Niramaya Health Insurance Scheme – A Ray of Hope for the Persons with Disabilities and their Caregivers
Year: 2026
Type: article
Abstract: Respected madam, Niramaya Health Insurance Scheme (NHIS) is an initiative by the Indian government for the persons with disabilities (PwD) under the National Trust Act.[1] It was launched initially on a pilot basis on March 26, 2008.[2] It offers an affordable health coverage of up to Rs. 1 Lakh per year with the provision of coverage of outpatient as well as inpatient departments treatments and therapies.[1] This insurance cover is available on reimbursement basis.[1] The disabilities that are covered under NHIS are intellectual disability, cerebral palsy, autism spectrum disorder, and multiple disabilities.[1,2] The overall prevalence of disability in India was found to be 0.93%, with 5.11% households having one or more PwD.[3] It is evident that mental health disorders are associated with financial difficulties,[4] which can hold true for all the disabilities. Preinsurance medical tests are not required to avail the benefits under NHIS.[1] The premium under this scheme varies from nil to 500 rupees per year according to monthly income.[2]Table 1 summarizes the details of NHIS in the concise manner.[1]Table 1: Details of various sections and appropriate sub-sections along with the cost of various treatment modalities covered under Niramaya Health Insurance Scheme[ 1 ]Under the Section II of NHIS, original treatment documents such as reports and films of X-ray, magnetic resonance imaging, and ultrasound are needed for the settlement of the claims.[1] Under the Section III of NHIS, a doctor’s prescription related to ongoing therapy is must at least once in a 6 months’ period which must mention about the category as well as duration of the ongoing therapy.[1] The concerned treating doctor should be a valid medical practitioner with a valid degree/license according to the medical council. Afterward, other documents and bills of the therapies from the rehabilitation professionals can be accepted.[1] So to avail the benefits under NHIS, the claimant must have current Niramaya Health ID, unique disability identity card, disability certificate, original treatment documents, original receipts and bills, final bill break-up, original copies of investigation reports, original copy of discharge card, bank passbook copy mentioning the name of PwD, and duly filled claim form containing the amount to be claimed on reimbursement basis.[5] The process of application including both enrolment as well as renewal of NHIS policy, recharge of NHIS policy, claim-related queries, conditions of exclusions, queries related to enrollment as well as renewal, claim process, list of required documents, relevant contact numbers, and benefit chart under NHIS are described in a concise manner in a portable document format (PDF) file from the website of The National Trust.[5] An Indian study observed that less than a fraction of the eligible PwD got enrolled under the NHIS and concludes that efforts are required for promoting the enrollment under NHIS for its utilization.[6] There is a lack of proper awareness about the NHIS among the healthcare professionals, caregivers and the PwD,[6] which may act as contributing factor toward underutilization of NHIS. Another Indian study found that the awareness about Niramaya scheme was very low with only 24% and 8% of the households were having awareness and enrollment, respectively.[7] Hence, this article was written with an aim of creating awareness about NHIS among all the concerned people for the better utilization of NHIS. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Annals of Indian Psychiatry
Author: Ajinkya Sureshrao Ghogare
Institution: Government Medical College and Hospital
Language: English
Subfield: Finance
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W7162106434