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Disabled insured for good health

By Amitava Banerjee

The government-funded Niramaya scheme extends health insurance cover of Rs 100,000 to persons with autism, cerebral palsy, mental retardation and multiple disabilities, bringing a large section of disabled people into the healthcare system

About 15 years ago, Simita, then a 10-year-old student of the Indian Institute of Cerebral Palsy (IICP), Kolkata, was diagnosed with perforations in the heart after suffering from cough and breathing trouble for a long time. The doctor advised an operation that would cost Rs 1.25 lakh.

It was impossible for Simita's parents to come up with the money. People with disability are not covered by health insurance. Members of the parent support group for disabled children at IICP met the insurance companies; nothing came of it. Finally, they raised the money through donations and Simita was operated upon successfully.

According to the 2001 census, about 22 million people in India are disabled. The WHO reports a figure of 70 million in 2007, the largest national population of disabled people in the world. Every year thousands of people with disabilities need medical care but cannot afford it because of the high cost of treatment. Following the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act in 2000, under which children with mental disabilities were provided a legal guardian, the government has been under pressure from various organisations to allow people with these disabilities to be covered under life and health insurance schemes.

In 2008, the Government of India finally launched a health insurance scheme called Niramaya, for persons with autism, cerebral palsy, mental retardation and multiple disabilities. The scheme can serve a large section of people who so far have remained outside the scope of any medical insurance in the country.

The Niramaya scheme is disabled-friendly in form and conditions. It is implemented and monitored by the National Trust for Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities through a Third Party Nodal Agency (TPNA) with the active participation of the Local Level Committees (LLC). The TPNA will liaise with the insurance company, empanelled health service providers, LLCs, the National Trust, the state government and all the stakeholders concerned, to generate awareness about the scheme, to underwrite the risks, and to ensure speedy settlement of claims.

"The main idea in introducing such a scheme is to enable persons with disability to have access to health services like any other person," says Minakshi, an activist and head of the legal cell of Vidyasagar, an institution for children with cerebral palsy in Chennai. The services covered by the insurance scheme include regular medical check-ups, hospitalisation, therapy, corrective surgery and transportation. Being an affected person herself, Minakshi hopes that "with the availability of such health services at affordable costs, parents will be encouraged to take their children to health centres regularly, even for cases that are not serious. It will certainly improve the general health conditions of people with disability."

The annual premium for this health scheme is initially pegged at Rs 250. If an insured person with cerebral palsy, mental retardation, autism or multiple disabilities has an income of less than Rs 15,000 per month, the premium will be shared by the state government and the central government/National Trust.

The insurance cover for every person in the scheme is up to Rs 100,000. Since this is like a group insurance scheme, the insurance company has the right to stop entertaining any further claim any time in a year if the total amount of the claim exceeds the total premium amount. It is clearly mentioned in the brochure that "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, ie, the insurance company can have a stop loss at 120% of total premium amount". Clients must therefore be made aware of their responsibility in incurring expenditure up to the level 'essential' so that more people can get the benefit.

The scheme aims to serve 100,000 people below the poverty line, with categorised disability in its first phase of implementation (two years) in 10 districts in 10 states: Central Delhi in Delhi, Chandigarh in Haryana, Jabalpur in Madhya Pradesh, Kaimur in Bihar, Agartala in the northeast, Rae Bareily in UP, Erode in Tamil Nadu, Ernakulam in Kerala, Ahmedabad in Gujarat and Bhageshwar in Uttarakhand.

The scheme is unique in the sense that there is no lower or upper age limit and a single premium applies across all age bands. Moreover, people may enter the scheme irrespective of the condition of their health. No medical tests are required prior to the contract with the insurance company, as is required for regular health insurance schemes. Pre- and post- hospitalisation expenses such as pathology, radiology, advanced diagnostic tests, post-operative monitoring and therapies etc are also included. All modes of authorised treatment - allopathic, homoeopathy, unani, ayurvedic, siddha etc -- are permitted. The scheme provides for cashless settlements in all listed hospitals and their branches all over India using smart or biometric cards provided by the authority. Treatment can also be availed of in hospitals other than those prescribed, but here payment is not cashless but will be reimbursed. Criteria for empanelled hospitals and nursing homes are also clarified. The National Trust will maintain the details of each beneficiary covered under the scheme, including their identification.

"The programme is bound to change the lives of people with disability, especially the poor section and those identified as living below the poverty line (BPL). These people remain outside the ambit of even minimal social protection. Access to healthcare facilities will surely boost their morale," says Sujata Parekh, social activist and consultant at the IICP. She points out that the scheme is a realisation of the commitment made by the government in various legislations like the Persons with Disability Act, 1995, and the National Trust Act, 2000. It also fulfils the commitment made to the United Nations by ratifying the UN Convention on the Rights of Disabled People in 2007.

Benefits assured to people with disability under various legislations have not often materialised. For example, people with disability are supposed to get a disability identity card issued by the state authority on the basis of the medical certificate that they produce. This card allows them to avail of various government facilities such as concessions in various modes of transport, enrolment in employment exchanges, stipend, pension etc. However, lack of coordination between medical professionals and the executive authority has resulted in a majority of disabled people in the country not having this card and therefore being deprived of the facilities that are rightfully theirs.

In the last decade, the Life Insurance Corporation tabled a life insurance plan for people with disability. Under the plan, the affected person would receive money in the form of a monthly pension from the insured sum only after the death of the parents. Parents, however, were in favour of getting the money in a lumpsum after the tenure of the premium payment so that they could plan for their children's future. At that time, children with delayed mental age could not legally handle money or property even after attaining adulthood, and the provision for appointing a legal guardian for adult persons who were incapable of taking care of themselves came into effect along with the National Trust Act, in 2000.

The Niramaya scheme can be misused like any other health insurance scheme. "Medical insurance is a scientific system to meet the urgent needs of society. Healthcare schemes in India, however, are mostly designed by agents, hospitals, nursing homes and doctors. Very often costs are manipulated and inflated - in medical tests, prescribed medicines and stay in hospitals," said Kusal Nag, an official of a nationalised insurance company. Like some other insurance companies, the Niramaya scheme has not defined the limitation of bed charges during hospitalisation so as to avoid misuse of social funds. It is important to curb the tendency to abuse this welfare scheme so that a larger number of needy people can take advantage of it.

Sarada Ambal, mother of an adult son with delayed mental development, suggests that the smart card can be put to a number of uses. "The smart health card or biometric card with the health insurance scheme will be more beneficial if the card could also be used as a permanent identity card for people with permanent disability even if the person discontinues the scheme," she says.

How to avail of the scheme

Contact the disability cell of your state social welfare ministry/related institutions/the National Trust/related NGOs. NGOs should send the enrolment form/applications under Niramaya directly to the National Trust either by post or electronically through their MIS. For electronic mode, an incentive of Rs 5 per form shall be given to NGOs in addition to Rs 15 for new enrolment. Forms are also available from 16B, Bada Bazar Road, Old Rajinder Nagar, New Delhi - 110060 Phone 011- 431- 87878 or can be downloaded from the National Trust website http://www.thenationaltrust.org.in/

(Amitava Banerjee is a freelance writer, disability activist and author of the book I Am a Special Girl)

Infochange News & Features, April 2009