Health Insurance Policy for Disabled Person

The need for suitable health insurance cover has been underscored by the fact that rising inflation has increased healthcare costs. In the absence of sufficient health coverage, facing a medical emergency can increase stress - mentally, physically, and financially.

More so is the case if an individual is disabled and needs financial coverage for his/her medical needs. In India, according to the National Statistics Office (NSO), as of December 2018, 2.2% population in India is suffering from some form of disability. 

Many disabled members are physically and financially dependent on their family members; hence they must get adequate insurance cover for their health needs. Let us first understand the different types of disabilities plaguing people in the world. 

Types of Disabilities

In India, a person needs to be at least 40% impaired to be considered as a disabled person under the Persons with Disability (Equal Opportunities, Protection of Rights and Full Participation) Act, 1955. Individuals who suffer from more than one kind of disability, or are more than 80% impaired, are referred to as severely disabled. Following are the major types of disabilities into which disorders are classified: 

1. Congenital Disabilities

Congenital disabilities, also known as birth defects, or congenital anomalies, are functional disorders that occur right from when an infant is born. While some congenital defects are detected prenatally, in many cases, infants are diagnosed with such defects later in their infancy. Many of these abnormalities are caused due to genetic factors, while some are caused due to socio-economic or demographic factors. In many cases, these are also caused due to the environmental factors that impacted the mother during her pregnancy. Many insurance companies do not provide cover for people with congenital defects, as insurance is a product that covers people from unknown risks and uncertainties.

However, on February 26, 2018, a ruling by the Delhi Court stressed that insurance companies cannot deny health insurance simply based on a person possessing congenital disorders. Before 2016, all congenital defects were included in the exclusions, however, after the IRDAI’s 2016 health insurance regulation, only those congenital defects are excluded which are external and visible on the main parts of the body. Genetic disorders which are not curable, and have been present from birth are not covered. Each differently-abled person who fills the insurance policy form has to expressly state the nature of the disease, so the insurance company can make a decision based on whether the disorder is curable, recurring, etc. and will decide the premium and waiting period accordingly.

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2. Accidental Disabilities

Accidental disabilities are those which occur after a person meets with an accident. According to the terms used in insurance, an accident can result in either total, partial, or temporary disabilities, and all these types are covered by health insurance companies in India. Data shows that a person dies an accident every four minutes, and a serious road mishap occurs every minute in India. This underscores the importance of accident insurance. 

3. Mental Disabilities

Mental disabilities are those that irreversibly impact the mood, thinking, and the mental balance of a person. As of 2017, 197.3 million people in India have some kind of mental disorder. Mental healthcare was not a part of health insurance until the Mental Healthcare Act was passed in 2017. According to Section 21(4) of the act, “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for the treatment of physical illness.” Some insurance companies have started providing cover for mental illnesses; however, providing adequate cover is quite difficult due to the difficulty in ascertaining the degree of a mental disorder, and thus pricing is to provide a standalone product. 

Due to these reasons, insurance companies generally do not provide a specific mental illness plan but do cover mental illnesses in some of their health insurance plans. Most of these health insurers provide in-patient hospitalization, and outpatient hospitalization, therapy, and counselling (if the plan offers OPD benefit). If an individual is looking for a mental illness cover, (s)he needs to check if his/her disorder needs hospitalization or simple therapy and counselling, and select a plan accordingly. If any individual has a pre-existing mental disorder, insurance companies choose to provide a suitable waiting period to cover it. If the risk of morbidity and the severity of the disorder is high, the insurance company may decide to refuse the cover.

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How is Eligibility Determined?

State of health: As with any insurance policy, the health condition of an individual is of utmost importance to check if the individual suffers from any pre-existing complications. The premium amount is calculated based on the risk that is determined by the state of health of an individual. For differently-abled individuals, the insurance company may check the health condition of the previous few months and establish the extent and degree of the risk that the insurance company needs to take. Based on this, the company may approve or reject the coverage. 

The family’s earning capacity: An insurance policy is issued based on the earning capacity of the family to which the dependent insured belongs. Many insurance companies take note of the family income to decide the cover and the premium. Based on the bank account statements of the previous few months, the insurance company decides the premium payment capacity and the total coverage.  

Insurance Schemes by the government for the disabled

Nirmalya Health Insurance Scheme

The Nirmalya Health Insurance Scheme is a comprehensive insurance plan launched by the National Trust for individuals suffering from disorders such as Cerebral Palsy, Autism, Mental Retardation, and Multiple Disabilities. This scheme is available in the country except for Jammu & Kashmir, and no pre-insurance tests are needed for it. All individuals need to enrol with the National Trust to avail of this insurance policy.

Features of the plan:

Swavalamban Health Insurance Scheme

The Swavalamban Health Insurance Scheme was launched by the Government of India on 2nd October 2015 to provide a comprehensive cover to the beneficiary and his family. This is a tailor-made policy issued by New India Assurance Company that provides health coverage to people suffering from blindness, low vision, leprosy-cured, hearing impairment, loco-motor disability, mental retardation, and mental illnesses. 

Features of the plan: 

Tax Benefits

While filing the income tax returns, individuals can claim income tax deduction either as a disabled person or as individuals who have disabled people to support. If an individual suffers from a 40%-79% disability, he can claim a deduction of Rs. 75,000 per year. Whereas, people with more than 80% disability can claim a deduction of Rs. 1,25,000. 

The deductions for disabled individuals are explained under Section 80DD and 80U of the Income Tax Act, 1961. Under Section 80DD, an individual can claim deduction on the part of the income spent on the medical treatment of dependent disabled individuals in their homes. The individual can also claim a deduction for any premium paid against disability insurance policy for his/her disabled family member. Under Section 80U, a disabled person can himself/herself claim a tax deduction for medical expenses.

To avail these tax benefits, the following documents need to be submitted: 

1. A medical certificate that describes the extent and type of disability
2. Form 10-IA in case of autism, cerebral palsy, or other multiple disabilities
3. Self-declaration certificate of the expenses incurred on the medical treatment
4. Premium payment receipts

Conclusion

Differently-abled individuals have the right to live a life of joy and satisfaction, and a suitable health insurance cover will ensure that all the financial and medical needs of these precious individuals are taken care of.