Last updated: July 12th, 2019 1:51 AM

Niramaya

The National Trust under Government of India has launched a Health Insurance Scheme called Niramaya for the welfare of individuals with autism, cerebral palsy, mental retardation and multiple disabilities. In this article, let us take a closer look at the scheme.

Objective

The scheme envisages empowering individuals with disabilities, by providing them with equal benefits of a normal human being. This health insurance facility functions with the following objectives.

• To provide affordable Health Insurance to individuals who have autism, cerebral palsy, mental retardation and multiple disabilities.
• To inculcate health-services seeking behaviour among individuals with developmental disabilities.
• To improve the general health condition and quality of life among disabled citizens.

Scheme Coverage

The scheme delivers a comprehensive cover that

• Has a single premium across age band
• Provides same coverage to all disabilities that are covered under the National Trust Act
• Provides an insurance cover of up to Rs. 1 lakh
• Does not select individuals. Instead, it applies to all individuals with developmental disabilities
• Has no excemption from pre-existing condition
• Offers services ranging from a regular medical check-up to hospitalization, therapy to corrective surgery and transportation
• Includes conditions that require frequent medical intervention as an in-patient
• Compensates pre and post hospitalisation expenses, subjected to limits
• Offers no pre-insurance medical tests
• Cashless hospitalisation in empanelled hospitals, reimbursement of claims for OPD services and treatment through non-empanelled hospitals

Eligibility Criteria

The eligibility standards have two different specifications, and the requirements vary from Registered Organization (RO) and Persons with Disabilities (PwDs). Eligibility Criteria for ROs All ROs of the National Trust has to pay a registration fee of Rs. 1000 to register under the Niramaya Health Insurance Scheme for enrolling PwDs under the said Act. Eligibility Criteria for PwD All PwDs should at least have one disability under the National Trust Act 1999 with a valid disability certificate.

Enrolment of Beneficiaries

All eligible applicants can apply for the scheme in the prescribed format, as mentioned by the officials. The applicants are mandated to submit the application form to the nearest organization that is registered with the National Trust or to any other agencies that have been entrusted for this purpose.

Empanelment of Health Service Providers

According to the regulations of the scheme, health services would be provided by a network of hospitals and nursing homes that are empanelled for this scheme. These service providers render the requirements of the scheme to the networked hospitals, based on the following requirements.

• It should have at least 20 in-patient medical beds in urban centres and 5 rural centres.
• It has to be fully equipped and engaged in providing Medical and Surgical facilities along with diagnostic facilities that include pathological tests, X-ray, E.C.G etc. for the care and treatment of injured or sick individuals as an in-patient.
• It has to have a fully equipped Operation Theatre of its own whenever there is a requirement for surgical operations.
• It has to have qualified doctors and nursing staffs working round-the-clock.
• The management should have a complete record on the day-to-day activities that are carried out in the hospital and has to provide necessary records of the insured patient to the insurer or his representative when required.
• It should use ICD and OPQS codes for drugs, diagnosis, surgical procedures etc.
• It should have sufficient experience in the required field.

Premium and Other Charges

The insurance company and the premium payable would be decided in a transparent process. The premium amount shall be paid by the National Trust in advance to the selected Insurance Company. However, there will be a nominal processing fee that has to be remitted to the National Trust.

Stop Loss

If the total claim exceeds the total premium amount, the Insurance Company covers the risk of up to 120% of the premium amount, that is, the insurance company can have a stop loss at 120% of the total premium amount. Likewise, for claims that fall short of total premium amount, the Insurance Company pays back 90% of the savings after deducting 20% as an administrative cost.

Implementation

The scheme is implemented and monitored by the National Trust through third-party Nodal Agency with the active participation of the Local Level Committee (LLC). The Nodal Agency liaises with the Insurance Company, empanelled health service providers, LLCs, SNAP/SNAC of the National Trust, State Government and all stakeholders who are concerned with generating awareness, underwriting the risks and speedy settlement of claims. The Nodal Agency settles the claims of reimbursement as soon as possible and then regains the same from the Insurance Company. The National Trust provides a rolling corpus, whereas the Nodal Agency bears the loss in such settlements.

Enrolment Process

Any eligible individual can apply for enrolment under the scheme in the prescribed format via the nearest registered organisation with the National Trust or to any other agencies that have been entrusted by the organization for this purpose. The PwD would be responsible for paying the application fee, and the RO would be entitled to INR 40, payable by the National Trust per form for processing. The step-by-step process of the enrolment procedure is given below. Step 1: Parents/guardian of PwD have to visit the nearest RO for Niramaya enrolment with the required documents. Step 2: RO sends the online application form/proposal. Step 3: The applicant has to fill the Niramaya application form online and upload the scanned documents as required after the verification of originals. Step 4: Once entering all the required details, the applicant has to submit the duly filled form on the National Trust portal. Step 5: After submitting the form, the applicant has to remit the required fee online. Step 6: The National Trust receives the application form and documents and checks for completion. If there are any missing or falsely stated information, the application has to be resubmitted within 15 days. Step 7: On successful enrolment and approval, Health ID no./card would be issued to the beneficiary. Step 8: The Health ID card is uploaded online, and the beneficiary can download it online or through RO.

Documents Required

The documents required to apply for this scheme varies according to the PwD category. For Below Poverty Line (BPL)

• BPL card
• Address proof
• Disability certificate (self-attested) issued from the District Hospital or appropriate Government authority

Non-BPL

• Disability certificate (self-attested) issued from the District Hospital or appropriate Government authority
• Address proof
• Income certificate of the parent or guardian of the competent authority as issued by the State (self-attested)

PwD with Legal Guardian

• Disability certificate (self-attested) issued from the District Hospital or appropriate Government authority
• Address proof
• Legal guardian certificate issued from the Local Level Committee that is constituted under Section 13 of The National Trust Act,1999

Enrolment Fee

1. Pwd of BPL category - Rs. 250
2. Pwd of Non-BPL category - Rs. 500
3. PwD with Legal Guardian - Free

Renewal Fee

The renewal fee is for one year, that is, up to 31st March of the next year of enrollment. Therefore every year the renewal of process has to be done online in the official website by the beneficiary or NGO and the fee has to be remitted according to the applicable rate as fixed by the National Trust.