Niramaya Health Insurance Scheme

The Niramaya Health Insurance Scheme, launched by the National Trust under the Ministry of Social Justice & Empowerment, offers up to ₹1,00,000 annual health coverage for individuals with developmental and intellectual disabilities. It is specifically designed to support persons with Autism, Cerebral Palsy, Intellectual Disability, and Multiple Disabilities, ensuring they receive affordable and continuous medical care. Here’s everything you need to know about the Nirmaya Health Insurance Scheme.

The Niramaya Health Insurance Scheme is a national health programme that provides comprehensive medical support for children and adults with disabilities covered under the National Trust Act. The scheme includes hospitalisation, corrective surgeries, OPD consultations, diagnostics, medicines, and essential therapies such as physiotherapy, speech therapy, and occupational therapy. It also covers preventive care, AYUSH treatments, and pre-existing conditions, making it a reliable safety net for families managing long-term disability-related health needs.

The scheme aims to provide comprehensive and affordable healthcare support to persons with developmental and intellectual disabilities.

• To offer financial protection through annual health coverage of up to ₹1,00,000.

• To ensure access to essential medical treatments, therapies, and rehabilitation services.

• To reduce the financial burden on families managing long-term disability-related healthcare.

• To promote early intervention, continuous care, and improved health outcomes for beneficiaries.

• To support inclusive healthcare by covering pre-existing conditions without discrimination.

Key features of the Niramaya Scheme include:

• Coverage Amount

Provides up to ₹1,00,000 annual health insurance per beneficiary.

• Pre-existing Conditions

Covers all disabilities and related conditions from day one.

• Medical Treatments

Includes OPD care, hospitalisation, diagnostics, medicines, and corrective surgeries.

• Therapies Covered

Offers physiotherapy, speech therapy, and occupational therapy support.

• Preventive & Alternative Care

Covers dental care, preventive health services, and AYUSH treatments.

• Eligibility Group

Designed specifically for persons with Autism, Cerebral Palsy, Intellectual Disability, and Multiple Disabilities.

• Affordable Premiums

Offers low-cost premiums with concessional rates for BPL families.

The scheme offers annual health insurance coverage of up to ₹1,00,000, distributed across specific healthcare needs to support persons with developmental and intellectual disabilities.

1. Hospitalisation Coverage (₹55,000)

Includes corrective surgeries for existing or congenital disabilities (capped at ₹15,000) and non-surgical or hospitalisation expenses up to ₹15,000 within the overall limit.

2. OPD Treatment Coverage (₹19,000)

Covers consultations, medicines, diagnostic tests, and other OPD services up to ₹15,000, along with preventive dental care up to ₹4,000.

3. Therapy Support (₹20,000)

Provides for physiotherapy, occupational therapy, speech therapy, and other ongoing therapies required to manage disability.

4. AYUSH & Alternative Medicine (₹4,000)

Reimburses treatments under Ayurveda, Yoga, Unani, Siddha, and Homoeopathy.

5. Transportation Assistance (₹2,000)

Covers travel expenses incurred while accessing medical treatment or therapy sessions.

The Niramya Insurance Scheme is exclusively available to individuals with disabilities covered under the National Trust Act, 1999. To qualify, the applicant must be diagnosed with one of the recognised developmental or intellectual disabilities: Autism, Cerebral Palsy, Intellectual Disability, or Multiple Disabilities. Beneficiaries must also be registered with the National Trust with a disability certificate.

Applying for the Niramaya Health Insurance Scheme is done through a Registered Organisation (RO) authorised by the National Trust. Below is the simplified process for new enrolment:

Step 1: The parent or legal guardian of the person with disability (PwD) visits the nearest Registered Organisation (RO) with all required documents.

Step 2: The RO fills out the Niramaya application form online, uploads scanned copies of documents, and verifies all originals submitted by the applicant.

Step 3: After the application is successfully approved, a Health ID number/card is generated for the beneficiary, which can be downloaded online or collected from the RO.

Here are the documents required for applying for the Niramaya Health Insurance Scheme:

For BPL (Below Poverty Line) Applicants

• Self-attested Disability Certificate issued by a District Hospital or authorised government body

• BPL Card as proof of economic status

• Address Proof (as accepted by the scheme)

• Receipt/Proof of payment of the enrolment fee

For APL Applicants (Family income up to ₹15,000 per month)

• Self-attested Disability Certificate issued by a District Hospital or authorised government authority

• Address Proof

• Proof of payment of the enrolment fee

• Self-attested Income Certificate of the parent/guardian issued by the competent state authority

For APL Applicants (Family monthly income above ₹15,000)

• Self-attested Disability Certificate issued by the competent government authority

• Address Proof

• Proof of payment of the enrolment fee

Here are the enrolment fees and charges for applicants under the Niramaya Health Insurance Scheme:

• For BPL Applicants: ₹250/-

• For APL Applicants below ₹15,000 monthly family income: ₹250/-

• For APL Applicants above ₹15,000 monthly family income: ₹550/-

To renew the Niramaya Policy, follow these simple steps:

Step 1: The parent or guardian logs in to the Niramaya portal (https://thenationaltrust.gov.in/auth/renew_gen.php) and enters the required details—Policy Period, Beneficiary ID, UDID/Enrollment Number, and Date of Birth.

Step 2: The Registered Organisation (RO) verifies the uploaded documents for accuracy and validity.

Step 3: The applicant pays the applicable renewal fee online.

Step 4: Once the payment is processed, the renewal is confirmed on the portal, and the beneficiary receives notification of policy extension for another year.

To renew the scheme, you would require the following documents:

• BPL Card

• Address Proof (only if there has been a change of address)

• Self-attested Income Certificate of the parent/guardian issued by the competent State authority (For APL Family Income Below ₹15,000).

• Proof of Payment of the renewal fee

Renewal Fees: ₹250 for Family Income below ₹15,000 and ₹500 for family income above ₹15,000.

You can file for claims against the Niramaya Scheme Online and Offline:

Online Claim Process

The online method allows beneficiaries to submit claims digitally through the MediAssist portal or mobile app.

Step 1: Log in to the MediAssist portal (https://portal.mediassist.in) using the login ID and password (DOB).

Step 2: Select “Submit Claim” and enter all required details to generate the claim form.

Step 3: Upload KYC documents (one-time) along with all medical bills, prescriptions, and supporting documents.

Step 4: Choose the ailment type, complete the declaration, and submit the claim.

Step 5: An auto-generated email with the claim form is sent to the registered email ID.

Offline Claim Process

Beneficiaries can also file claims physically by submitting documents to the insurance provider’s claim centre.

Step 1: Visit: https://mediassisttpa.in website to download the claim form

Step 2: Click on “Claim Form Insured (Part A)” to download the PDF file of the claim form.

Step 3: Fill the Claim form, attach required documents and send to Mediassist TPA at the following address:

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

You require the following documents to claim the Niramaya Health Insurance Scheme:

• Niramaya Card or Health ID Number of the beneficiary

• Self-attested Disability Certificate issued by a competent authority

• Original prescriptions issued by the treating doctor

• Original bills for hospitalisation, medicines, doctor consultations, therapies, and conveyance

• Original diagnostic reports, such as lab tests, scans, or other investigations

• Bank details of the beneficiary, including Account Holder Name, Account Number, Bank Name, Branch, and IFSC Code

Important Notes

• Original reports and films (MRI, X-ray, ultrasound, etc.) must be submitted along with the claim; photocopies are not accepted for settlement.

• For ongoing therapies, a doctor’s prescription is required at least once every six months, clearly mentioning the therapy type and duration. Subsequent therapy bills and documents from qualified rehabilitation professionals will be accepted.

• Prescribing doctors must be registered medical practitioners with a valid licence as per Medical Council regulations.

To download the Niramaya health card online, follow these steps:

Step 1: Visit the Niramaya Scheme portal through the National Trust website.

Step 2: Log in using your Beneficiary ID / Enrollment Number, Date of Birth, and other required details.

Step 3: Once logged in, go to the Niramaya Health Card / Health ID section.

Step 4: Click on Download Health Card, and the digital card will be generated in PDF format.

Step 5: Save or print the card for use during medical treatments and claim submission.

You can do an online status check of the Niramaya Health Card by following these steps:

Step 1: Visit the official Niramaya Health Insurance Scheme portal via the National Trust website.

Step 2: Enter your Beneficiary ID / Enrollment Number, Date of Birth, and any other required details.

Step 3: Navigate to the Application Status or Health Card Status section on the dashboard.

Step 4: Your current status, such as Pending, Approved, Rejected, or Card Generated, will be displayed on the screen.

Step 5: If approved, you will also see an option to download the Niramaya Health Card directly.

Source of information - https://www.myscheme.gov.in/schemes/nhis

Guidelines - https://nationaltrust.nic.in/niramaya/

Enrolment Form - https://thenationaltrust.in/auth/Niramaya/HTML/new4.php

Claims Form - https://thenationaltrust.gov.in/upload/uploadfiles/files/claimformnew.pdf

User Manual - https://cdnbbsr.s3waas.gov.in/s3300891a62162b960cf02ce3827bb363c/uploads/2025/04/20250422881539735.pdf