Swavalamban Health Scheme
  • Features of Swavalamban Scheme
  • Tax Saving Benefits
  • Guide for Enrolling Scheme
Swavalamban Scheme
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Swavalamban Health Insurance Scheme

Swavlamban Health Insurance is an impressive scheme for persons with Disabilities (PwD), launched on 2nd October 2016. It was established by Govt. of India along with an alliance of The New India Assurance Co. Ltd.

However, the scheme is designed to provide affordable health insurance coverage up to INR 2 lakhs/ - for persons with disabilities belonging to the BPL category. For instance, a person with Low Vision Blindness, Leprosy-Cured, Loco-Motor Disability, Hearing impediment, Mental illness, and Mental retardation.

However, 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.

What are the Key Features of the Swavlamban Health Insurance Scheme?

  • The premium of the Swavlamban Health Insurance Scheme is the same nationwide, around INR 357/- for PwD with 10% of the actual premium plus service tax.
  • The scheme offers comprehensive coverage of up to INR 2 lakhs/ - to the beneficiary and his family on the family floater for 12 months.
  • The scheme is applicable for applicants between the age group of 0 - 65 years belonging to the below-poverty 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 plan India and strives to provide cashless hospitalization facilities for insured applicants.
  • To enroll in the Swavlamban Health Insurance Scheme, the differently able applicant must carry the PwD certificate issued by the PwD Act, 1995.
  • The parent/ legal guardian can also be covered under the policy if the applicant is a minor.
  • The scheme also covers a pre-existing aliment and pre-post hospitalization as subject to limits.
  • Pre-existing conditions are included in the scheme, but if remedial surgery for existing impairment is required, it can be done with the consent of the insurer/ TPA.

Eligibility Criteria:

Concept Feature Description
TypeGroup Health Insurance/ Family Floater
Sum InsuredINR. 2 lakhs/ - to the beneficiary and his family
Period One year from the policy issue date
PremiumA central government-subsidized premium of around INR 357/- for PwD (p.a.), with a 90% subsidy (total premium: around INR 3,000 p.a.)
Family InsuredPwD below the age of 18 - Family/ Legal Guardians
PwD above the age of 18 - Husband and up to 2 kids, till they cross the age of 18.
Income LimitThe scheme applies to applicants below-poverty category with a family income of less than INR 3 lakhs annually.
Who can Be CoveredFamily size up to 1 + 3. The person with a disability must be the key member. The program may also cover the parents of a minor who has a disability.

Coverage Under Swavlamban Health Insurance Scheme

  • The scheme covers up to INR 10,000 annually for OPD expenses for any curative therapy for a person with disabilities.
  • The scheme also covers up to INR 3,000 for OPD expenses for insured applicants with mental illness or retardation.
  • In case the applicant needs curative surgery to treat existing impairment, it can be done after the approval of the insurer/ TPA.

Guidance for Enrolling the Scheme

  • To enroll in the scheme, you must provide the following documents:-
  • Government-issued ID cards such as PAN cards, Aadhar, cards, Voting Card, and Driver's licenses.
  • Passport-size two photographs of family members.
  • Disability medical certificate issued by PwD Act, 1995.
  • Self-attested copy of Ration Card/ BPL/ Priority category/ AAY (Antyodaya Anna Yojana)

How to Apply?

Once you've 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 Swavlamban Health Insurance Scheme

Advantages Limitation
With the vast network of Hospitals of The New India Assurance, Insured persons can conveniently opt for cashless hospitalization facilities.Please note that the listed disabilities are not covered under this scheme:
  • Autism
  • Multiple disabilities
  • Cerebral Palsy
The scheme's benefits also cover the family of PwD applicants.The scheme does not cover the expenses of rehabilitation facilities such as day-care/ halfway home/long-stay facilities.
Treatment for pre-existing medical problems is also covered, and the enrollment process is quite straightforward.The scheme's launch was not publicized much, leading to limited awareness of Swavlamban Health Insurance among PwD.

Swavlamban 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 you've to take treatment in a non-network hospital, then approval from the TPA is required. Even applicants don't have to get approval during an emergency hospitalization. However, the scheme also takes full accountability for the policyholder's pre-existing illness. But while claiming you must submit the certificate of disability issued by the PwD Act, 1995 to the TPA.

Here are the list of authorized TPA and their contact number listed below in table-

Name of the TPA Toll-Free Number
MD India Healthcare Services (TPA) Pvt. Ltd.1800-233-116
1800-233-4505
Raksha TPA Pvt. Ltd.1800-180-1444
Vidal Health TPA1800-425-8885
Medicare TPA1800-345-3339
Medi Assist India TPA Pvt, Ltd.1800-425-9449

Redressal Process

If the insured applicant facing an issue with any sort of grievance over any assistance factor, they can reach out to a customer representative of The New India Agency. Even if the person's concern is still unsatisfied, they can escalate it to a named person in the Department of Empowerment of PwD.

Conclusion

Overall, with the Swavlamban Health Insurance Scheme, the government strives to offer affordable health insurance plans and improve the 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, around 2.21% of the total population is somehow physically disabled. and such a scheme can bring much positivity to the lives of the PwDs.

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Simran Kaur Vij

Written By: Simran Kaur Vij

Simran is an insurance expert with more than 3 years of experience in the industry. She may have all the answers to your insurance queries. With a background in Banking, she proactively helps her readers to stay on par with all the latest Insurance industry developments.