Central Govt Social welfare & EmpowermentHealth & Wellness

Niramaya Health Insurance Scheme

The Niramaya Health Insurance Scheme provides up to ₹1,00,000 per year in health insurance coverage to persons with Autism, Cerebral Palsy, Mental Retardation, or Multiple Disabilities at a heavily subsidized premium. Coverage includes hospitalization, OPD treatment, therapies, dental care, and alternative medicine (AYUSH). Enroll through the nearest Registered Organization recognized by the National Trust.

Department Of Empowerment Of Persons With Disabilities For: Individual Official Source
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About This Scheme

The Niramaya Health Insurance Scheme provides up to ₹1,00,000 per year in health insurance coverage to persons with Autism, Cerebral Palsy, Mental Retardation, or Multiple Disabilities at a heavily subsidized premium. Coverage includes hospitalization, OPD treatment, therapies, dental care, and alternative medicine (AYUSH). Enroll through the nearest Registered Organization recognized by the National Trust.

Full official description

“Niramaya Health Insurance Scheme” was launched by the Department of Empowerment of Persons with Disabilities, Ministry of Social Justice & Empowerment. Government of India. The objective of the scheme is to provide affordable Health Insurance to persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities. The scheme provides insurance coverage of up to ₹1,00,000/-, which must be renewed annually after the financial year.

Benefits

  • Total annual health insurance coverage: up to ₹1,00,000
  • Hospitalization (including corrective surgery for existing disabilities): up to ₹55,000
  • OPD treatment (medicines, pathology, diagnostics): up to ₹15,000
  • Dental preventive care: up to ₹4,000
  • Ongoing disability therapies: up to ₹20,000
  • AYUSH (alternative medicine) treatment: up to ₹4,000
  • Transportation costs for treatment: up to ₹2,000
  • Insurance renewed annually

Who Can Apply (Eligibility)

  • Must have at least one disability listed under the National Trust Act, 1999: Autism, Cerebral Palsy, Mental Retardation, or Multiple Disabilities
  • Must hold a valid disability certificate
  • Available across all of India (except Jammu & Kashmir)

Exclusions

  • The scheme will be available in the entire country except J&K. The scheme further envisages that there shall be.

How to Apply

1
Online

Enrolment process:

Step 1: Parents/ guardian of the PwD will visit the nearest Registered Organization (RO) for Niramaya enrolment with required documents. Step 2: RO will fill up the Niramaya application form online and upload the scanned documents as required after verification of the originals. Step 3: On successful enrolment and approval, Health ID No. /card will be issued to each beneficiary or can be downloaded by the beneficiary online or through RO.

Scheme Renewal process:

Step 1: The parent/guardian of the beneficiary can renew the scheme with the required documents online by logging on to the Niramaya website through providing below details: Policy Period, Beneficiary ID, UDID No/Enrollment no, Date of birth. Step 2: RO to verify the validity of documents Step 3: Pay the application fees online. Step 4: After receipt of payment, the RO/beneficiary will be notified of the renewal for another year through the website.

Scheme Claim Process:

All claims for settlement under Niramaya have to be submitted to the canters of the insurance provider in the prescribed Claim Form along with relevant vouchers/bills, etc. (preferably within 30 days of treatment) or discharge from hospital. Step 1: Log on to https://portal.mediassist.in - MediAssist Employee portal. (Your username will be as @NATIONALTRUST.Com and password will be your date of Birth of Beneficiary e.g. DD-MM-YYYY)

  • You can also download the Mediassist App from Android/Apple/Window store in a phone [Username - @NATIONALTRUST.Com and password will be DD-MM-YYYY (Date of Birth of the Beneficiary] Step 2: Click on Submit claim option and fill the details to generate the claim form. Step 3: Click on “Save and Next” once all the details are filled. On 3rd Page, employee KYC documents are to be updated (one time activity). Step 4: Upload relevant documents. Step 5: After Moving to the final Page ”Declaration and Claim Submission” select the ailment type. Step 6: Upload the softcopy of the documents. Step 7: Acknowledge the declaration and Click submit to successfully generate the claim form. Step 8: An Auto-generated mail will be triggered to your registered Email ID containing the claim form.

Dedicated helpline for claims : 040-68178569/71326135.

To register or track your Claim, please contact MediAssist at:

Phone: 040-68213648 | Toll Free – 1800 572 9792

For any query regarding reimbursement of claim, email to MediAssist TPA on – niramaya[at]mediassist[dot]in

2
Offline

PROCESS FOR OFFLINE CLAIM SUBMISSION:

Step 1: Visit: https://mediassisttpa.in Step 2: Click on “Download Claim Form” or visit – https://mediassisttpa.in/#claim-forms Step 3: Click on “Claim Form Insured (Part A)” to download pdf file of claim form. Step 4: Fill Claim form, attach required documents and send to Mediassist TPA on following address: MEDI ASSIST INSURANCE TPA PRIVATE LIMITED, 1st Floor, Block D, Noida Sector 3, Noida, Uttar Pradesh, PIN- 201301 Phone: 040-68213648, Toll Free – 1800 572 9792

Frequently Asked Questions

What is Niramaya scheme?

Niramaya Health Insurance Scheme ,launched by the Department of Empowerment of Persons with Disabilities, aims to provide affordable health insurance to the Persons with Disabilities (PwDs).

What are the benefits under the scheme?
  1. Health insurance coverage.
  2. Outpatient department (OPD) treatment.
  3. Regular medical checkups.
  4. Dental care.
  5. Surgery.
  6. Non-surgical/hospitalization.
  7. Ongoing therapies.
  8. Alternative medicine.
  9. Transportation costs
What is the health insurance maximum coverage amount?

This scheme provides affordable health insurance cover of up to [?]1,00,000/-.

Is there any limitation of hospitals to avail this scheme benfits?

No, treatment can be taken from any hospital.

Is this is a health insurence scheme?

Yes

Who will be covered under this scheme?

All PwDs who have at least one of the disabilities under the National Trust Act, 1999 with valid disability certificate are eligible to apply for the scheme.

What is the enrolment process?

Parents/guardian of the PwD will visit the nearest RO for Niramaya enrolment with required documents.

How to find the nearest for Niramaya enrolment ?
What is the renewal process?

To renewal the scheme benefits, follow the below url and provide the required details URL : https://thenationaltrust.gov.in/auth/renew_gen.php and

How the reimbursement can be avail under this scheme?

All claims for settlement under Niramaya have to be submitted to the centres of the insurance provider in the prescribed Claim Form along with relevant vouchers / bills, etc. (preferably within 30 days of treatment) or discharge from hospital.

Ready to apply?

Visit the official government portal to apply for this scheme.

Apply on myScheme.gov.in

Documents Required

  • > **Enrollment Process:**
  • For BPL (Enrolment Fee - ₹250/-)**
  • Disability certificate (Self attested) issued from the District Hospital or appropriate Government authority BPL card
  • Address Proof
  • Proof of payment.
  • For APL (if family income up to ₹ 15,000/- Per Month) (Enrolment Fee - ₹250/-)**
  • Disability certificate issued from the District
  • Hospital or appropriate Government authority (Self attested)
  • Address Proof
  • Proof of payment
  • Income certificate of (Self attested) the parent/ guardian competent authority as issued by the State.
  • For APL (if family income above ₹15,000/- Per Month) (Enrolment Fee - ₹550/-)**
  • Disability certificate (Self attested) issued
  • by the competent authority as issued by the
  • State
  • Address Proof
  • Proof of payment.
  • > **For Renewal:**
  • For BPL:**
  • BPL card.
  • Address Proof (in case of change of address).
  • For APL (if family income up to ₹ 15,000/- Per Month) (Renewal Fee - ₹250/-)**
  • Address Proof (in case of change of address)
  • Income certificate (self attested) of the parent/ guardian competent authority as issued by the State
  • Proof of payment.
  • For APL (if family income above ₹15,000/- Per Month) (Renewal Fee - ₹500/-)**
  • Proof of payment
  • Address proof (in case of change of address).
  • > **For Claim Process:**
  • Copy of Niramaya card or mention Health ID Card number.
  • Self-attested copy of Disability Certificate.
  • All original prescription papers given by the doctor.
  • All original bills of Hospital / Medicine / Doctor fee / Therapy fee / Conveyance etc.
  • All reports in original.
  • Complete bank details of Beneficiary :
  • Name of Account Holder.
  • Account No. / Bank Name / Branch / (City & State).
  • Bank account IFSC Code.
  • > **Note:**
  • Need for ORIGINAL REPORTS / FILMS LIKE MRI, X-RAY, ULTRASOUNDS ETC.:** Original documents are required including the film for settling of Claims. - **Prescription for Ongoing Therapies:** Doctor’s prescription at least once in Six months is essential in which the category of therapy and duration of therapy should be clearly mentioned. Thereafter other documents from Rehabilitation Professional for therapy, and related bills will be acceptable. Doctor who prescribes the prescription should be a valid medical Practitioner with valid license/degree as per Medical council rules.

Tags

Person With DisabilityInsuranceFinancial AssistanceAutismCerebral PalsyMental Retardation
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