Health Insurance For The Disabled In India

A disability is a physical or mental impairment that can hinder your ability to perform daily tasks. According to the Persons with Disability Act of 1955, a person having a minimum of 40% of bodily impairment is considered a disabled individual.

• As of February 2023, the IRDAI issued a circular reiterating their 2016 guidelines which state that all non-life insurers must provide health insurance plans with specific covers for Persons with disabilities (PWD), Persons afflicted with HIV/AIDS and those with mental illnesses.

• These policies should be available for one year and be renewable. In addition, insurers are prohibited from denying their services or products to people who fall under any of the above-mentioned categories.

• Insurers must determine the price and coverage of these health covers and comply with the norms stated in their 2016 Health Insurance Regulations. The coverage can only be expanded from the minimum scope and parameters and should never be narrowed down.

• All insurers who are issued a Certificate of Registration to sell General and/or Health Insurance under their businesses are mandated to provide these covers with their health insurance plans for the above-stated categories immediately.

Congenital Disability: People in this category are afflicted with physical or mental disabilities from birth that result from hereditary genetic mutations or environmental factors. For example, cleft lips, cleft palates, down syndrome, spina bifida, etc., all fall under congenital disabilities.

Previously these were considered universal exclusions by insurers. However, per the amended IRDAI 2016 Regulations, only external congenital disabilities can be excluded from health policies.

- Accidental Disability: As the name suggests, disabilities resulting from injuries sustained during accidents fall under this category. Accidental disabilities can be further categorised into three types: total, partial and temporary. Some examples under these categories include loss of limbs, partial or total paralysis, loss of hearing, loss of eyesight, etc.

Most insurers provide covers for accidental disability covers. So you will often find many plans providing personal accident covers. Health insurance for disabled veterans is one example.

At Tata AIG, we provide accident insurance for our comprehensive health insurance plans for permanent total or partial disabilities that result from accidents. Note that coverage will only be provided if your disability was caused during the policy’s term.

- Mental Disability: These disorders affect a person's mood and thinking patterns. For example, depression, autism, anxiety disorders, schizophrenia, etc., all fall under mental disorders.

Under the Mental Healthcare Act 2017, insurers are instructed to provide coverage for mental illnesses under medical insurance plans on the same basis as physical illnesses. Simply put, insurers must treat mental illnesses on par with physical illnesses.

While insurers in India can not deny you health insurance based on your disability, they may be unable to provide coverage for treatments relating to your disability. This can be due to a number of reasons, but most often, it can simply be because their plans do not cover these treatments under policy terms or a lack of plans offering coverage for certain disabilities due to their rarity. However, some insurance providers do offer health insurance with coverage for the disabled in India.

Most private insurers often provide partial coverage for disabilities under their health insurance plans. At Tata AIG, we provide individual health insurance plans for persons with disabilities and HIV/AIDS. This is a 1-year policy with no maximum cover ceasing age.

This plan is available to All Persons with Disability who have at least one of the disabilities listed under Specified Disabilities under The Rights Of Persons With Disabilities Act, 2016.

You simply need to present a valid disability certificate and your KYC documents to be eligible to purchase this plan. Moreover, as an added benefit, health insurance plans from our website also make you eligible for tax deductions under Section 80D of the Income Tax Act.

Similarly, there are also government health insurance schemes for persons with disabilities that offer substantial coverage. You can choose one of our individual plans, or you can opt for a government health scheme, depending on your specific needs and desired coverage.

- Niramaya Health Insurance Scheme

The Nirmaya government health scheme aims to provide coverage for mental illnesses like autism, mental retardation, and cerebral palsy. It requires no pre-purchase medical tests. However, this government health insurance for the mentally disabled is only available to those enrolled under the National Trust.

- Swavlamban Health Insurance Scheme

The Swavlamban scheme is a group or family floater health insurance policy offering coverage for you and your family. This government health plan covers disabilities like hearing impairments, blindness, locomotor disabilities, and mental disorders. There are also no exclusions for preexisting illnesses and no requirement for any pre-medical tests.

- Sharing Accurate Information: When applying for health insurance for disabled persons, you must provide accurate and up-to-date information regarding your disabilities. So you must provide information about your exact disabilities and any pre-existing conditions you may have.

Under IRDAI guidelines, your insurer can reject your application or claim if you have provided inaccurate information, so ensure that all your details are relevant and up-to-date..

- Submission Medical Reports: Most insurers either request documents on your medical history or require a medical check-up when you apply for health insurance for persons with disabilities.

This is done to assess the extent of your disabilities and to calculate your premium, so ensure you have all your medical documents on hand before applying for health insurance coverage for the disabled.

- Family Income: Your insurer may ask you to present payslips for the past 3 months or your previous month's bank statements to get a rough estimate of your ability to pay for your premiums and the health insurance policy.

- Policy Premiums: Your policy premiums will be determined after the approval of your medical insurance application.

At Tata AIG, we calculate your premiums based on age, location, medical history, the type of add-ons you have chosen, medical history, exact disabilities and preexisting conditions (if any).

You should also note that all insurance premiums include an 18% GST in their overall price.

- Extent of Disability: Health insurers first check the extent of your disability before approving your health insurance purchase. This is done to calculate the investment risk on their side and to calculate your premium amounts accordingly.

- Current Health Condition: Most insurers also check your current health conditions when you purchase a health insurance scheme for persons with disabilities.

Insurers will request your most recent medical records or require a medical check-up. Your insurance application will either be approved or denied based on these assessments.

- KYC Documents:

- Identity Proof: Passport, Aadhar, ration card, Voter ID, PAN card, etc.

- Address Proof: Utility bills that state your residential address, bank passbook, ITR statements, or any identity proofs that also state your address.

- Income certificate.

- Disability certificate.

- Medical records.

In addition to the health insurance tax benefits provided under Section 80D, persons with disabilities can also claim tax deductions under Sections 80U and 80DD of the Income Tax Act.

- Section 80U: Offers tax deductions for individuals who suffer from disabilities.

- Section 80DD: Offers tax deduction if an individual’s family member(s) suffers from a disability. A family member here refers to siblings, parents, spouse, children or a Hindu United Family (HUF) member.

To claim these deductions, you must have at least 40% bodily impairment or disability certified by a medical authority. You also can not claim deductions for both sections at the same time.

- Under these sections, disabilities that are covered are:

• Blindness

• Hearing impairment

• Mental illness

• Leprosy

• Locomotor disabilities

• Mental retardation

• Mental illnesses or disorders

These sections also provide deductions for more severe disabilities or multiple disabilities that impair 80% of the body, like autism and cerebral palsy.

Both sections offer deductions of up to ₹75,000 for disabled individuals and a maximum deduction of ₹1,25,000 in case of 80% disability.

- Documents Needed To Claim Tax Benefits For Health Insurance For Disabled Persons In India:

• Medical certificate that details the type and extent of disability.

• Form 10-IA in case of multiple disabilities, autism or cerebral palsy.

• Self-declaration certificate on the expenses incurred from medical treatments.

• Premium payment receipts.

Finding health insurance coverage for disabled individuals in India can be incredibly challenging, especially if you have multiple disabilities or a severe disability that affects most of your body.

However, as stated, there are government schemes and many individual plans from insurance providers like us that offer to cover the recurring expenses resulting from medical treatments for your disabilities.

If you are not disabled but are looking for plans that offer coverage for accidental disabilities, we also have several health insurance plans that offer accident insurance covers on our website.