Swavalamban Health Scheme

Swavalamban Health Insurance Scheme

The Swavalamban Health Insurance Scheme is an impressive initiative for Persons with Disabilities (PwD), launched on October 2, 2016. It was established by the Government of India in alliance with The New India Assurance Co. Ltd.

The scheme is designed to provide affordable health insurance coverage of up to INR 2 lakhs for persons with disabilities belonging to the Below Poverty Line (BPL) category. This includes individuals with low vision, blindness, leprosy-cured conditions, locomotor disability, hearing impairment, mental illness, and mental retardation.

The scheme is coordinated with the Trust Fund for Empowerment of Differently Abled Persons (SID) to enhance the general health of PwD and improve their quality of life.

Key Features of the Swavalamban Health Insurance Scheme

• The premium for the Swavalamban Health Insurance Scheme is the same nationwide. PwD pay around INR 357/-, which is 10% of the actual premium plus service tax, as the scheme offers a 90% government subsidy.
• The scheme offers comprehensive coverage of up to INR 2 lakhs to the beneficiary and their family on a family floater basis for 12 months.
• The scheme is applicable for applicants between 0-65 years of age, belonging to the Below Poverty Line (BPL) category (40% disability or more) with a family income of less than INR 3 lakhs annually.
• The New India Assurance Company has 7,500+ network hospitals across India and strives to provide cashless hospitalization facilities for insured applicants.
• To enroll in the Swavalamban Health Insurance Scheme, the applicant must have a PwD certificate issued under the PwD Act, 1995.
• The parent or legal guardian can also be covered under the policy if the applicant is a minor.
• The scheme also covers pre-existing ailments and pre/post-hospitalization expenses, subject to limits.
• Pre-existing conditions are covered. However, remedial surgery for existing impairment requires consent from the insurer/TPA.

Eligibility Criteria

Coverage Under Swavalamban Health Insurance Scheme

• The scheme covers up to INR 10,000 annually for OPD expenses for curative therapy for persons with disabilities.
• The scheme also covers up to INR 3,000 for OPD expenses for insured applicants with mental illness or retardation.
• Curative surgery for existing impairment is covered after approval from the insurer/TPA.

Guidance for Enrolling in the Scheme

To enroll in the scheme, you must provide the following documents:

• Government-issued ID cards such as PAN card, Aadhaar card, Voter ID, and Driver’s License.
• Two passport-size photographs of family members.
• Disability medical certificate issued under the PwD Act, 1995.
• Self-attested copy of Ration Card / BPL / Priority category / AAY (Antyodaya Anna Yojana) card.

How to Apply

Once you have all the required documents, you must fill out the application form and submit it to the concerned ICDS scheme offices along with supporting documents.

To obtain the application form, visit the official website of the Kerala Social Security Mission and Social Justice Department.

Advantages and Limitations of the Swavalamban Health Insurance Scheme

Swavalamban Health Insurance Scheme - Claim Process

With The New India Assurance Company’s comprehensive network of hospitals across India, insured applicants can easily opt for cashless hospitalization facilities. If treatment is taken in a non-network hospital, approval from the TPA is required. However, applicants do not need approval during emergency hospitalization. The scheme also covers the policyholder’s pre-existing illnesses. While claiming, you must submit the certificate of disability issued under the PwD Act, 1995, to the TPA.

Authorized TPAs and Contact Numbers

Redressal Process

If an insured applicant faces any grievance regarding assistance, they can reach out to a customer representative of The New India Assurance. If the concern remains unresolved, it can be escalated to a named person in the Department of Empowerment of PwD.

Conclusion

Overall, the Swavalamban Health Insurance Scheme is the government's effort to offer affordable health insurance plans and improve conditions for PwD. A tailor-made plan, as per the needs of a person with a disability, can help them live with dignity. In India, approximately 2.21% of the total population lives with some form of physical disability, and such a scheme can bring significant positivity to the lives of PwDs.