The National Trust
Trust
Scheme Guidelines
Niramaya
Health Insurance Scheme
The National Trust
For the welfare of Persons with Autism, Cerebral Palsy,
Mental Retardation and Multiple Disabilities
Department of Empowerment of Persons with Disabilities
Ministry of Social Justice & Empowerment, Govt. of India
16-B, Bada Bazar Road, Old Rajinder Nagar, New Delhi-110 060 Ph: 011-43187878, Fax: 43187880
Email: contactus@thenationaltrust.in Website: www.thenationaltrust.in, www.thenationaltrust.gov.in
23 Niramaya-Health Insurance Scheme
Table of Contents
Abbreviations 2
1 Niramaya 4
1.1 Objective 4
1.2 Scheme Description 4
1.3 Funding Pattern 4
1.4 Eligibility Criteria 5
1.5 Process 5
1.5.1 PwD Enrolment by RO (first approval) process 7
1.5.2 Scheme Renewal 8
1.5.3 Claim Process 9
1.6 Forms 11-18
1 Niramaya-Health Insurance Scheme
Abbreviations
Abbreviation Description
APL Above Poverty Line
ADL Activities of Daily Living
BPL Below Poverty Line
DD Demand Draft
DC District Collector/Deputy Commissioner
DM District Magistrate
IT Return Income Tax Return
KPI Key Performance Indicators
LG Legal Guardianship
LLC Local Level Committee
LIG Low Income Group
Above LIG People above the Low Income Group Limit
NGO Non-Government Organisation
OPE Out of pocket expenses
PwD Persons with Autism, Cerebral palsy, Mental Retardation and
Multiple Disabilities
PwD Act 1995 Persons with Disabilities Act 1995
RO Registered Organisation
RCI Rehabilitation Council of India
SE Special Education
SNAC State Nodal Agency Centre
NT The National Trust
Description of Terms
Term Description
Low Income Group BPL limit set by the state + additional 50% of BPL Limit of the
concerned state/competent authority
Legal Guardian Guardian appointed by the Local Level Committee as per the
"The National Trust Act 1999"
Disabilities covered under Autism, Cerebral Palsy, Mental Retardation and Multiple
the National Trust Act Disabilities
Finance Department Internal Finance/ Accounts Division of the National Trust
Niramaya-Health Insurance Scheme 2
Disclaimer
• The National Trust reserves the right to modify the objective, scheme description and/or any
other details specific to the scheme at any point of time without notification.
• It is the responsibility of the RO to achieve the objectives of the scheme via the support of the
National Trust and by their own resources.
• RO can avail multiple schemes from the National Trust and can also open up multiple centres
for running different schemes.
• ROs are expected to strictly adhere to all the timelines mentioned in each step of the process.
However, in case of any failure in doing so, the National Trust reserves the right to reconsider
the further action to be taken, provided the RO submits a reasonable explanation for the delay.
• The National Trust reserves the right to evaluate the scheme once in every 3 years
• The National Trust reserves the right to discontinue, postpone or withhold sanction of the
scheme considering the availability of finances.
• The scheme shall be governed and construed in accordance with the laws of India and shall be
subject to the exclusive jurisdiction of the courts of New Delhi only.
• The system of registration by any organisation of persons with disabilities, any organisation of
parents of persons with disabilities or a voluntary organisation has been defined in the
National Trust. It is mandatory for the organisations of persons with disabilities, organisations
of parents of persons with disabilities and voluntary organisations to register with the
National Trust for availing scheme/funding from the National Trust. However, it has been
decided that the registration of organisation of persons with disabilities, organisations of
parents of persons with disabilities and voluntary organisations with National Trust will
remain valid till six months of the last date of their registration under the PwD Act, 1995. After
this particular date, the registration will stand cancelled. However, it has been decided to
continue the scheme/funding for the whole current financial year in the interest of the persons
with disabilities. No funding will be extended/renewed/given after the end of financial year,
if the organisation of persons with disabilities, organisation of parents of persons with
disabilities and voluntary organisations do not get certificate under the PwD Act, 1995.
• If scheme benefits/funding has been obtainded from the National Trust on the basis of forged/
false documents, the concerned R.O. shall be blacklisted for three years after giving an
oppourtunity of being heard.
3 Niramaya-Health Insurance Scheme
1 ‘Niramaya’
Health Insurance Scheme
1.1 Objective
The objective of ‘Niramaya’ scheme is to provide affordable Health Insurance to persons with Autism,
Cerebral Palsy, Mental Retardation and Multiple Disabilities.
1.2 Scheme Description
The scheme envisages delivering comprehensive cover which will
• Have a single premium across age band.
• Provide same coverage irrespective of the type of disability covered under the National Trust
Act.
• Insurance cover upto Rs.1.0 lakh on reimbursement basis only.
• All persons with disabilities under the National Trust Act with valid disability certificate will be
eligible and included.
The scheme will be available in the entire country except J&K. The scheme further envisages
that there shall be.
• Services ranging from regular Medical Checkup to Hospitalization, Therapy to Corrective Surgery,
Transportation as per the benefit chart issued/revised by the National Trust which may be revised
from time to time.
• No pre-insurance medical tests.
• Treatment can be taken from any hospital.
1.3 Funding Pattern
All enrolled beneficiaries will get a health insurance cover of upto Rs.1.0 lakh.
Funds allocated under each of the above mentioned heads is as follows:
Niramaya-Health Insurance Scheme 4
Niramaya' Health Insurance Scheme Revised Benefit Chart
On Reimbursement Basis only (w.e.f. April, 2015)
Section Sub- Detail Sub Limit Over all Limit
Section of Section
I Over all Limit of Hospitalization 70,000/-
A Corrective Surgeries for existing 40,000/-
Disability including congenital disability
B Non- Surgical/ Hospitalization 15,000/-
C Surgery to prevent further aggravation 15,000/-
of disability
II Overall Limit for Out Patient Department (OPD) 14,500/-
A OPD treatment including the medicines, 8,000/-
pathology, diagnostic tests, etc.
B Regular Medical checkup for non-ailing 4,000/-
disabled
C Dental Preventive Dentistry 2,500/-
III Ongoing Therapies to reduce impact of disability and 10,000/-
disability related complications
IV Alternative Medicine 4,500/-
V Transportation costs 1,000/-
OVERALL LIMIT OF THE COVERAGE FOR A PERSON: Rs.1,00,000/-
The sub-allocation outlined above may undergo an annual alteration based on the agreement between
the National Trust and the Insurance Provider and will be notified on the website.
1.4 Eligibility Criteria
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.
1.5 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 Niramaya
3. Claim settlement
Please note that every year the process shall be specified by NT which reserves the right to change it
without prior notification.
5 Niramaya-Health Insurance Scheme
Following figure depicts the complete process flow for Niramayas cheme:
Niramaya-Health Insurance Scheme
6
Note that the ROs are expected to strictly adhere to all the timelines mentioned in each step of the process. However, in case of any failure
in doing so, the National Trust reserves the right to reconsider the further action to be taken, provided the RO submits a reasonable
explanation for the delay.
1.5.1 PwD Enrolment by RO (first approval) process
PwD enrolment process defines the steps to be followed while enrolling for Niramaya for the first time.
It also details out the required information and documents at each step and timelines for various activity
wherever applicable.
Any eligible person can apply for enrolment under the Scheme in the prescribed format through the
nearest organization registered with the 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/guardian of the PwD will visit the nearest RO for Niramaya enrolment with required
documents (as detailed in Step 2)
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 form on the National Trust portal.
- Pay the application fees online (as detailed in the table):
PwD Category Enrolment Fee Required Documents
(In Rs)
BPL 250 - Disability certificate (Self attested) issued
from the District Hospital or appropriate
Government authority
- BPL card
- Address Proof
- Proof of payment
APL (if family 250 - Disability certificate issued from the District
income up to Hospital or appropriate Government
INR 15,000/- PM) authority (Self attested)
- Address Proof
- Proof of payment
- Income certificate of (Self attested) the
parent/ guardian competent authority as
issued by the State
APL (if family 500 - Disability certificate (Self attested) issued
income above by the competent authority as issued by the
INR 15,000/- PM) State
- Address Proof
- Proof of payment
Note: Documents received without application fees shall not be entertained
7 Niramaya-Health Insurance Scheme
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.
1.5.2 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 pm), the parent/guardian of the
beneficiary can renew the scheme online by logging on to the Niramaya website (http://
niramayascheme.com). In case of APL (family income upto Rs.15000 pm)/BPL, the parent/guardian of
the beneficiary will have to revisit 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 (as detailed in Step 2)
STEP 2.The RO will follow the process detailed below for renewal of the PwD:
- RO to verify the validity of documents (outlined in the table given below)
- Click on the renewal link on the Niramaya website
- Pay the application fees online (as detailed in the table)
PwD Category Renewal Fee Required Documents
(In Rs)
BPL o - BPL card
- Address Proof (in case of change of address)
APL (if family 250 - Address Proof (in case of change of address)
income up to INR - Income certificate (self attested) of the
15,000/- PM) parent/ guardian competent authority as
issued by the State
- Proof of payment
APL (if family 500 - Proof of payment
income above - Address proof (in case of change of address)
INR 15,000/- PM)
STEP 3.After receipt of payment, the RO/beneficiary will be notified of the renewal for another year
through the website.
Niramaya-Health Insurance Scheme 8
1.5.3 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 relevant vouchers / bills, etc. (preferably within 30 days of
treatment) or discharge from hospital. The claim form can be downloaded from the 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 submit it to the regional centres of
the insurance provider.
STEP 3.The insurance provider will verify the documents and transfer the approved claim to the
given bank account as per IRDA guidelines.
*Documents required to be submitted at the time of claim:
(a) Copy of Niramaya card or mention Health ID No.
(b) Self-attested copy of Disability Certificate.
(c) All original prescription papers given by the doctor.
(d) All original bills of Hospital / Medicine / Doctor fee / Therapy fee / Conveyance
etc.
(e) All reports in original*
(f) Complete bank details of Beneficiary : Account No. / Bank Name / Branch / (City
& State)
(g) IFSC Code
(h) Name of Account Holder.
*can vary according to the req. of the Insurance Provider/TPA
Key Performance Indicators
All Registered Organizations 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 following KPIs.
9 Niramaya-Health Insurance Scheme
KPI Name KPI Description Target Documents required
1. Turnaround Time taken for the Within 30 days of • In case of approval, the
time for the National Trust to the receipt of Health ID must be uploaded
application release the Health ID application on the website within 30
to the applicant days of receipt of
application.
• In case of rejection, the
reason must be conveyed to
the applicant. If the reason
is 'incomplete documents',
the National Trust must
convey the list of missing
documents to the applicant
and allow him or her 15
days to furnish it.
2. Niramaya Overview of Biannual report to be • Niramaya Status Report
Status Report Niramaya to be released by the detailing the following:
released by the National Trust in - Number of applications
National Trust official September and received, approved and
and Insurance March for each rejected.
Provider responsible financial year • Under benefit chart
for the scheme to (Hospitalisation, OPD,
understand its ongoing Therapies,
functioning Alternative Medicines &
(minimum 500 Transportation Cost
words) - Reasons for rejection, in
case of any
- Heads under which
applications were
received
- Difficulties in process (if
any)
Niramaya-Health Insurance Scheme 10
BASIC CRITERIA FOR REGISTRATION FOR THE SCHEME
1. Registered Name (at the State/ by
the competent authority) of
Association of Persons with
disabilities OR Association of
Parents of persons with Disabilities
OR Voluntary Association
2. Date of expiry of registration with
The National Trust
3. Date of Expiry of registration
of the NGO under PwD Act 1995
4. Registered Address of RO House No.
Street Name
Landmark
District
State
Pin code
5. Whether the name and registered Yes No
address is same as the Name
and address registered with
the bank
6. If No, Name and address Name
registered with the bank House No.
Street Name
Landmark
District
State
Pin code
11 Niramaya-Health Insurance Scheme
7. Whether RO is blacklisted by Yes No
the National Trust/ any other
government organization as on
date of submission of application
form
8. Bank details Name of the Account Holder
Bank Account No.
Bank Name
Branch (City & State)
Branch Code
IFSC Code
Niramaya-Health Insurance Scheme 12
Niramaya Application Form for Enrolment of PwD
Enrolment form
1. Name of referring RO
2. The National Trust Registration
number of RO
3. Name of PwD
4. Address of PwD House No.
Street Name
Landmark
District and State
Pin code
5. Contact No. (Mobile)
6. Father’s/ Husband’s Name
7. Date of Birth Date Month Year
8. Gender Male Female
9. Marital status Single Married Other
10. Name of Legal Guardian and
relationship with PwD
11. Mobile No. of Legal Guardian
12. Disability Autism
Cerebral Palsy
Mental Retardation
Multiple Disabilities
13 Niramaya-Health Insurance Scheme
13. Income BPL Upto Above
Rs. 15,000 p.m. Rs. 15,000 p.m.
14. Details of Nominee Name
Age
Relationship with PwD
Email ID
Contact number
15. Bank details of the PwD Name of the Account Holder
Bank account no.
Bank Name
Branch (City & State)
IFSC code
16. Renewal Fee payment details If online payment is done:
Reference number (URN number)/ Transaction ID
Date of transaction
If payment is done through - NEFT/ RTGS or
submitted in the National Trust Account
Transaction ID
Date
Amount (in INR)
17. Attachments i. Disability Certificate
ii. BPL card (for BPL)
iii. Address proof
iv. Income certificate
Niramaya-Health Insurance Scheme 14
v. Proof of payment of enrolment fee
vi. Passport size photograph
Signature
Name
Place
Date
15 Niramaya-Health Insurance Scheme
Niramaya Renewal Application Form of PwD
Enrolment form
1. Name of referring RO
2. The National Trust Registration
number of RO
3. Name of PwD
4. Niramaya Application ID No.
5. Address of PwD House No.
Street Name
Landmark
District and State
Pin code
6. Contact No. (Mobile) of Pwd/ Legal Guardian
7. Father’s/ Husband’s Name
8. Date of Birth Date Month Year
9. Gender Male Female
10. Name of Legal Guardian and
relationship with PwD
11. Mobile No. of Legal Guardian
12. Disability Autism
Cerebral Palsy
Mental Retardation
Multiple Disabilities
Niramaya-Health Insurance Scheme 16
13. Income BPL Upto Above
Rs. 15,000 p.m. Rs. 15,000 p.m.
14. Details of Nominee Name
Age
Relationship with PwD
Email ID
Contact number
15. Bank details of the PwD Name of the Account Holder
Bank account no.
Bank Name
Branch (City & State)
IFSC code
16. Renewal Fee payment details If online payment is done:
Reference number (URN number)/ Transaction ID
Date of transaction
If payment is done through - NEFT/RTGS
submitted in National Trust Account
Transaction ID
Date
Amount (in INR)
17. Attachments i. Disability Certificate
ii. BPL card (for BPL)
iii. Address proof
iv. Income certificate
17 Niramaya-Health Insurance Scheme
v. Proof of payment of enrolment fee
vi. Passport size photograph
Signature
Name
Place
Date
Niramaya-Health Insurance Scheme 18
