Swavlamban Health Insurance Scheme: All you need to Know

To begin with, what is Swavlamban health insurance scheme?

This prestigious health insurance scheme was initiated on 2nd October 2016 solely for Persons with Disabilities (PwD). It was launched under the power of New India Assurance Company limited with the association with Ministry of Social Justice and Department of Empowerment of Persons with Disabilities.

The Mission of Swavlamban Health Insurance Scheme:

  • To provide with low cost and affordable health insurance to people with Low Vision, Blindness, Leprosy-Cured, Loco-Motor Disability, Hearing Impairment, Mental illness and Mental retardation.
  • To improve the quality of life for PwD.
  • To improve general health conditions for PwD.

Key Features of Swavlamban Health Insurance Scheme:

  • The steady premium of INR 357/- for every PwD living across the country. (10% of actual premium plus Service Tax)
  • Sum cover of 2 lacs on the family floater for 12 months. Family size up to 1+3, primary member is mostly the person with PwD but in the case of minor being, PwD the parent/guardian of the minor can also be covered under the scheme.
  • Age band covered under Swavlamban Health Insurance Scheme is 0-65 years.
  • To get enrolled in Swavlamban Health Insurance Scheme the PwD need to carry the PwD certificate issued by PwD Act, 1995.
  • PwD family income not exceeding 3 lacs P.A or below are also eligible.
  • No pre-medical tests involved before enrolling into the policy.
  • Pre-post hospitalization covered as subject to limits.
  • OPD cover for curative therapy up to INR 10,000/- for 12 months for PwD. For persons with mental disability or mental retardation, OPD covers INR 3000/- P.A.
  • Pre-existing conditions can’t be excluded but curative surgery for existing impairment can be done with the consent of insurer/TPA.

Please note: People with multiple disabilities, cerebral Palsy and autism are not covered under this scheme.

Advantages of Swavlamban:

  • Cashless treatment of PwD in the hospitals that are identified under New India Assurance.
  • Free OPD treatment up to 10,000 and health insurance scheme included.
  • The family of PwD is covered within the additional benefits of the scheme.
  • Treatment for pre-existing medical problems is also offered to the PwD.
  • Transparency is always maintained in the claim process.
  • Due to New India Assurance network, the enrollment procedure is also very simple.

Claim Process:

  • New India Assurance creates a network of hospitals, where the insured person can get the cashless treatment.
  • If in any case, the insurance PwD wishes to take the treatment outside the network hospitals he/she needs the permission from TPA. However, these permissions are not necessary when the case is of emergency hospitalization.
  • The policy takes full responsibility of the patient’s pre-existing illness. If in any case, the insured PwD wishes to take the treatment outside the network hospitals he/she needs the permission from TPA.
  • At the time of claim, the PwD needs to provide the PwD certificate to the TPA issued under the Persons with Disability Act, 1995.

Redressal process:

  • If the insured person is having any kind of grievance over any service aspect, he/she can approach a nominated person of New India Agency.
  • In case the person is not satisfied with the process, he can escalate it to a named person in the Department of Empowerment of PwD.

Limitation of Swavlamban:

  • There are certain PwD excluded such as;
  1. Autism
  2. Multiple disabilities
  3. Cerebral palsy
  • Awareness regarding Swavlamban Health Insurance is limited among PwD.
  • Swavlamban emergency procedures and provisions need more advancement.

How to move forward with cashless claim settlement:

Name of TPA:

Raksha TPA Pvt. Ltd.

Contact toll free: 1800-180-1444

MDIndia Healthcare Services (TPA) Pvt. Ltd.

Contact toll free: 1800-233-1166, 1800-233-4505

Vidal health TPA

Contact toll free: 1800-425-8885

Medi Assist TPA Pvt. Ltd.

Contact toll free: 1800-425-9449

Medicare TPA

Contact toll free: 1800-345-3339

Way forward:

  • Swavlamban is a step forward for the progress of PwD.
  • Awareness regarding Swavalamban scheme must grow among PwD, and more and more should make the most out of it.
  • Swavlamban implementation and monitoring needs to be enhanced even more.
  • Identification of the benefactors is the major challenge.

Overall this scheme is a major step in the improvement of conditions for PwD, this scheme is a positive measure in utilizing the PwD talent and recognizing them as spectacular unique individuals. To know more, stay connected with Byju’s

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