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Health Insurance for Differently-Abled Individuals

According to the 2011 Census reports, there are around 26.8 million individuals suffer from different chronic disabilities. Presently in India, there are only a few insurance companies that offer specific critical illness insurance coverage to differently-abled individuals. However, most of these policies do not really provide complete benefits to the insured. For long, there has been a debate on why Indian insurance sector is hesitant in offering comprehensive coverage to individuals with disabilities.

In order to help out people with disabilities, Indian government has introduced various schemes to provide such people with some relief and relaxation in relation to their health insurance policies. But here’s the deal: Such government schemes only cover the basic medical treatments and no extra coverage is offered for intense medical treatments.

There are some private insurance firms too that offer necessary coverage to the people with disabilities. However, such plans are usually very expensive. Simply stated, there are very few insurance benefits that a person with disability has at his/her disposal.

Who is Considered Specially-Abled?

People suffering from one of the below mentioned disabilities are considered to be specially-abled: 

  • Congenital Disability – This is a specific medical condition where a person is affected right from his or her birth. Some common congenital disorders include heart conditions, cystic fibrosis, spina bifida, Fragile X syndrome, Cerebral Palsy, and others.
  • Accidental Disability – This is a condition of disability caused due to an accident. Those with broken or impaired limbs are covered under accidental disability. Even those with partial or complete blindness caused due to an accident are covered under Accident Disability.
  • Mental Disability – It refers to any disabilities related to mental disorder or illness. It covers people with psychiatric disorder, behavioral distress or mental impairment.

Individuals with congenital disability and mental disability fall under the high risk category. Therefore, these individuals are not eligible for the complete coverage of critical illness insurance policy. However, those with accidental disability are eligible for health insurance coverage. The accidental disability benefit is offered either as a part of the policy or as a standalone rider benefit.

You may like to Read: Myth Busted! Health Insurance for the Disabled in India

Government Sponsored Health insurance Policies for Differently-Abled Individuals:  

Though there are no specific or tailored critical illness insurance policies for those with disabilities, the government of India provides a health insurance options to provide some relief to differently-abled individuals.

  • Nirmalya Health Insurance - This government initiated health insurance policy is specially designed for the individuals with mental disabilities. Under this insurance plan, the insured gets coverage of up to Rs 1 lakh for medical treatment including both pre and post hospitalization expenses.

If the family’s monthly income is less than Rs. 15,000, then the policy holder is liable to pay only Rs 250 as the fixed premium payout. But if the monthly income of family is over Rs 15,000, then the premium to be paid is Rs 500.

  • Swavalamban Health Insurance – Yet another government sponsored health insurance policy, Swavalamban Health insurance custom tailored to suit the needs of those with disabilities.

This plan has been carefully designed to make sure that the insured is able to pays a single premium in one-go and avail the coverages at any time for medical treatments. It is important to remember that this health insurance policy is available only for those disabled individuals who have family income lower than Rs 30,000.

In addition to these brilliant government-sponsored health insurance schemes, Apollo Munich Health Insurance Company also offers special coverage for disabled individuals. Remember,

As discussed above, the eligibility for insurance coverage depends on the risk scale of the insurance seekers. But risk rate is not the only criteria; there are many other factors that impact the eligibility of a disabled individual.

Factors Determining the Eligibility for Health Insurance Policy:

  • Current Health State – This is the first thing that an insurer checks before offering health insurance coverage to people with disability. Generally, insurers check for the last two months health status of the specially-abled individuals, in order to minimize their risk. In case, one is suffering from any chronic ailments or issues at the time of policy issuance, then there are high chances that the insurer will reject one’s eligibility.
  • Family Earnings – Well, this is perhaps the most important factor that determines eligibility of a disabled person for health insurance coverage. Depending on the overall income of the family, the insurer offers an appropriate insurance policy to an individual. In addition to the eligibility, the premium too is decided on the basis of one’s family earning in many cases.
  • Premium Paying Capacity – Every insurance plan has its own premium share. The insurer personally checks your bank accounts & statements, and will determine whether you are eligible for health insurance coverage or not.

So there you have it - three important factors that decide the eligibility of disabled individuals for a health insurance plan.

Things to Know When Buying Health Insurance Policy

  • Documentation – Whether you’re buying a government-sponsored health insurance plan or are planning to invest in a health insurance policy from a private insurer, you’ll need to submit your present medical report. You’ll go for a medical test at a government authorized hospital and consult a registered doctor to collect a valid medical report. On the basis of your medical documents, the insurer will approve or reject your request for insurance coverage.
  • Tax Benefits –Yet another thing that a differently abled individual must know is the fact that government offers tax deduction benefits to such individuals investing in health insurance plans. As per the government regulations, anyone who with partial or severely disabled can avail tax deductions benefits. Section 80U allows partially disabled taxpayers to avail tax deduction for up to Rs 50,000. Whereas severely disabled tax payers are allowed maximum tax deductions of up to Rs 1 lakh.
  • Premium Payout – Remember, insurers have full privilege to determine the amount of premium. Well known insurance companies such Apollo Munich Health Insurance Company charge premiums as per the current GST terms, location, and age of the disabled individual. From July 1, 2017, GST rate of 18% is applicable on every type of financial services including health insurance plans.

Over to You!

If you are suffering from disorders that don’t affect the mobility of the body, then you can easily avail a health insurance plan. Some such disorders include amputated foot disability, speech disability and learning disability. But, be ready with your medical test reports from a registered doctor, as the insurer will definitely ask for them. Don’t forget to check out for the premium and amount of coverage being offered.