Taking Cover. Health covers for the differently-abled

Medical costs can burn a hole in your pocket and set back your finances and savings. More so if there is no insurance cover or if the expenses are recurring in nature, as in the case of people with disabilities.

In view of the upcoming ‘‘International Day of Persons with Disabilities’’ on December 3, we take a look at the options available for the disabled.

The Government offers the Niramaya health insurance policy for persons with autism, cerebral palsy, mental retardation and multiple disabilities. The cover offered is ₹1 lakh, irrespective of the type of disability.

The insurance cover can be used for a wide range of services such as regular medical check-ups, hospitalisation, therapy and corrective surgery, subject to sub-limits for each category. Medical tests are not mandatory for getting this cover and treatment can be taken at any hospital. The policy also compensates for out-patient services, including medicines, pathology, diagnostic tests done at non-empanelled hospitals. Transportation costs are also covered.

To enrol, you need a disability certificate issued by an authorised entity and proof of address. The annual payment is ₹500 if the family income is over ₹15,000 per month. Medical expenses have to be first borne by the insured; they must apply for reimbursement by submitting documents such as medical bills, hospitalisation report and discharge card.

For people with blindness, low vision, hearing impairment, loco-motor disability, mental illness and those who have earlier been leprosy patients, the New India Assurance Company offers the Swavlamban health insurance scheme (in association with Ministry of Social Justice and the Department of Empowerment of Persons with Disabilities). The policy is open to 0-65 year-olds who have an annual family income below ₹3 lakh.

There are no medical tests and the premium is ₹355 per person. The plan offers coverage of up to ₹2 lakh as a family floater (family size up to four) for one year. There is no exclusion of pre-existing conditions. Corrective surgery for existing impairment can be done after obtaining consent. Pre- and post-hospitalisation expenses are also covered, subject to limits. Out-patient cover for corrective therapy is up to ₹10,000 a year (₹3,000 for persons with mental retardation/illness ).

Private insurers also offer covers subject to certain conditions. The coverage and premium depends on the kind and percentage of disability, says Dhruv Sarin, head of health insurance, Policybazaar.com. Typically, those affected by polio or with less than 40-50 per cent disability can be covered. Insurers such as Max Bupa, Royal Sundaram, Cigna and Religare are known to be more disabled -friendly.

The insured needs a doctor certificate and may also have to go through tests. The cost of the policy varies and may be higher by up to 20-50 per cent than the usual amount based on the risk assessment. Some insurers may also add a waiting period of three to four years. There may also be partial or permanent exclusion or co-payment requirements, says Sarin.

Although government schemes are available, they have some limitations. The cover is low and there is no cashless option. A number of documents have to be submitted to get reimbursement. Secondly, those with over 40 per cent disability may face rejection by private insurers. Besides, certain conditions such as cerebral palsy, autism, any spine/head injury, and blindness are not covered. One with low or poor vision will be covered for hospitalisation due to other health problems but not for eye and related issues, notes Abha Khetarpal, President and Founder, Cross the Hurdles, a non-profit organisation.

Employees with disabilities who are covered through the employer group insurance schemes may also face rejection of claims due to their pre-existing condition.

Options are limited for those disabled due to accidents. Says Ketna Mehta, Founder of Nina Foundation “The average monthly expense for paraplegic (spinal cord injury - waist down) is ₹50,000 and for quadriplegic (chest down) is ₹1 lakh. Such expenses, cannot be managed by many.” One solace though is that eligible individuals with disability can claim a deduction of upto ₹75,000 and those with severe disability, ₹1.25 lakh under Sec 80U of the Income Tax Act, for their expenses.

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