The 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 this scheme is to provide affordable health insurance to persons diagnosed with Autism, Cerebral Palsy, Mental Retardation, and Multiple Disabilities. The scheme offers insurance coverage of up to ₹1,00,000/-, which must be renewed annually.
Benefits
- Health Insurance Coverage: Up to ₹1,00,000/-.
- OPD Treatment: Covers medicines, pathology, diagnostic tests, etc.
- Regular Medical Checkups: For non-ailing individuals with disabilities.
- Dental Care: Preventive dental services.
- Surgery Coverage: For conditions preventing further disability worsening or for existing disabilities (including congenital).
- Hospitalization & Non-Surgical Treatments: Full coverage for in-patient and non-surgical treatments.
- Ongoing Therapies: For disability management and related complications.
- Alternative Medicine: Covered under the scheme.
- Transportation Costs: Reimbursement for transportation related to medical care.
Eligibility
- All persons with disabilities listed under the National Trust Act, 1999.
- A valid Disability Certificate is required.
Exclusions
- The scheme is not applicable in Jammu & Kashmir.
Application Process
Online Enrollment Process
- Visit the Nearest Registered Organization (RO) handling Niramaya enrollments with the required documents.
- The RO will fill out the application form online and upload scanned documents after verifying the originals.
- After successful enrollment, a Health ID Number/Card will be issued to each beneficiary.
- The card can be downloaded online or collected from the RO.
Renewal Process
- Login to the Niramaya website and enter details like:
- Policy Period
- Beneficiary ID
- UDID Number/Enrollment Number
- Date of Birth
- RO verifies the validity of documents.
- Pay the renewal fee online.
- Upon payment confirmation, the scheme is renewed for another year.
Claim Process
- Download the Claim Form from Raksha TPA Portal under the “Downloads” menu.
- Fill out the Claim Form and attach supporting documents (medical bills, prescriptions, hospitalization report, discharge card, etc.).
- Submit the claim to the insurance provider’s regional center.
- The insurance provider verifies the documents and transfers the claim amount to the beneficiary’s bank account as per IRDA guidelines.
Documents Required
Enrollment ProcessFor BPL Category (₹250 Enrollment Fee)
- Disability Certificate (Self-attested) issued by District Hospital or Government Authority.
- BPL Card.
- Address Proof.
- Proof of Payment.
For APL Category (If Family Income ≤ ₹15,000/month) (₹250 Enrollment Fee)
- Disability Certificate (Self-attested).
- Address Proof.
- Proof of Payment.
- Income Certificate from competent authority.
For APL Category (If Family Income > ₹15,000/month) (₹550 Enrollment Fee)
- Disability Certificate (Self-attested).
- Address Proof.
- Proof of Payment.
Renewal ProcessFor BPL Category
- BPL Card.
- Address Proof (if changed).
For APL Category (If Family Income ≤ ₹15,000/month) (₹250 Renewal Fee)
- Address Proof (if changed).
- Income Certificate (Self-attested).
- Proof of Payment.
For APL Category (If Family Income > ₹15,000/month) (₹500 Renewal Fee)
- Address Proof (if changed).
- Proof of Payment.
Claim Process
- Copy of Niramaya Card/Health ID Number.
- Self-attested Disability Certificate.
- All original prescriptions from the doctor.
- All original bills for Hospital, Medicines, Doctor Fees, Therapy Fees, Conveyance, etc.
- All medical reports in original.
- Bank details of the Beneficiary (Account Holder Name, Account Number, Bank Name, Branch, IFSC Code).
Frequently Asked Questions
- What is Niramaya Health Insurance Scheme?
It is a government-sponsored health insurance scheme for persons with Autism, Cerebral Palsy, Mental Retardation, and Multiple Disabilities. - What is the maximum health insurance coverage under the scheme?
₹1,00,000 per annum. - Is there any restriction on hospitals for availing benefits?
No, treatment can be availed in any hospital that meets the scheme criteria. - Who is covered under the scheme?
Persons with disabilities listed under the National Trust Act, 1999, with a valid Disability Certificate. - How to enroll in the scheme?
- Visit the nearest Registered Organization (RO).
- RO will fill the application online and upload scanned documents.
- After approval, a Health ID Card will be issued.
- How to find the nearest RO for Niramaya enrollment?
Visit the Niramaya website or contact the Ministry of Social Justice & Empowerment. - What is the renewal process?
- Login to the Niramaya website.
- Enter Beneficiary ID, UDID Number, and Date of Birth.
- Verify documents.
- Pay the renewal fee online.
- How can I claim reimbursement under the scheme?
- Download the Claim Form from the Raksha TPA website.
- Fill out the form and attach supporting medical documents.
- Submit it to the insurance provider’s regional center.
- Approved claims are transferred to the beneficiary’s bank account.