National Trust

for the welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities.

www.thenationaltrust.co.in

Jun 09, 2015 E-Card For The Policy Coverage Date 2nd April, 2015 Are Available Now. The beneficiaries covered in Oct 2014 are also required to print new Ecards & use the new Health ID. Apr 22, 2015 The Claims Of E-Card Issued By ICICI Which Are Valid Till Oct 2015 Should Sent To ICICI Lombord Hydrabad if the beneficiary has taken treatment till 14th May 2015 or admitted prior to that. Claims of Beneficiary covered in Oct 14 policy taken treatment/ admited on or after 15th May 2015 & E Card Issued By Oriental Insurance Should Be Sent To Nearest Office Of Raksha TPA. May 25, 2015 NIRAMAYA ENROLMENT IS NOW EVERY MONTH Jun 30, 2015 All the beneficiaries covered in October 2014 policy pls be noted that i) Their policy period is now upto 31st March, 2016 and ii) To do online renewal in January-February, 2016, instead of July-August, 2015.

NIRAMAYA - Health Insurance Scheme (Revised Scheme w.e.f. April, 2015)

'Niramaya' Health Insurance Scheme for the welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities.

Objective

In order to enable and empower persons with developmental disability to live as independently and as fully as possible, health services and their access to persons with developmental 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 developmental 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 & Multiple Disabilities.
  • To encourage health services seeking behaviour among persons with developmental disability.
  • To improve the general health condition & quality of life of persons with developmental disability

Scheme & its coverage

The scheme envisages to deliver comprehensive cover which will

  • Have a single premium across age band
  • Provide same coverage irrespective of the type of disability covered under the National Trust Act.
  • Insurance cover up to Rs.1.0 lakh.
  • All persons with developmental disabilities will be eligible and included and there will be no 'selection'.
  • The scheme will be available in the entire country except J&K.

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 Check-up to Hospitalization, Therapy to Corrective Surgery, Transportation.
  • Conditions requiring repetitive medical intervention as an in-patient.
  • Pre & Post hospitalization expenses, subject to limits.
  • No pre-insurance medical tests.
  • Reimbursement of claims in case of OPD services from any Qualified Medical Practitioner and for IPD treatment can be taken from a Hospital anywhere in the country.

The details of services with financial limits (Benefit Chart)is given at Annexure – 'A'.

Enrolment of Beneficiaries, through registered organisations)

Any eligible person can apply for enrolment under the Scheme in the prescribed format given on the website and submit it to the nearest organization registered with the National Trust or to any other agencies specially entrusted in this regard by the National Trust. On successful enrolment and approval, Health ID No. / card will be issued to each beneficiary and then can print Ecard through the website.

There will be a nominal processing fee as determined from time to time which shall be payable to the National Trust.

Fresh enrolment may be done throughout the year through our registered organizations.

Both the fresh enrolment and renewal will be from the enrolment date with the Insurance Company to the end of the financial year. Any beneficiary enrolled during any month of the financial year will be covered upto 31st March. The enrolment / renewal fee will be full and will be eligible to claim upto Rs.1 lakh.

Premium & other charges

The insurance company shall be selected and premium shall be decided through a transparent process. The premium amount shall be paid by the National Trust in advance to the selected Insurance Company.

Implementation

The entire scheme may be implemented & monitored by the National Trust through registered organisation with the active participation of the Local Level Committees (LLC). The registered organisation shall liaise with the Insurance Company, health service providers, LLCs, State Nodal Agency Centres (SNAC) of the National Trust, State Govt. and all the stakeholders concerned for awareness generation, enrolment as well as for the speedy settlement of claims.

Enrolment / Renewal Fee under Niramaya

The enrolment / renewal fee is for one year i.e. upto 31st March of next year. This means, every year the renewal of policy has to be done online through www.niramayascheme.com by beneficiary or NGO and the fee has to be paid as per the applicable rate (fixed by National trust) directly in the Bank, in any branch, either by DD/ NEFT or cash only (not by Cheque) in National Trust (Niramaya) account either in Corporation Bank or State Bank of India. The details of banks are given below :

Date of coverage period

Bank name where payment is to be made (any branch)

Payable to "Niramaya National Trust" at New Delhi

Enrolment / Renewal Amount to be paid

Both the fresh enrolment and renewal will be from the enrolment date to the end of the financial year (upto 31st March).

(i) Corporation Bank

OR
(ii) State Bank of India

Corp Bank :
A/c. No.
CLSB/01/090021 (Branch Code- 2099) K.G. Marg IFSC Code : CORP0002099
SBI : A/c. No.
30396764585 (Branch Code -5943), K.G. Marg IFSC Code : SBIN0005943

(i) Rs.250/- if family monthly income is upto Rs.15000/- pm.
OR
(ii) Rs.500/-  if family monthly income is above Rs.15000/- pm.
(iii) Renewal is free only for BPL category.

Claim Form under Niramaya Scheme

Claim Form for settlement, through reimbursement basis only, under Niramaya has to be submitted in the prescribed Claim Form alongwith relevant vouchers / bills, etc. within 30 days of treatment or discharge from hospital. The claim form can be downloaded from the website and sent to the Third Party Administrator, authorized by the Insurance Company.

  1. The Insurance Company for the period 2015-16,  is The Oriental Insurance Co. Ltd., DO -20, N-39, Bombay Life Building, Connaught Circle, New Delhi- 110001; and
  2. Third Party Administrator (TPA) is Raksha TPA Pvt. Ltd,
  3. Claim Form may kindly be sent to the Regional Centres of Raksha TPA Pvt. Ltd. Click link  for the list.     
  4. For any query regarding reimbursement of claim, kindly contact :

Head office of Raksha TPA Pvt. Ltd. C/o. Escorts Corporate Centre, 15/5 Mathura Road, Faridabad – 121 003, Haryana. Tel.No.0129 4289999, 18001801444.

 

Contact persons of Raksha TPA


No

Employee

Contact No.

Email ID

1

Sh. Neeraj Jha

7838151581

neerajjha@rakshatpa.com

2

Sh. Balvinder Rana

7838151530

balvinderrana@rakshatpa.com

3

Sh. Anshul Jain

7838151508

anshul@rakshatpa.com

Guidelines for Enrolment

Enrolment is being done online by all Registered Organisations. List of Registered Organisations is available on the website. Click for the list
The applicant is required to submit the duly filled in enrolment form to the registered NGO, along with the following documents :

  1. Disability certificate issued from the District Hospital or appropriate Government authority.
  2. Address Proof.
  3. One Passport size photograph of the Special Need person.
  4. BPL card, if applicable.
  5. Income certificate (Latest IT return, or Income certificate from Tehsildar).
  6. Proof of payment of applicable fee (Bank receipt).
  7. Bank details for settlement of claims.

Guidelines for Claim Settlement

Fill the claim form properly. All the fields must be filled and enclose the following documents :
(a)        Copy of Niramaya card or mention Health ID No.
(b)        Attested copy of Disability Certificate.
(c)        All original prescription papers given by the doctor.
(d)       All original bills of Hospital / Medicine / Doctor fee / Therapy fee / Conveyance etc., should be self-attested.
(e)        All reports in Original.
(f)        Complete bank details of Beneficiary : Account No. / Bank Name / Branch /
IFSC Code / Name of Account Holder.
Most Important Tip : Please update your mobile number on the website of the National Trust by click on link Mobile No., to get updated information about NIRAMAYA on regular basis.  

ANNEXURE - A

Niramaya' Health Insurance Scheme Revised Benefit Chart

On Reimbursement Basis only (w.e.f. April, 2015)

 Section

 Sub- Section

 Detail

 Sub Limit

Over all Limit of Section 

 I

 Over all Limit of Hospitalization

 70,000/-

 

 A

Corrective Surgeries for existing Disability including congenital disability

    40,000/-

 

 

 B

Non- Surgical/ Hospitalization

    15,000/-

 

 

 C

Surgery to prevent further aggravation of disability

    15,000/-

 

 II

Overall Limit for Out Patient Department (OPD)

  14,500/-

 

 A

OPD treatment including the medicines, pathology, diagnostic tests, etc.

     8,000/-

 

 

 B

Regular Medical checkup for non-ailing disabled

     4,000/-

 

 

 C

Dental Preventive Dentistry

     2,500/- 

 

 III

Ongoing Therapies to reduce impact of disability, disability and disability related complications 

  10,000/-

 IV

 Alternative Medicine

    4,500/-

 V

 Transportation costs 

     1,000/-

 OVERALL LIMIT OF THE COVERAGE FOR A PERSON:  Rs.1,00,000/-

Copyright © 2015 National Trust. All Rights Reserved

Concept By: Sneh Nagda