Niramaya’s Health Insurance Scheme 
 

Eligibility Criteria

All PwDs who have at least one of the disabilities under National Trust Act, 1999 with valid disability certificate are eligible to apply for the scheme


Process
 

This section describes the process that should be followed with respect to Niramaya Scheme.

  1. Submission of online application through organisation registered with the National Trust.
  2. Enrolment of PwD for Niramay
  3. Claim settlement.


PwD enrolment process defines the steps to be followed while enrolling for Niramaya for the first time. It also details out the requirement information and documents at each step and timelines for various activities wherever applicable.

Any eligible person can apply for enrolment under the scheme in the prescribed format through the nearest organisation registered with National Trust or to any other agencies specially entrusted in this regard by the National Trust at any time during the year. The PwD will be responsible for paying the application fee as applicable and the RO will be entitled to INR 40 payable by the National Trust per form for processing.


Step 1

Parents / guardians of the PwD will visit the nearest with required documents RO for Niramaya enrolments.

Step 2

The RO will follow the process detailed below for enrolment of the PwD

-       RO to send the online application form / proposal.

-       Fill up the Niramaya application form online and upload the scanned documents as required after verification of originals

-       Submit the duly filled in the form on the National Trust Portal.

-       Pay the application fee online.

Step 3

After the National Trust receives the application form and the documents, these are checked for completion. However, if there is any missing information or wrongly submitted information which needs to be submitted again, the RO is given 15 days time to submit it again.

Step 4

On successful enrolment and approval, Health ID No./Card will be issued to each beneficiary. Communication to RO by the National Trust shall be done within 30 days on receipt of final documents.

Step 5

Enrolment is completed the Health ID Card is uploaded online and can be downloaded by the beneficiary online or through RO.


Scheme Renewal

The Niramaya Scheme is valid till March 31st of the financial year in which enrolment is undertaken. Beneficiaries are expected to renew the scheme three months prior to expiry to continue availing the scheme. In case of APL category (family income above Rs. 15000/- per month), the parent/guardian of the beneficiary ca renew the scheme online by logging on to the Niramaya website (http://niramayascheme.com). In case of APL (family income upto Rs. 15000/- per month) BPL, the parent/guardian of the beneficiary will have to re visit the RO for renewal through the process outlined below.


Step 1

Parents / guardian of the PwD will visit the nearest RO for Niramaya renewal with required documents.

Step 2

RO will follow the process detailed below for renewal of the PwD

-       RO to verify the validity of documents

-       Click on the renewal link on the Niramaya website

-       Pay the application fees online

Step 3

After receipt of payment, the RO/beneficiary will be notified of the renewal for another year through the website.


Claim Process

All claims for settlement under Niramaya have to be submitted to the centres of the insurance provider in the prescribed Claim Form along with the relevant vouchers / bills etc., (Preferably within 30 days of treatment) or discharge from hospital. The claim form can be downloaded from website or collected at the local SNAC and reimbursement can be sought through the following process.

Step 1

Beneficiaries to download the claim form from ( www.niramayascheme.com)

Step 2

Submit the filled claim form along with complete supporting documents*(medical bills, prescription, Hospitalization report, discharge card etc) and submitting it to the regional centres of the insurance provider.

Step 3
The insurance provider will verify the documents ad transfer the approved claim to the given bank account as per IRDA guidelines.

Documents required to be submitted at the time of claim

-       Copy of Niramaya card or mention Health ID No.

-       Self-attested copy of Disability Certificate

-       All original prescription papers given by the doctor

-       All original bills of hospital / medicine / doctor fee / therapy fee / conveyance etc

-       All reports in original

-       Complete bank details of beneficiary account no./Bank name / Branch/ (City & State)

-       IFSC Code

-       Name of the Account Holder

  • *Can vary according to the requirement of the Insurance Provider / TPA


Key performance Indicators

*All registered Organisations are encouraged to ensure that the beneficiaries they cater to the National Trust Schemes are enrolled under Niramaya Scheme. Further, the stakeholders are expected to follow the KPIs.