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Health Insurance for Disabled in India

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Home / Health Insurance / Articles / Health Insurance For Disabled People in India

Health Insurance for Disabled in India: Comprehensive Coverage
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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.

What is a disability?
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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
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Under health insurance for disabled in India, disabilities are usually categorised into the following three types.

Congenital disability
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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.

Accidental disability
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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.

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

Share accurate information
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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.

Submit medical reports
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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.

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

Extent of disability
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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
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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
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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.

Health Plans for the Disabled by the Government
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The Indian Government offers two health plans exclusively for disabled persons.

Niramaya Health Insurance
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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. 

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

Swavlamban Health Insurance
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This is a 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

How to find the right health policy for a disabled person
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Finding the right health policy for a disabled person can be a bit overwhelming, but with a little bit of research and consideration, you can find one that meets your needs. Here are a few tips to help you get started.

  1. Identify your specific healthcare needs: The first step in finding the right health policy for a disabled person is to identify your specific healthcare needs. This will help you to determine what types of coverage you require and what you can afford.

  2. Research the different types of policies: Once you've identified your healthcare needs, it's time to research the different types of policies that are available. There are a variety of policies out there, so it's important to choose one that fits your needs.

  3. Compare policies: Once you've narrowed down your options, it's time to compare policies. Look at the different coverage options and costs associated with each policy to determine which one is the best fit for your needs.

  4. Consider any additional benefits: Some policies may offer additional benefits, such as access to a nurse helpline or coverage for alternative therapies. Be sure to consider these benefits when making your decision.

  5. Seek professional advice: If you're still unsure about which policy is right for you, consider seeking advice from a healthcare professional or insurance broker. They can help you to navigate the complex world of healthcare policies and find one that meets your specific needs.

Tax benefits for disabled persons
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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
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The following documents need to be submitted to avail of tax benefits.

Acko Specially Abled Health Cover
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Standard Health Insurance plan specially designed for the persons with a disability (as per The Rights of Persons with Disabilities Act, 2016), persons with HIV/AIDS (as defined under HIV and AIDS Act, 2017)

For enrolling in Acko Specially Abled Health Cover, please reach out to [email protected]

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

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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.