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Friday, 17 July 2015

Niramaya Health Insurance Scheme - National Trust

NIRAMAYA - Health Insurance Scheme (Revised Scheme w.e.f. April, 2015)
(For further clarification you can reach us at here)

Objective

In order to enable and empower persons with developmental disability to live as independently and as fully as possible, health services and their access to persons with developmental disabilities assume a very significant role. In this context, the health insurance facility becomes important but presently such products are not easily available for persons with developmental disabilities. In such a situation, a health insurance scheme "Niramaya" is conceived with the following objectives.

  • To provide affordable Health Insurance to persons with Autism, Cerebral Palsy, Mental Retardation & Multiple Disabilities.
  • To encourage health services seeking behavior among persons with developmental disability.
  • To improve the general health condition & quality of life of persons with developmental disability

Scheme & Its coverage
The scheme envisages to deliver comprehensive cover which will

  • Have a single premium across age band
  • Provide same coverage irrespective of the type of disability covered under the National Trust Act.
  • Insurance cover up to Rs.1.0 lakh.
  • All persons with developmental disabilities will be eligible and included and there will be no 'selection'.
  • The scheme will be available in the entire country except J&K.

The scheme further envisages that there shall be -

  • No exclusion of Pre-existing condition
  • Same cover as that for other persons
  • Services ranging from regular Medical Check-up to Hospitalization, Therapy to Corrective Surgery, Transportation.
  • Conditions requiring repetitive medical intervention as an in-patient.
  • Pre & Post hospitalization expenses, subject to limits.
  • No pre-insurance medical tests.
  • Reimbursement of claims in case of OPD services from any Qualified Medical Practitioner and for IPD treatment can be taken from a Hospital anywhere in the country.



 

Enrollment of Beneficiaries, (through registered organizations)
Any eligible person can apply for enrollment under the Scheme in the prescribed format given on the website and submit it to the nearest organization registered with the National Trust or to any other agencies specially entrusted in this regard by the National Trust. On successful enrollment and approval, Health ID No. / card will be issued to each beneficiary and then can print Ecard through the website.
There will be a nominal processing fee as determined from time to time which shall be payable to the National Trust.

Fresh enrollment may be done throughout the year through our registered organizations.
Both the fresh enrollment and renewal will be from the enrollment date with the Insurance Company to the end of the financial year. Any beneficiary enrolled during any month of the financial year will be covered upto 31st March. The enrollment / renewal fee will be full and will be eligible to claim upto Rs.1 lakh.

Implementation
The entire scheme may be implemented & monitored by the National Trust through registered organization (RO) with the active participation of the Local Level Committees (LLC). The registered organization (RO) shall liaise with the Insurance Company, health service providers, LLCs, State Nodal Agency Centres (SNAC) of the National Trust, State Govt. and all the stakeholders concerned for awareness generation, enrollment as well as for the speedy settlement of claims.

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