Niramaya Health Insurance Scheme

Description
“Niramaya Health Insurance Scheme” was launched by the Department of Empowerment of Persons with Disabilities, Ministry of Social Justice & Empowerment. Government of India. The objective of the scheme is to provide affordable Health Insurance to persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities. The scheme provides insurance coverage of up to ₹1,00,000/-, which must be renewed annually after the financial year.

Exclusions
• The scheme will be available in the entire country except J&K. The scheme further envisages that there shall be.

Benefits
• Health insurance coverage: Up to ₹1,00,000/- for various expenses.
• Outpatient department (OPD) treatment: Covers medicines, pathology, diagnostic tests, etc.
• Regular medical checkups: For non-ailing individuals with disabilities.
• Dental care: Preventive dentistry services.
• Surgery: To prevent further disability worsening or for existing disabilities (including congenital).
• Non-surgical/hospitalization: Coverage for non-surgical treatments and related stays.
• Ongoing therapies: For managing disability and related complications.
• Alternative medicine: Coverage for alternative treatment options.
• Section II: Outpatient Department (OPD) : The overall OPD treatment limit is ₹19,000/-, broken down as:
• Section III: Ongoing Therapies
• Section IV: Alternative Medicine (AYUSH)
• Section V: Transportation

Eligibility Criteria
1. - All the disable person who have at least one of the disabilities under the [National Trust Act, 1999](https://cdnbbsr.s3waas.gov.in/s3300891a62162b960cf02ce3827bb363c/uploads/2024/09/20240918793880368.pdf) with valid disability certificate.

Application Process
Step 1: Step 1: Parents/ guardian of the PwD will visit the nearest Registered Organization (RO) for Niramaya enrolment with required documents.
Online
Step 1: Parents/ guardian of the PwD will visit the nearest Registered Organization (RO) for Niramaya enrolment with required documents.

Step 2: Step 2: RO will fill up the Niramaya application form online and upload the scanned documents as required after verification of the originals.
Online
Step 2: RO will fill up the Niramaya application form online and upload the scanned documents as required after verification of the originals.

Step 3: Step 3: On successful enrolment and approval, Health ID No. /card will be issued to each beneficiary or can be downloaded by the beneficiary online or through RO.
Online
Step 3: On successful enrolment and approval, Health ID No. /card will be issued to each beneficiary or can be downloaded by the beneficiary online or through RO.

Step 4: Step 1: The parent/guardian of the beneficiary can renew the scheme with the required documents online by logging on to the Niramaya website through providing below details: Policy Period, Beneficiary ID, UDID No/Enrollment no, Date of birth.
Online
Step 1: The parent/guardian of the beneficiary can renew the scheme with the required documents online by logging on to the Niramaya website through providing below details: Policy Period, Beneficiary ID, UDID No/Enrollment no, Date of birth.

Step 5: Step 2: RO to verify the validity of documents
Online
Step 2: RO to verify the validity of documents

Step 6: Step 3: Pay the application fees online.
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Step 3: Pay the application fees online.

Step 7: Step 4: After receipt of payment, the RO/beneficiary will be notified of the renewal for another year through the website.
Online
All claims for settlement under Niramaya have to be submitted to the canters of the insurance provider in the prescribed Claim Form along with relevant vouchers/bills, etc. (preferably within 30 days of treatment) or discharge from hospital.

Step 8: Step 1: Log on to https://portal.mediassist.in - MediAssist Employee portal. (Your username will be as <application_id>@NATIONALTRUST.Com and password will be your date of Birth of Beneficiary e.g. DD-MM-YYYY)
Online
• You can also download the Mediassist App from Android/Apple/Window store in a phone [Username - <application_id>@NATIONALTRUST.Com and password will be DD-MM-YYYY (Date of Birth of the Beneficiary]

Step 9: Step 2: Click on Submit claim option and fill the details to generate the claim form.
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Step 2: Click on Submit claim option and fill the details to generate the claim form.

Step 10: Step 3: Click on “Save and Next” once all the details are filled.
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On 3rd Page, employee KYC documents are to be updated (one time activity).

Step 11: Step 4: Upload relevant documents.
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Step 4: Upload relevant documents.

Step 12: Step 5: After Moving to the final Page ”Declaration and Claim Submission” select the ailment type.
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Step 5: After Moving to the final Page ”Declaration and Claim Submission” select the ailment type.

Step 13: Step 6: Upload the softcopy of the documents.
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Step 6: Upload the softcopy of the documents.

Step 14: Step 7: Acknowledge the declaration and Click submit to successfully generate the claim form.
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Step 7: Acknowledge the declaration and Click submit to successfully generate the claim form.

Step 15: Step 8: An Auto-generated mail will be triggered to your registered Email ID containing the claim form.
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Step 8: An Auto-generated mail will be triggered to your registered Email ID containing the claim form.

Step 16: Step 1: Visit: https://mediassisttpa.in
Offline
Step 1: Visit: https://mediassisttpa.in

Step 17: Step 2: Click on “Download Claim Form” or visit – https://mediassisttpa.in/#claim-forms
Offline
Step 2: Click on “Download Claim Form” or visit – https://mediassisttpa.in/#claim-forms

Step 18: Step 3: Click on “Claim Form Insured (Part A)” to download pdf file of claim form.
Offline
Step 3: Click on “Claim Form Insured (Part A)” to download pdf file of claim form.

Step 19: Step 4: Fill Claim form, attach required documents and send to Mediassist TPA on following address:
Offline
MEDI ASSIST INSURANCE TPA PRIVATE LIMITED,
1st Floor, Block D, Noida Sector 3, Noida, Uttar Pradesh, PIN- 201301
Phone: 040-68213648, Toll Free – 1800 572 9792

Required Documents
• Need for ORIGINAL REPORTS / FILMS LIKE MRI, X-RAY, ULTRASOUNDS ETC.: Original documents are required including the film for settling of Claims.
• Prescription for Ongoing Therapies: Doctor’s prescription at least once in Six months is essential in which the category of therapy and duration of therapy should be clearly mentioned. Thereafter other documents from Rehabilitation Professional for therapy, and related bills will be acceptable. Doctor who prescribes the prescription should be a valid medical Practitioner with valid license/degree as per Medical council rules.

Frequently Asked Questions
Q: What is Niramaya scheme?
A: Niramaya Health Insurance Scheme ,launched by the Department of Empowerment of Persons with Disabilities, aims to provide affordable health insurance to the Persons with Disabilities (PwDs).

Q: What are the benefits under the scheme?
A: 1. Health insurance coverage.
2. Outpatient department (OPD) treatment.
3. Regular medical checkups.
4. Dental care.
5. Surgery.
6. Non-surgical/hospitalization.
7. Ongoing therapies.
8. Alternative medicine.
9. Transportation costs

Q: What is the health insurance maximum coverage amount?
A: This scheme provides affordable health insurance cover of up to [?]1,00,000/-.

Q: Is there any limitation of hospitals to avail this scheme benfits?
A: No, treatment can be taken from any hospital.

Q: Is this is a health insurence scheme?
A: Yes

Q: Who will be covered under this scheme?
A: All PwDs who have at least one of the disabilities under the National Trust Act, 1999 with valid disability certificate are eligible to apply for the scheme.

Q: What is the enrolment process?
A: Parents/guardian of the PwD will visit the nearest RO for Niramaya enrolment with required documents.

Q: How to find the nearest for Niramaya enrolment ?
A: Follow the below link
URL : https://thenationaltrust.gov.in/content/registered_organization.php

Q: What is the renewal process?
A: To renewal the scheme benefits, follow the below url and provide the required details
URL : https://thenationaltrust.gov.in/auth/renew_gen.php and

Q: How the reimbursement can be avail under this scheme?
A: All claims for settlement under Niramaya have to be submitted to the centres of the insurance provider
in the prescribed Claim Form along with relevant vouchers / bills, etc. (preferably within 30 days of treatment) or discharge from hospital.