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Health Insurance for Disabled in India

According to the 2011 census, there are over 26.8 million people with disabilities (PwDs) in India—which is around 2.2% of the population, though other sources have higher estimates. When you have a physical or mental disability, everyday life itself can be harder, not to mention the financial strain of higher medical costs.

Since health insurance is one of the best ways to have financial security from medical costs, you might be wondering “Is there any health insurance for disabled people in India?”. Well, let us assure you that there are.

There are various government schemes for people with disabilities, but these tend to have limited coverage. Some private insurers also offer health insurance plans, though these are often more expensive. Let us take a look at the insurance benefits available to a person with disabilities:

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How is Disability Determined in Health Insurance?

In India, under the Persons with Disability (Equal Opportunities, Protection of Rights and Full Participation) Act, 1955, a person who has at least a 40% impairment is considered disabled. If they have more than one kind of disability, or more than 80% impairment, they are considered severely disabled.

Here are three major types of disabilities as they are classified in India:

Congenital Disability – These are conditions that are present from birth either due to hereditary reasons or certain environmental factors. Some common examples include heart conditions, cystic fibrosis, spina bifida, Down’s syndrome, Cerebral Palsy, etc.
Accidental Disability – Such conditions occur when someone meets with an accident that results in either total, partial, or temporary disabilities. This may include broken arms or legs, loss of an arm or leg, loss of eyesight or hearing, paralysis, etc.
Mental Disability – This refers to a mental disorder or illness that impacts the mood, behaviour, thinking, and mental balance of a person. They include depression, bipolar disorder, anxiety, dementia, as well as psychiatric disorders like schizophrenia, and developmental disorders like autism.

Important Things to Consider When Buying Health Insurance for Disabled Individuals

Whether you’re buying a government-sponsored health insurance plan or you’re planning to go with a private insurer, before buying a health insurance policy for disabled individuals, there are some things that you keep in mind:

1. Declare the Correct Information

When filling out the proposal for their health insurance, you must declare your disabilities, and any other pre-existing conditions correctly. Not doing so can affect you at the time of claims.

Check: Pre Existing Disease Cover in Health insurance

2. Have the Proper Documentation

You might be required to submit certain documents or medical reports. This usually includes a report from a doctor to understand the level of impairment of the disability (i.e. how much it affects a person’s ability to perform daily tasks).

You may also be asked to go through additional medical tests at a government authorized hospital from a registered doctor, and based on these tests and reports the insurer will decide whether or not to accept your insurance application.

3. Consider the Premium Amount

Once your insurance application is accepted by a private insurer, remember that it is up to the insurer to decide the premium for your policy. This will vary based on your disability, age, family medical history, other pre-existing conditions, and more. Additionally, there will also be a GST of 18% charged on your premium.

4. Remember the Tax Benefits

While you might be apprehensive about a high premium, keep in mind that disabled individuals can avail of tax deduction benefits on their health insurance.

Section 80U of the Income Tax Act allows partially disabled people to get a tax deduction of up to ₹50,000, while severely disabled individuals can get tax deductions of up to ₹1 lakh.

And according to section 80DD, the family members can also get a deduction on insurance premiums for dependent disabled individuals.

Know about:

How to Look for Health Insurance for Disabled Persons?

As we have mentioned above, there are actually a few health insurance options for people with disabilities.

Individuals with accidental disabilities will be covered by most regular health insurance plans, with no extra clauses added. In fact, if they had a Personal Accident Cover before the accident, you will have extra financial security and a fixed benefit in case of some disablement.

However, it must be noted that Individuals with congenital and mental disabilities will fall under a high-risk category and thus either may not be covered by regular health insurance plans, or end up getting only partial coverage. Hence, they can look towards government health schemes for better medical protection.

Government-Sponsored Health Insurance Policies for Disabled Individuals

The Government of India offers two special health insurance schemes for those with disabilities:

Nirmalya Health Insurance: covers people with mental disabilities up to ₹1 lakh for medical treatments. It does not require pre-insurance tests, but individuals must enroll with the National Trust to avail of this policy.
Swavalamban Health Insurance: this is offered to any person with a disability whose annual family income is less than Rs 3,00,00.

Here is how the two policies compare:

Parameters	Nirmalya Health Insurance	Swavalamban Health Insurance
Age Limit	No age limits	18-65 years
Eligibility	Must be enrolled with The National Trust	Family income less than ₹3 Lakh per annum
Sum Insured	₹1 Lakh coverage	₹2 Lakh coverage
Coverage Limits	Includes limits for: OPD expenses: ₹14,500, Ongoing therapy: ₹10,000, Alternative medicines: ₹4,500, Transportation costs: ₹1,000	Covers disabled person, spouse, and two children
Premium	₹250 (If family income is less than ₹15,000), ₹500 (If family Income is more than ₹15,000)	₹3,100 (only 10% to be collected from the insured)
Documents Required	Valid disability certificate	Disability certificate, Proposal form, Receipt of premium payment, Income certificate, Identity proof

How to Determine Your Eligibility for Health Insurance?

There are also some factors that will determine your eligibility criteria for health insurance. They are as follows:

Current Health Status: The first thing an insurer will check when it comes to insuring a person with a disability is the state of their health over the past few months. This is to establish the risk involved for them. Based on the health reports, and any further tests to check for chronic ailments and pre-existing complications, they may approve or reject the insurance coverage.
Income: Another important factor that determines the eligibility of disabled people is their ability to pay their premiums. So, they will check your earning capacity, bank accounts, and statements. However, many disabled people are financially dependent on their family members, and in such cases, they will also check the overall income of the family. Based on these factors, they will decide whether or not to cover the individual.

If you or a family member lives with a disability, hopefully, now you have a better idea about what you can do buying a health insurance policy.

Unfortunately, there is still a lot of scope for improvement when it comes to health insurance for disabled individuals. Currently, only those disabled individuals who aren’t considered high-risk have options when it comes to private insurance plans. But there is sure to be reforms and improvements in the future so that everyone, even those with severe disabilities can be covered with health insurance too.

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