of disability while approving health insurance for disabled people. This is to determine the extent of your disability and calculate the consequent risk. This may also affect the premium payable for the policy.

  • Current health condition

Your current health condition is usually taken into account while buying health insurance as a PWD. Thus, insurers may request your medical records over the recent few months. Based on these assessments the insurance request will either be approved or rejected.

Documents required to be submitted

The documents that are required to be submitted for buying health insurance for PwDs may differ from one company to another. Nonetheless, the following documents are usually requested.

  • Identity proof (Aadhaar Card, PAN card, Driving Licence, etc.)

  • Income certificate

  • Disability certificate

  • Past medical records

Health insurance plans for the disabled by the Government

The Indian Government offers two health insurance policies exclusively for disabled persons.

1. Niramaya Health Insurance

This Government launched a health insurance plan that provides coverage for individuals with disabilities. It especially provides Rs. 1 lakh sum towards treating mental disabilities like autism, retardation and cerebral palsy. 

While buying Niramaya Health Insurance no medical tests are required. However, this policy can be availed only from the National Trust. 

Age criteria No age limit
Documents required for enrolling Disability certificate
Sum insured Rs. 1,00,000
Coverage limits Ongoing therapy: Rs. 10,000, Hospitalisation: Rs. 70,000, Transportation expenses: Rs. 1,000, Alternative medicines: Rs. 4,500, Outpatient department(OPD): Rs. 14,500
Premium payable Family income < Rs. 15,000: Rs. 250, Family income > Rs. 15,000: Rs. 500

2. Swavlamban Health Insurance

This isa group health insurance/family floater plan that covers both persons with disabilities and their family members. It offers coverage for conditions like blindness, hearing impairment, loco-motor disability, mental illness, etc. Even this health insurance plan does not require any pre-medical tests while buying. Also, there are no exclusions for pre-existing conditions.

Age criteria 18 to 65 years
Family income criteria Family income < Rs. 3 lakh per annum
Sum insured Rs. 2,00,000
Premium payable Rs. 3,100 (only 10% has to be paid from your pocket, the rest will be funded by the Government)
Individuals covered The disabled person, his/her spouse and up to two children
Documents required for enrolling Identity proof, Proposal form, Income certificate, Premium payment receipt

Tax benefits for disabled persons

While filing for income tax, both the person with the disability and their family members can avail of tax benefits. For persons with 40% to 79% disability a tax deduction of up to Rs. 75,000 can be availed per year. Furthermore, persons with more than 80% disability can avail of a tax deduction of Rs. 1,25,000 per year.

Under Section 80U, a disabled person can claim tax deductions on medical expenses incurred over the year. Additionally, under Section 80DD, payments made towards medical treatments for the PwD by family members are tax-deductible too. Also, insurance premiums paid on behalf of the PwD can also be claimed. Note that these tax benefits are subject to changes.,

Documents required for availing of tax benefits

The following documents need to be submitted to avail of tax benefits.

  • Premium payment receipt

  • A medical report describing the extent of disability

  • Self-declaration stating the medical expenses incurred during the year

  • Form 10-IA needs to produce in the case of mental disabilities

Frequently asked questions

Here are some of the most frequently asked questions regarding health insurance plans for disabled people in India.

Is health insurance free for disabled persons in India?

No, health insurance is not free for disabled persons in India. However, there are two Government Health Insurance schemes that offer low-cost health insurance for PwDs in India. Namely, Niramaya Health Insurance and Swavlamban Health Insurance.

What are the coverages that one can avail of under a health insurance plan for mental disabilities?

Usually, health insurance plans offer coverage for in-patient and out-patient hospitalisation, counselling and therapy. However, this is the case only if the plan extends an OPD benefit.

Is depression considered a mental disability and is it covered under health insurance?

Yes, depression is considered a mental disability and is usually covered under health insurance. Health plans usually also cover other mental illnesses like anxiety, bipolar disorder and posttraumatic stress disorder. Please refer to the precise policy wordings for details. 

Apart from disabilities, what are the other coverages of Niramaya Health Insurance?

Apart from treatments for disabilities, Niramaya Health Insurance also covers medicine bills, diagnostic tests, dental check-ups, etc.

Is it difficult to buy health insurance after incurring accidental disability?

No, it is not difficult to buy health insurance after incurring an accidental disability. Usually, health insurers consider individuals with accidental disabilities as low-risk as compared to individuals with other types of disabilities. 

What constitutes a permanent disability in health insurance?

Permanent disability in health insurance refers to a disability that hinders life function for a protracted period of time. Such disabilities usually do not heal after being treated and given substantial time to recover.

What is a high-risk cover in health insurance and is it necessary for disabled persons?

A high-risk cover in health insurance refers to an insurance plan that offers coverage for high-risk ailments. Coverage for these ailments is usually not included under standard health insurance plans. Critical illnesses such as hypertension, heart disease and diabetes are usually considered high-risk ailments in health insurance.

Some disabilities that may not be covered under regular health insurance plans, may be covered under a high-risk cover. However, these plans are usually expensive and offer only limited coverage for disability-related treatments.

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