National Trust

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

Apr 10, 2014 DURING 2013-14 TOTAL 5554 CLAIMS OF RS 2,50,19,713 HAVE BEEN PAID UNDER NIRAMAYA SCHEME. Apr 14, 2014 NIRAMAYA E-CARDS FOR THE APRIL 2014 POLICY CAN BE DOWNLOADED NOW

NIRAMAYA - Health Insurance Scheme

A 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 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 & Multiple Disabilities.
  • To encourage health services seeking behaviour among persons with disability.
  • To improve the general health condition & quality of life of persons with disability.
  • Implementation
  • The entire scheme will be implemented through an Insurance company & monitored by the National Trust.  

Scheme & its coverage

  • The scheme envisages delivering 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 upto Rs.1.0 lakh per covered beneficiary.
  • All persons with developmental disabilities covered under National Trust Act, will be eligible and those enrolling with National Trust would be included and there will be no ‘selection’.
  • The scheme will be available in the entire country except in Jammu & Kashmir.
  • 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.

Enrolment of Beneficiaries, through registered organisations)

Any eligible person can apply for enrolment under the Scheme through the nearest organization registered with the National Trust or to any other agencies specially entrusted in this regard by the National Trust. Registered organizations with National Trust should send Enrolment Form/Applications under Niramaya through online using our MIS (www.niramayascheme.com). On successful enrolment and approval, the same would be covered in the Insurance Policy. The online applications received between 1st September to 28th February would be covered from April month and applications received between 1st March to 31st August would be covered from October month.

Enrolment / Renewal Fee under Niramaya

Enrolment fee under the Scheme can be paid either by DD/ NEFT or cash only (not by Cheque) in National Trust (Niramaya) account.

The enrolment fee is for one year. This means, every year the renewal of policy has to be done online through www.niramayascheme.com and the fee has to be paid as per the applicable rate (fixed  by National trust)  directly in the Bank, in any branch, as per the details given below :

Coverage date every year Last date for online fresh / renewal Bank name where payment is to be made (any branch) Payable to "Niramaya National Trust" at New Delhi Enrolment Amount to be paid

(i) 2nd April
(for online enrolment from 1st September to 28th February)

(ii) 2nd October
(for online enrolment from 1st March to 31st August)

28th February
(every year)

31st August
(every year)

(i) Corporation Bank
OR

(ii) State Bank of India

Corp Bank :
A/c. No.
CLSB/01/090021 (Branch Code- 2099)

SBI : A/c. No.
30396764585 (Branch Code -5943)

(i) Rs.250/- if family monthly income is upto Rs.15000/- pm.

(ii) Rs.500/-  if family monthly income is above Rs.15000/- pm.

Premium & other charges to Insurance Company

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.

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

Stop Loss

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% of the total premium as administrative cost.

Niramaya Benefit Chart

The details of services with financial limits are given in Annexure - ‘A’.

Claim Form under Niramaya

All Claims for settlement under Niramaya has to be submitted to ICICI Lombard in the prescribed form alongwith relevant vouchers / bills, etc. within 30 days of treatment or discharge from hospital.....download Claim Form from the website.

For any query regarding reimbursement of claim, kindly contact:

ICICI Lombard General Insurance Company, Narain Manzil, 3rd floor, 23, Barakhamba Road, New Delhi – 110 001.

Toll Free Nos: 1800-209-8888, 1800-233-4505, 1800-233-1166,

Tel: 011-66310689 / 66310600, Fax No.66310636;

Email ID: ihealthcare@icicilombard.com or  ayushi.sharma@icicilombard.com

For claim status : www.icicilombard.com

Printing of E-Card: As a document of policy coverage, provision of printing of E-Card has been started by using Application ID No., through our website.

ANNEXURE - A

NIRAMAYA - BENEFIT CHART (ON REIMBURSEMENT BASIS)

Section

Sub- Section

Detail

Sub Limit

Over all Limit of Section

I

OVERALL LIMIT OF HOSPITALIZATION

1,00,000

 

A

Hospitalization

1,00,000

 

 

B

Corrective Surgeries for existing
disability including congenital disability

   50,000

 

 

C

Non-Surgical

15,000

 

 

D

Surgery to prevent further aggravation of disability

15,000

 

II

OVERALL LIMIT OF OUT PATIENT DEPARTMENT (OPD)

10,000

 

A

OPD treatment including the pathology, diagnostic tests

5,000

 

 

B

Regular Medical check-up for non-ailing disabled.

5,000

 

 

C

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

7,500

 

 

D

Dental Preventive Dentistry

7,500

 

III

A

Alternative Medicine (to be considered within limit of IPD or OPD).

 

2,000

IV

A

Transportation costs (to be considered within limit of IPD or OPD).

150 per visit (for 3 visits)

450

OVERALL LIMIT OF THE COVERAGE FOR A PERSON IS  :  RS. 1,00,000

IMPORTANT INFORMATION :

RENEWAL OF POLICY:
  1. Appeal to all ROs for on-line Enrollment / Renewal of beneficiaries and intimation regarding enhancement of incentive for enrollment. Click to view the appeal of Chairperson, NT
  2. Beneficiaries covered under Niramaya Policy from 2012 - 2013. Click to View/ Download the list 
  3. Every year kindly renew the policy, as per the details given below :
    • For coverage date 2nd April - By 28th February
    • For coverage date 2nd October - By 31st August
  1. While applying for renewal, kindly quote the bank details of beneficiary as it is Mandatory for reimbursement of claim.
  2. Please note that NIRAMAYA is a health insurance scheme and not the Life Insurance Scheme. As per the policy eligible claims will be reimbursed. In case of death of beneficiary no any claim/compensation will be payable under this scheme.

(B) As the Niramaya scheme does not have cashless facility, there is no need for the card. For reimbursement of claim, you may mention Application ID No. / Health ID No. and enclose any Identity proof.
However, those beneficiaries who are not able to print E-Card can also claim for reimbursement by giving their Health ID No.

(C) Times of India Social Impact Award for Niramaya

The Chairperson National Trust received ‘The Times of India Social Impact Award’ for the period 2012, under Health Category in Government Sector on 28th January, 2013 in a function held in Delhi in which Hon’ble President of India was the Chief Guest. 

(D) Free Niramaya Enrolment by Govt. of Madhya Pradesh

Govt. of Madhya Pradesh has decided to bear the cost of enrolment of beneficiaries under Niramaya Scheme through District Collectors of each District in Madhya Pradesh. Click here to read letter. For further details, kindly contact ‘Niramaya’ volunteer Mr. Pankaj Maru of Sneh Nagda, Madhya Pradesh (09425195626).

Concept By: Sneh Nagda

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