In India, there are over 2.5 crore people living with disabilities (PwDs), as per the 2011 census. For individuals with disabilities and their families, securing the right health insurance is crucial to ensure access to necessary medical care without facing financial hardships. This article delves into the various aspects of health insurance for disabled individuals in India, including available options, eligibility criteria, and important factors to consider.
What is a Disability?
A disability is defined as a physical or mental impairment that significantly impacts a person’s ability to perform everyday tasks. According to the Persons with Disabilities Act of 1995, an individual with at least 40% bodily impairment is considered disabled. Those with more than one disability or with 80% bodily impairment are classified as severely disabled.
Categories of Disabilities in Health Insurance
In the context of health insurance, disabilities are generally categorized into three types:
1. Congenital Disability
Congenital disabilities are present from birth and are often hereditary or caused by environmental factors. Examples include cleft lip, spina bifida, and other congenital anomalies. Initially, congenital disabilities were universally excluded from health insurance coverage. However, following the Insurance Regulatory and Development Authority of India’s (IRDAI) 2016 regulations, only external congenital defects are excluded from coverage.
2. Accidental Disability
Accidental disabilities result from injuries sustained in accidents and can be categorized into total, partial, or temporary disabilities. Examples include the loss of limbs, hearing, or eyesight, and paralysis. Health insurance policies typically cover accidental disabilities, though the extent of coverage may vary.
3. Mental Disability
Mental disabilities affect a person’s thinking, mood, or behavior. Common examples include autism, schizophrenia, and depression. The National Mental Health Survey of 2016 highlighted that 14% of India’s adult population requires mental health interventions. The Mental Healthcare Act of 2017 mandates that insurers treat mental illnesses on par with physical illnesses, providing much-needed coverage for mental disabilities.
Health Insurance Options for Disabled Persons
Individuals with congenital or mental disorders are often considered high-risk by insurers, which can lead to limited coverage under standard health insurance plans. Fortunately, there are government-backed health insurance schemes like Niramaya and Swavlamban that provide substantial coverage for PwDs.
| Health Insurance Plans for Disabled in India | ||
|---|---|---|
| Feature | Niramaya Health Insurance | Swavlamban Health Insurance |
| Age Criteria | No age limit | 18 to 65 years |
| Family Income Criteria | N/A | Family income < ₹3 lakh per annum |
| Sum Insured | ₹1,00,000 | ₹2,00,000 |
| Premium Payable | Family income < ₹15,000: ₹250 Family income > ₹15,000: ₹500 |
₹3,100 (only 10% from the individual, the rest funded by the government) |
| Individuals Covered | Individual with disability | The disabled person, their spouse, and up to two children |
| Documents Required | Disability certificate | Identity proof, Proposal form, Income certificate, Premium payment receipt |
| Coverage Limits | Ongoing therapy: ₹10,000 Hospitalisation: ₹70,000 Transportation expenses: ₹1,000 Alternative medicines: ₹4,500 Outpatient Department (OPD): ₹14,500 |
N/A |
Important Factors to Consider While Buying Health Insurance for Disabled Individuals
1. Provide Accurate Information
It is essential to accurately disclose all disabilities and pre-existing conditions when applying for health insurance. Providing incorrect or incomplete information can lead to claim denials in the future.
2. Submit Medical Reports
Insurance companies may require past medical records to assess the extent of disability and any pre-existing conditions. These records are crucial in determining the premium and coverage for the policy.
3. Understand the Policy Premium
The premium for health insurance policies is calculated based on factors such as age, type of disability, medical history, and existing health conditions. The premium amount, inclusive of an 18% GST, must be paid regularly to maintain coverage.
Eligibility Criteria for Health Insurance for PwDs
When evaluating health insurance applications from PwDs, insurers typically consider the following criteria:
1. Extent of Disability
The extent of the disability is assessed to determine the associated risk and the premium for the policy.
2. Current Health Condition
Insurers may request recent medical records to evaluate the current health condition of the applicant. This assessment plays a critical role in the approval or rejection of the insurance application.
3. Required Documents
The required documents for purchasing health insurance for PwDs may vary between insurers but generally include:
- Identity proof (Aadhaar Card, PAN Card, Driving License)
- Income certificate
- Disability certificate
- Past medical records
Tax Benefits for Disabled Persons
PwDs and their family members can avail of tax deductions under the Income Tax Act. For individuals with 40% to 79% disability, a deduction of up to ₹75,000 per year is available. Those with more than 80% disability can claim up to ₹1,25,000 per year.
Under Section 80U, PwDs can claim deductions on medical expenses, while Section 80DD allows family members to claim deductions for medical expenses incurred for the disabled person. Premiums paid for health insurance policies covering PwDs are also eligible for tax benefits.
Conclusion
Securing health insurance for persons with disabilities (PwDs) in India is vital to ensure they have access to necessary healthcare services without facing overwhelming financial challenges. Government schemes like Niramaya and Swavlamban offer tailored coverage options specifically designed to meet the unique needs of disabled individuals and their families. When selecting a health insurance plan, it’s important to thoroughly assess the coverage options, provide accurate health information, and understand the premiums involved. By making informed decisions, PwDs can benefit from comprehensive healthcare coverage, which plays a crucial role in improving their quality of life and financial security.
