Annual Report 2010-2011 - National Trust

National Trust
12. NIRAMAYA – Health Insurance Scheme
12.1 Niramaya – Health Insurance Scheme for persons with Autism, Cerebral Palsy,
Mental Retardation & Multiple Disabilities has been the flagship scheme of National
Trust. Started in ten districts on pilot basis, the scheme has been extended to cover
the entire country (excluding J&K), by popular demand.
12.2 The health insurance scheme for persons with disabilities was started, as health is
the primary concern of any individual. The scheme has some path breaking features
like - no age bar, no exclusion of pre-existing medical conditions, and no pre-insurance
medical test. Cashless treatment, one of the earlier features has been discontinued;
however reimbursements are being made. The fee under the scheme has been revised
at Rs. 500 per annum for family income more than Rs. 15000 per month and Rs. 250 per
annum for family income upto Rs. 15000 per month. However, the scheme continues
to be free for BPL families on production of BPL/Income certificate from competent
authority.
12.3 Benefit chart under the scheme has also been slightly modified to adjust with the
claim pattern which will be effective from next insurance cycle, i.e. 2.4.2011/12.10.2011
as the case may be. The revised chart is given below:-
Section Sub Section Detail Sub Limit Overall Limit of Section
I
Hospitalization
A Hospitalization 1,00,000
B Corrective Surgeries for existing 50,000
Disability including congenital disability
C Non-surgical 15,000
D Surgery to prevent further aggravation 15,000
of disability
OVERALL LIMIT OF HOSPITALIZATION – RS. 1,00,000/-
II Out Patient Treatment 10,000
A OPD treatment including the pathology, 5,000
diagnostic tests
B Regular Medical checkup for non-ailing 5,000
disabled.
C Ongoing Therapies to reduce impact 7,500
of disability and disability-related
complications.
D Dental Preventive Dentistry 7,500
OVERALL LIMIT OF OUT PATIENT TREATMENT RS. 15,000/-
IV Transportation costs (to be considered Rs. 150 per 1,500
within limit of IPD or OPD). visit (for 3
visits)
V Alternative Medicine (to be considered (per 2,000
within limit of IPD or OPD).
treatment
cycle)
OVERALL LIMIT OF THE COVERAGE FOR A PERSON RS. 1,00,000/-
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