Niramaya Health Insurance Scheme for Disabled Persons

What is the Niramaya Health Insurance Scheme?

Niramaya is a health insurance scheme implemented by the National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities under the Ministry of Social Justice and Empowerment. It provides ₹1,00,000 per year health coverage for persons with specific disabilities at a very low premium:

• ₹250/year for BPL families
• ₹500/year for non-BPL families

Key Benefits

What is Covered?

• OPD (outpatient consultations, physiotherapy, occupational therapy)
• Surgeries and hospitalization
• Dental treatment
• Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homeopathy (AYUSH)
• Autism and related therapies — speech therapy, behavioral therapy
• Corrective surgeries
• Transportation costs to hospital (up to ₹500 per visit)

Who is Eligible?

The disabled person must have ONE of these conditions:

1. Autism Spectrum Disorder (ASD)
2. Cerebral Palsy
3. Intellectual Disability (Mental Retardation)
4. Multiple Disabilities (combination of above)

Note: The scheme does not cover other disabilities like physical disability, hearing/visual impairment alone. It is specific to the four conditions listed above.

Additional requirements:

• Must be a permanent resident of India
• Must have a valid disability certificate from a government hospital / CMO
• Family must apply through a registered organization (RO) empanelled with National Trust

Documents Required

1. Disability certificate — issued by CMO / Civil Surgeon / Government hospital (minimum 40% disability)
2. Aadhaar Card — of the disabled person and parent/guardian
3. BPL card or income certificate — for ₹250 premium benefit
4. Photograph — of the disabled person
5. Bank details — for claim reimbursements
6. Application form — from the Registered Organization (RO)

How to Apply — Step by Step

Step 1 — Find a Registered Organization (RO)

Niramaya applications are submitted through National Trust's Registered Organizations — NGOs and disability organizations empanelled with National Trust.

Find your nearest RO at: thenationaltrust.gov.in → Schemes → Niramaya → Find RO

Step 2 — Collect Application Form

Get the Niramaya application form from the RO. Fill it completely.

Step 3 — Attach Documents

Attach:

• Disability certificate
• Aadhaar / proof of residence
• Income proof (for BPL premium rate)
• Photographs

Step 4 — Pay Premium

Pay the premium (₹250 or ₹500) at the RO. The RO submits the application to the National Trust along with the premium.

Step 5 — Receive Policy

After processing (~2–4 weeks), the insurance policy certificate is issued by the insurance company through the National Trust. Retain this for claim purposes.

How to File a Claim

1. At the time of treatment: Show the Niramaya policy certificate at the empanelled hospital (cashless) or pay and get reimbursement
2. Collect bills: Hospital discharge summary, prescriptions, lab reports, bills
3. Submit to RO: Give the claim documents to your Registered Organization within 30 days of discharge
4. RO submits to TPA/Insurance: The RO forwards to the Third Party Administrator (TPA)
5. Claim settlement: Reimbursement is transferred to the bank account within 15–30 days

Frequently Asked Questions

1. My child has autism. Which hospital can I go to under Niramaya?

Niramaya works on a reimbursement basis (and cashless at some empanelled hospitals). You can go to any government or private hospital for treatment and claim reimbursement. Contact your RO for the list of empanelled hospitals in your area.

2. Is the ₹1 lakh per person or per family?

Per disabled person. Each person with the qualifying disability is separately insured for ₹1 lakh/year.

3. My child has physical disability. Is Niramaya available?

No. Niramaya is specifically for autism, cerebral palsy, intellectual disability, and multiple disabilities involving these. For other disabilities, explore PM-JAY (Ayushman Bharat) or your state's disability welfare schemes.

4. What is the UDID card and is it required for Niramaya?

The UDID (Unique Disability Identity) card is India's national disability ID. While a regular government-issued disability certificate is currently accepted for Niramaya, having a UDID card makes the process faster. Apply at swavlambancard.gov.in.

5. The premium is ₹250. Is there any way to get it free?

Currently, the minimum premium is ₹250 for BPL families. Some state governments or NGOs subsidise this further. Check with your state's Social Welfare Department.

Official Links