color chooserblueRedGreenOrangePurple
Font ResizeFont DecreaseRevert font size to defaultIncrease font size
OOPS. Your Flash player is missing or outdated.Click here to update your player so you can see this content.
You are here: Home Legal Instruments Schemes and Initiatives The National Trust NIRAMAYA
Loading...
The National Trust Health Insurance Scheme - NIRAMAYA PDF Print E-mail

NIRAMAYA

A Health Insurance Scheme

For the welfare of persons with Autism,

Cerebral Palsy, Mental Retardation and Multiple Disabilities

THE NATIONAL TRUST

16-B, Bada Bazar, Old Rajender Nagar

NEW DELHI - 110060

Phone: 91-11- 23766898, 43520861, Fax: 91-11-23731648

E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it Website: www.thenationaltrust.in

Scheme Website: niramayascheme.com

Download Enrolment Form

OBJECTIVE

In order to enable and empower persons with disability to live as independently and as fully as possible, health services and their access to persons with disabilities assume a very significant role. In this context, the health insurance facility becomes important but presently such products are not easily available for persons with disabilities. In such a situation, a health insurance scheme “Niramaya” is conceived with the following objectives

  • To provide affordable Health Insurance to persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities
  • To encourage health services seeking behavior among persons with disability
  • To improve the general health condition and quality of life of persons with disability


SCHEME AND ITS COVERAGE

The scheme envisages to deliver ‘Community based’ cover which will –

  • Have a single premium across age band
  • Provide same coverage irrespective of the type of disability
  • Insurance cover upto 1.0 lakh Rs. and
  • All persons with disabilities will be eligible and included and there will be no ‘selection’


The scheme further envisages that there shall be -

  • No exclusion of Pre-existing condition
  • Same cover as that for other persons
  • Services ranging from regular Medical Chekup to Hospitalization, Therapy to Corrective Surgery, Transportation
  • Conditions requiring repetitive medical intervention as an in-patient
  • Pre and Post hospitalization expenses, subject to limits
  • No pre-insurance medical tests
  • Cashless settlements only
  • Smart / Biometric cards with not only health data but also provision for other (Micro) financial data

The details of services with financial limits are as given in Annexure - ‘A’. In the first phase, the scheme will be available in the selected districts as given in Annexure - ‘B’.

ENROLMENT BENEFICIARIES -

The National Trust will maintain the details of each beneficiary covered under the scheme. This will be a part of their identification and enrolment under the scheme.

ENPANELLMENT OF HEALTH SERVICE PROVIDERS

Under the scheme, health services will be provided by a network of hospitals, nursing homes which will be duly empanelled for the scheme. Such service provider shall be of good quality fulfilling relevant requirements of the scheme and in case of networked hospitals, should comply with the minimum criteria as under:

  • Should have at least 20 in-patient medical beds in urban centers and 5 in rural centers.
  • Fully equipped and engaged in providing Medical and Surgical facilities along with Diagnostic facilities i.e. Pathological test and X-ray, E.C.G. etc for the care and treatment of injured or sick persons as in-patient.
  • Fully equipped Operation Theatre of its own wherever surgical operations are carried out
  • Fully qualified nursing staff under its employment round the clock.
  • Fully qualified doctor(s) should be physically in charge round the clock.
  • Maintaining complete record as required on day to day basis and be able to provide necessary records of the insured patient to the Insurer or his representative as and when required.
  • Using ICD and OPQS codes for Drugs, Diagnosis, Surgical procedures etc.
  • Having sufficient experience in the specific identified field.


PREMIUM AND STOP LOSS

The premium shall be decided by inviting tender from the eligible insurance companies.

The premium amount for BPL category of persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities will be shared by the State Govt. and Central Govt. / the National Trust. Other categories of persons may join the scheme on payment of suitable premium amount.

In case of total claims exceeding the total premium amount, the Insurance Company will cover the risk up to 120% of the total premium amount i.e. the insurance company can have a stop loss at 120% of total premium amount. Similarly in case of claims falling short of total premium amount, the Insurance Company shall pay back 90% of the savings, after deducting 20% as administrative cost.

Funding / Budget:

IMPLEMENTATION

The entire scheme shall be implemented and monitored by the National Trust through a Third Party Nodal Agency (TPNA) with the active participation of the Local Level Committees (LLC). The Third Party Nodal Agency shall liaise with the Insurance Company, empanelled health service providers, LLCs, SNAP/SNAC of the National Trust, State Govt. and all the stakeholders concerned for awareness generation as well as for underwriting the risks and for the speedy settlement of claims.

BUDGET

In the first phase, it is expected to cover 1 lakh BPL beneficiaries for health insurance upto Rs. 1 lakh at a premium of Rs. 99/- per annum per beneficiary. The total cost of the Scheme will be as below

Premium Amount @ 99/- for 1 lakh BPL beneficiaries

Rs. 99 lakh

Service Charges for Third Party Administration @ 10%

Rs. 10 lakh

Miscellaneous (Awareness, Publicity, Contingency etc.)

Rs. 16 lakh

Total (per annum)

Rs.125 lakh

ANNEXURE - A

HEALTH INSURANCE BENEFITS

List of Benefits (including pre-existing conditions) Limits (Rs.)

1

Cashless Hospitalization (over all limit including the following sub-limits)

100000

2

Domiciliary Hospitalization including Nursing charges (not exceeding 4 days per incidence)

25000

3

Corrective Surgeries for existing disability including congenital disability.

20000

4

Surgery to prevent further aggravation of disability

20000

5

Post operative care including Therapies for 6 months

15000

6

Regular Medical checkup for non-ailing Disabled (disability oriented preventive purposes)

2500

7

Pathology, Radiology, Advance tests for Diagnosis of illness and monitoring disability

10000

8

Ongoing Therapies to reduce impact of disability and disability related complications

7500

9

Transport charges for seeking medical services including ambulance services

1500

10

Dental : Preventive Dentistry

7500

11

Transport charges for seeking medical services

1500

12

Alternative Medicine

2000

ANNEXURE - B

LIST OF DISTRICTS TO BE COVERED UNDER THE SCHEME IN FIRST PHASE

SN

STATE/ UT

DISTRICT

1

BIHAR

KAIMUR

2

CHANDIGARH

CHANDIGARH

3

DELHI

CENTRAL DELHI

4

GUJARAT

AHMEDABAD

5

KERALA

KASARGODE

6

MADHYA PRADESH

JABALPUR

7

TAMILNADU

ERODE

8

TRIPURA

AGARTALA

9

UTTAR PRADESH

RAE BAREILY

10

UTTRAKHAND

BAGESHWAR

Download Enrolment Form

Last Updated on Friday, 07 June 2013 12:55
 

Quick Links and Latest Updates

Disability Register Census 2011 Disability Data| Presentation on Data Disability 2011| Disabled population by type of Disability, Age and Sex
Legal Instruments Central Ministries Schemes | States Schemes | Scheme of Sports for PwDs | ADIP Scheme (updated)| User Manual for NGO Application Tracking System | Procurement Plan 2013-14 for World Bank Assistance under SSA-III| Outcome Budget 2013-14 Department of School Education and Literacy | PM National Council Skill Development Programme | ICDS SchemeNew
State Policies Bihar| Goa| Himachal Pradesh| Orissa| Rajasthan (in Hindi)| Tamil Nadu|
Resources Women with Disabilities (new section added)New| Union Budget 2014-15 DisabilityNew
Publications Annual Reports (new section added)New
Publications RCI | CCPD | NT | WHO New(New Publications Added) | World Bank | ILO | European Union | UNESCO | UN | History of Disability and UN | UNESCO Global Report: Opening New Avenues for Empowerment: ICTs to Access Information and Knowledge for Persons with Disabilities, February 2013 | ILO Publications: Disability in the Workplace: Employer's Organizations and Business Networks| United Nations: Thematic Study on the Work and Employment of PWDs| United Nations: Best Practices for Including PWDs in all Aspects of Development Efforts| UNICEF: The State of the World's Children 2013 Children with Disabilities| MHRD: SSA Framework for Implementation | WHO:International Perspective on Spinal Cord Injury
For Hearing Impaired Test your Hearing | Jobs | Navshikhar Sign Language | Braille Learning
Circulars/Notices RTE Act | Streamlining the procedure for grant-in-aid to NGOs under various schemes/programs of MSJE
Punarbhava Acknowledgements UNESCO Global Report | Planning Commission, GoI's Working Group Report on Science and Technology for Vulnerable Sections of Society | Digital Review of Asia Pacific 2009-10
Recruitment Drives Vikram Sarabhai Space Center ThiruvananthapuramNew| Union Public Service CommissionNew| Railway Recruitment BoardsNew| Jharkhand Staff Selection CommissionNew
Misc. Access Hub (We are not responsible for information contained on this link)


Disability Registration Form

Image of National Disability Register
Cases and Judgements

Image of Cases and Judgements
RCI Programmes

Image of Programmes of RCI
Career

Image of Careers
Assistive Devices

Image of Assistive Devices
Valid W3C XHTML 1.0 Transitional Valid CSS