Health Insurance for the Disabled: An Introduction
The health insurance gap for the disabled has been a cause for concern for many years. However, health insurance providers in India are working to bring health insurance plans for persons with disability (PwDs). Health insurance plans for the disabled cover medical expenses, such as cashless hospitalization, OPD care, major surgeries, pharmacy bills, and more. Leading health insurers are offering health plans for the disabled, like Star Special Care Plan and Future Generali HIV & Disability Suraksha, among others.
We will discuss the current landscape of disability health insurance in India, highlighting the available schemes, the challenges, and the way forward towards a more inclusive healthcare system.
Key Facts
More than 80% of persons with disabilities (PwDs) in India remain uncovered by health insurance. A recent survey conducted across India by the National Centre for Promotion of Employment for Disabled People (NCPEDP) highlighted glaring gaps in access to government and private medical insurance. The survey involved 5,000 people with disabilities across 34 States and Union Territories.
Disability Health Insurance Plans
Here are some disability health insurance plans available in India:
| Disability Health Plans | Sum Insured |
| Star Special Care | Up to ₹3 Lakh |
| Star Special Care Gold | Up to ₹5 Lakh |
| Reliance Specially Abled Health Insurance | Not Specified |
| SBI Divyang Suraksha | Up to ₹5 Lakh |
| New India Atmanirbhar Health Policy | Not Specified |
| Future Generali HIV & Disability Suraksha | ₹4 Lakh & ₹5 Lakh |
List Of Disabilities Covered By Insurance Schemes in India
Here is a list of disabilities covered by health insurance schemes:
- Blindness
- Chronic neurological conditions
- Low vision
- Specific learning disabilities
- Hearing impairment
- Autism
- Dwarfism
- Cerebral palsy
- Thalassemia
Other disabilities are covered as per the policy document.
What Is Disability?
Disabilities are physical or mental impairments that hinder or make an individual incapable of performing daily activities or work. These can include impairments in physical movement, cognition, sensory functions, or mental health. Disabilities can be caused by various reasons, including congenital conditions (present at birth), accidents, or mental illness.
Do Health Insurance Schemes cover Disabilities in India?
Yes, in 2016, IRDAI mandated all non-life insurers to offer health insurance plans covering persons with disabilities, those affected by HIV/AIDS, or mental ailments. This mandate led to private health insurers launching multiple health plans for the disabled. The government also includes persons with disabilities in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), recognizing the need for holistic healthcare.
Who Can Buy Disability Health Insurance Schemes In India?
Eligibility criteria for disability health insurance plans can vary by insurer and specific plan. Generally, most individual health insurance plans have a minimum entry age of 18 years. Children with disabilities can often be covered under a family floater health plan, with specific eligibility criteria depending on the insurer.
Benefits of Disability Health Insurance Schemes
Medical schemes for disability include the following benefits:
Reduces Out-of-Pocket Burden
With increasing medical inflation, medical treatments for disabled people can be a significant financial burden, potentially depleting savings. Persons with disabilities often face significantly higher healthcare costs due to specialized treatments, therapies, and potential long-term care needs. Health insurance helps reduce this out-of-pocket burden, making quality healthcare more affordable and accessible.Access to Quality Healthcare
Investing in a medical insurance scheme for persons with disabilities provides access to a wide network of hospitals and specialized doctors, ensuring quality healthcare and timely treatments.Disability-Specific Treatments
Selecting the right medical scheme for disability-specific needs is crucial. For instance, while some may require autism-related health coverage, others might need different treatments. Disability health insurance schemes ensure adequate and appropriate disease-specific healthcare.Peace of Mind
With financial worries reduced, individuals can focus more on their health, rehabilitation, and overall well-being, rather than constantly worrying about affording necessary care.Tax Benefits
Premiums paid for health insurance policies are eligible for tax deductions under Section 80D of the Income Tax Act, 1961, providing an additional financial benefit.
Inclusions of Disability Health Insurance Schemes
Common inclusions for disability health insurance schemes are:
- In-patient hospitalization
- OPD care
- Regular health check-ups
- Dental care, including preventive surgeries
- Surgeries to prevent further worsening of disability
- Ongoing therapies to manage the impact of disability and related complications
- AYUSH coverage
- Ambulance cover
- Modern treatments
- Cataract treatment
- Pre-hospitalization expenses
- Post-hospitalization expenses
Exclusions of Disability Health Insurance Schemes
Exclusions for disability health insurance schemes include:
- Cosmetic surgeries
- Specific health insurance schemes, like the Niramaya Health Scheme, are designed to cover only autism, cerebral palsy, mental retardation, and multiple disabilities, and may not cover other disabilities.
- Illegal activities
- Injuries or illnesses due to intoxication
- Listed pre-existing diseases (PEDs) may be excluded or have specific waiting periods, depending on the insurer.
- War or nuclear attack injuries
Do Government Health Schemes Cover Persons with Disabilities?
Central and State governments have introduced specific health insurance schemes and provisions. Let's explore their purpose, inclusions, and coverage.
Niramaya Health Insurance Scheme
A government-sponsored insurance program in India that provides affordable health insurance to persons with disabilities, specifically those with autism, cerebral palsy, mental retardation, and multiple disabilities. It offers a sum insured of ₹1 Lakh and covers OPD treatments, regular medical check-ups, dental care, surgeries, ongoing therapies, alternative medicine, and more.Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
This flagship health insurance scheme covers persons with disabilities in India; however, a large number of PwDs are unaware of its provisions. AB-PMJAY aims to cover secondary and tertiary care hospitalization costs, providing financial support to a wide range of family demographics, including those with disabilities. The plan offers ₹5 Lakh coverage.
The Way Forward
Improving access to health insurance for persons with disabilities in India requires a multi-faceted approach involving the government, private and public health insurance providers, and the community. Concerted steps must be taken to achieve comprehensive disability health insurance coverage. This includes enhanced awareness campaigns, inclusive government schemes for persons with disabilities, increased involvement of private health insurance providers, and more.
Adopting a collective approach will help India move towards a future where PwDs have financial protection and access to quality healthcare. For more information on health insurance for persons with disabilities, connect with PolicyX health insurance experts.
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