Disability insurance provides financial protection to individuals who are unable to work due to a disability. Policyholders pay insurance premiums to an insurer, and in return, they receive regular payments, typically a percentage of their pre-disability income, if they become disabled and are unable to work.
The policy outlines specific criteria for determining disability, such as the inability to perform one's occupation or any occupation, depending on the policy terms. Disability insurance aims to replace lost income during the period of disability, helping individuals cover living expenses, medical bills, and other financial obligations until they can return to work or reach retirement age.
Also, read how health insurance works in India.
Eligibility criteria for this scheme
- Any Indian citizen with 40% or more disability.
- Age above 18 years and less than 65 years. However, in the case of persons with mental disablement, the eligible age would be above 14 years.
- Possession of Unique Disability ID (UDID) Number/ UDID enrolment number.
This scheme provides affordable health insurance cover of up to Rs. 2 lakh for individuals with disabilities.
What are the inclusions of health insurance for the handicapped?
Disability medical insurance provides financial support for essential healthcare needs. While coverage varies by insurer, common inclusions are:
- Hospitalisation expenses – Covers inpatient treatment, surgeries, and ICU charges.
- Pre- and post-hospitalisation – Includes medical tests, doctor consultations, and follow-ups.
- Daycare procedures – Covers treatments that don’t require 24-hour hospitalisation.
- Rehabilitation and therapy – Support physiotherapy, occupational therapy, and speech therapy.
- Assistive devices – Covers expenses for wheelchairs, prosthetics, and hearing aids.
What are the exclusions of health insurance for the handicapped?
Disability health coverage comes with certain exclusions that policyholders must be aware of:
- Pre-existing disabilities – Some insurers may not cover disabilities present before policy purchase.
- Cosmetic treatments – Procedures like plastic surgery (unless medically required) are not covered.
- Self-inflicted injuries – Disabilities caused by intentional harm or substance abuse are excluded.
- Experimental treatments – Coverage is not provided for unapproved or experimental medical procedures.
- Waiting period restrictions – Certain conditions may have a waiting period before coverage begins.
Claim settlement process for disability insurance
Filing a claim for disability insurance involves a structured process to ensure smooth reimbursement or cashless treatment:
- Inform the insurer – Notify the insurance provider immediately after hospitalisation or medical treatment.
- Submit required documents – Provide medical reports, doctor's prescriptions, hospital bills, and identity proof.
- Claim verification – The insurer assesses the claim details and may request additional information.
- Approval or rejection – Upon verification, the insurer approves or denies the claim based on policy terms.
- Reimbursement or direct settlement – In a cashless claim, the insurer pays the hospital directly, while in reimbursement cases, the insured receives compensation after submitting bills.
Important factors to consider while buying health insurance for disabled individuals
When purchasing health insurance for individuals with disabilities, there are some important factors to consider:
- Type of disability: Different health insurance plans might offer different types of coverage for different disabilities. One must check if the plan covers the expenses related to your particular disability.
- Sum insured: A sufficient sum insured would ensure that one does not run out of funds when medical expenses arise.
- Age: Some health insurance policies set age limits for coverage; one must check if their age falls under the eligibility criteria.
- Premium: The premium that one has to pay for the policy should be affordable and within budget.
- Exclusions: Exclusions can vary depending on the policy. One should carefully read the policy terms and conditions to know what disabilities or health conditions are excluded from coverage.
• Nirmaya health insurance scheme
The objective of this scheme is to provide affordable health insurance to persons with autism, cerebral palsy, mental retardation, and multiple disabilities. All persons with disabilities under the National Trust Act with a valid disability certificate will be eligible. It provides an insurance cover of up to Rs. 1 lakh.
Know about the other government health schemes in India, their benefits, coverage, eligibility, and more.
Health insurance for the disabled in India is an essential financial safety net to cover high medical expenses. Before selecting a policy, individuals should ascertain their requirements and choose a plan that provides sufficient coverage and flexibility. One should also consider government-sponsored schemes providing tailor-made health coverage options. It is better to be prepared for any unfortunate events than to regret not taking a policy.
