Niramaya Health Insurance Scheme

Anyone with at least one disability recognised…

Anyone with at least one disability recognised under the National Trust Act, 1999, holding a valid disability certificate, is eligible.

Section I: Hospitalization

: Hospitalisation expenses are capped overall at ₹55,000/-, covering:

Corrective surgeries for an existing disability, including a…

Corrective surgeries for an existing disability, including a congenital one (capped at ₹15,000/- under Sec I(A); anything else falls within Sec I(A)'s overall ₹40,000/- limit, apart from these corrective surgeries)

Non-surgical treatment or hospitalisation costs, covered up to…

Non-surgical treatment or hospitalisation costs, covered up to ₹15,000/-.

Section II: Outpatient Department (OPD)

: OPD treatment is capped overall at ₹19,000/-, split as:

OPD treatment -- medicines, pathology, diagnostic tests, etc

OPD treatment -- medicines, pathology, diagnostic tests, etc. -- covered up to ₹15,000/-.

Preventive dentistry, covered up to ₹4,000/-

Preventive dentistry, covered up to ₹4,000/-.

Section III

Section III: Ongoing Therapies

₹20,000/- in total goes toward ongoing therapies aimed…

₹20,000/- in total goes toward ongoing therapies aimed at limiting the disability's impact.

Section IV

Section IV: Alternative Medicine (AYUSH)

AYUSH-system treatment is reimbursable up to ₹4,000/-

AYUSH-system treatment is reimbursable up to ₹4,000/-.

Section V

Section V: Transportation

Medical-treatment-related transport costs are covered up to ₹2,000/-

Medical-treatment-related transport costs are covered up to ₹2,000/-.

Address proof

Address proof

Proof of payment

Proof of payment.
For APL (if family income up to ₹ 15,000/- Per Month) (Enrolment Fee - ₹250/-)
1. - 1. Disability certificate issued by the District

Hospital or appropriate Government authority (self-attested)

Hospital or appropriate Government authority (self-attested)

Address proof

Address proof

Proof of payment

Proof of payment

Income certificate (self-attested) of the parent/guardian, from the…

Income certificate (self-attested) of the parent/guardian, from the competent authority as issued by the State.
For APL (if family income above ₹15,000/- Per Month) (Enrolment Fee - ₹550/-)
1. - 1. Disability certificate (self-attested) issued

by the competent authority as issued by the

by the competent authority as issued by the

State

State

Address proof

Address proof

Proof of payment

Proof of payment. For Renewal:
For BPL:
1. - 1. BPL card.

Address proof, in case of a change of…

Address proof, in case of a change of address.
For APL (if family income up to ₹ 15,000/- Per Month) (Renewal Fee - ₹250/-)
1. - 1. Address proof, in case of a change of address

Income certificate (self-attested) of the parent/guardian, from the…

Income certificate (self-attested) of the parent/guardian, from the competent authority as issued by the State

Proof of payment

Proof of payment.
For APL (if family income above ₹15,000/- Per Month) (Renewal Fee - ₹500/-)
1. - 1. Proof of payment

Address proof, in case of a change of…

Address proof, in case of a change of address. For Claim Process:
A copy of the Niramaya card, or the Health ID Card number.
Self-attested copy of the Disability Certificate.
All original prescription papers from the doctor.
All original bills for Hospital/Medicine/Doctor fee/Therapy fee/Conveyance, etc.
All reports, in original.
Complete bank details of the beneficiary:
Name of the account holder.
Account No./Bank Name/Branch/(City & State).
Bank account IFSC Code. Note:
Need for ORIGINAL REPORTS / FILMS LIKE MRI, X-RAY, ULTRASOUNDS ETC.: Claims can only be settled with original documents, including the film itself.
Prescription for Ongoing Therapies: A doctor's prescription is needed at least once every six months, clearly stating the therapy category and its duration; after that, documents from a Rehabilitation Professional covering the therapy, plus related bills, are also acceptable. Whoever writes the prescription must be a valid medical practitioner holding a valid licence/degree under Medical Council rules.