Insurance policies for the Physically and Mentally Challenged

The Demographics

India houses the largest population of disabled people in the world; 26.8 Million disabled in India, as per Census 2011, that basically means every 2 out of 100 Indians are disabled. With such an astounding number of disabled people in India, almost every family is either dependent on a disabled person, or is responsible for taking care of a disabled member.

Why do they matter ?

The only disability a person can have is his attitude! There would not be gems like Albert Einstein , Mozart , Frida Kahlo, Helen Keller who suffered various mental and physical challenges and yet excelled in their talents and abilities. We have an obligation and a duty to protect and enable such people who may have disabilities but are not limited in their knowledge and talent.

What’s the future of this section of people?

Due to the various socio-economic limitations , this section of people have the slowest progress in infrastructure and quality of life. They are often dependent on people for functioning on any regular day. However, a steady progress is made in making life easier for them.

Special Aadhaar Card

The Unique Identification Authority of India (UIDAI) has eased out the norms of biometric data entry for physically challenged people. The government has also started a special mobile van to enroll them for Aadhaar Card.

Visually impaired and people can also buy insurance and investment products. Companies use software that reads out the policy to them. Fortunately, the visually-impaired can use automated teller machines (ATMs). Banks like Union Bank of India have set up talking ATMs, where both the card reader and card slot are Braille- supported.

The Regulatory framework

While there are no restrictions for providing insurance facilities to handicapped and mentally challenged persons, it is the professional decision of the insurance company based on their own risk bearing capacity and approach. There are no specific Regulations/Guidelines issued by the Authority in this regard.

How does the government help in easing rules for this section:

The Government of India is implementing a scheme by name ‘NIRAMAYA’ through which the handicapped and mentally challenged persons are covered for medical treatment upto Rs. 1 lakh. Aam Admi Bima Yojana (AABY) is also a Government Social Security Scheme being administered through Life Insurance Corporation of India (LIC) that provides life/accident insurance protection to the rural and urban poor persons (including rural landless households) and people belonging to certain identified vocational groups. One such identified vocation is “Physically Handicapped Self-Employed Persons
Additional programs and schemes have been set up to aid the mentally challenged section of people, this is the NIRMAYA scheme which is further explained below.

IRDAI has also notified IRDA (Rural and Social Sector Obligations) 2002 mandating every insurer to cover the specified number of lives from the defined social sector market segment. Of the categories of lives that are defined as social sector lives, “other categories of persons” is one of the categories, which includes persons with disability as defined in the Persons with Disabilities (Equal Opportunities, Protection of Rights, and Full Participation) Act, 1995 and who may not be gainfully employed; and also includes guardians who need insurance to protect spastic persons or persons with disability.

Is there an effort to enable?

Several schemes have been launched by NTC in order to support them further in daily needs –

 DISHA – School readiness scheme for children upto 10 years

VIKAAS – A day care scheme for children with Autism , CP , retardation , multiple disabilities

SAMARTH – A respite home for children or PwD from families of BPL , LIG families .

GHARAUNDA – A Scheme to provide housing and care service throughout the life of the person

SAHYOGI – A scheme to set up care giver cells for training and creating skilled workforce for PwD

GYAN PRABHA – To encourage PwD in education and vocational

PRERNA – A marketing scheme to create viable and wide spread channel to sell products and services made by PwD

SAMBHAV – A scheme to set up additional resource centres in the city and collect aids, software and devices

 

The Policies and the protection Offered

If the person being insured is partially handicapped and employed or self employed then he, himself can buy LIC POLICY on his name and any normal LIC POLICY will work for him . Like LIC ENDOWMENT PLAN, LIC MONEY BACK PLAN etc. (Note: It should not be a high risk plan like LIC JEEVAN ANAND or LIC JEEVAN MITRA TRIPLE COVER). For taking LIC POLICY on his name he has to undergo  medical test and LIC OF INDIA will pay for this test. These tests are basically questionnaires and are known as CNS Questionnaire and Deformity Questionnaire.

What is CNS Questionnaire: Is a questionnaire related to the Central nervous system condition to be filled by the medical examiner before the policy is availed .

If he is fully physically or mentally handicapped and dependent on someone even then LIC OF INDIA offers twoplans namely JEEVAN AADHAR and JEEVAN VISHWAS which can be bought for handicapped people.

Health Insurance

Niramaya can help ease your burden

The National Trust has introduced “Niramaya”, an insurance scheme for persons suffering from autism, cerebral palsy, mental retardation, multiple disabilities (sclerosis) and other similar diseases. The scheme covers overall medical expenses up to `1 lakh within separate sub-limits. With an application fee of Rs.250 for APL and free incase of BPL families, the application will be processed and claims upto Rs.1 Lakh can be made on reimbursement basis and treatments can be obtained in any hospital.

Swavlamban Health Insurance Scheme:

New India Assurance Company Limited have launched a Group Mediclaim Policy for persons with disabilities. Swavlamban Health Insurance Scheme has been conceived with the objective of providing affordable Health Insurance to people who are blind, low vision, leprosy, hearing disability, motor and mental disabilities. It also aims to improve the general Health condition and quality of life of persons with disabilities.

The scheme has been designed to provide comprehensive cover to the beneficiary as well as his family (persons with disabilities, Spouse & up to two children) with a single premium across age band and can be availed by persons with disabilities aged between 18 years and 65 years with family annual income of less than Rs. 3,00,000 per annum.

The scheme also ensures coverage of any pre-existing condition and a health Insurance cover up to Rs. 2,00,000 per annum as family floater.

The scheme will be implemented through active participation of the National Institutes and Composite Regional Centers for Persons with Disabilities (CRC’s) under the DEPwD, MOSJ&E.

• Sum insured of Rs. 2 lacs on family floater for a period of 12 months.
• Family size up to 1+3. Primary member is Person with disabilities.
• Age band 18 – 65 years.
• Available for persons with disabilities with annual income of Rs. 3 lacs and below on declaration basis in proposal form.
• No premedical tests.
• Uniform premium contribution of Rs. 355 per person / family.
• OPD cover for corrective therapy up to Rs. 10,000 a year for person with disability. For persons with mental retardation and mental illness, OPD cover is Rs. 3000 per annum.
• No exclusion of pre-existing conditions. However corrective surgery for existing impairment can be done with consent of insurer/TPA.
• Pre-post hospitalization expenses covered sub to limits.
• Rest of terms as per standard New India Flexi Floater Group Mediclaim Policy.
• Persons with multiple disabilities, Cerebral Palsy & autism are not covered under this scheme.

What is the cost involved ?         

For a PwD , if he has a disability of more than 40% , private insurance companies do not cover . There are many schemes set up by the government to support such people and their families. The plans start with as low as Rs.250 premium per person and upto 16,000 depending on age.

For Jeevan Aadhar – This is an illustration of a parent of age 35 years having a special child of age 5 years. The premium is Rs 4095 for Rs 1 lakh SA and paid for 15 years. The table below is an example of a policy taken for a child of 5 years who is a PwD ( person with disability) , the guardian , trust or parent can take this policy with nominee as the child . The maturity amount or death benefit is to be used for the benfit of the disabled child alone. Since there is a variable addition paid after completion of 10 years of premium payment , the IRR is the highest then.

For Jeevan Vishwas – This is an illustration of a parent of age 35 years having a special child of age 5 years. The premium is Rs 4008 for Rs 1 lakh SA and paid for the term of policy or earlier death. This example shows the benefit or maturity amount that will be received by the nominee ( the disabled child) if the premiums are paid regularly for min 10 years  . Here again a loyalty addition is made as a survival benefit after the first 10 years. The Jeevan Vishwas policy has less stringent rules about the disability certificate , they only need a parents declaration.

The NGO sector is all set to play a vital role in financing health care through health insurance schemes. This will also lead to a change in the system of health care delivery and payment mechanisms. In such a situation, the interests of the poor and under privileged sections of the society need to be guarded by appropriate regulatory mechanisms so as to ensure that equity and efficiency are maintained in the provision of health care.

Couple of studies have also looked into the experiences of prepayment schemes run by NGOs in India. Pre-payment/insurance schemes were usually contributions made by individuals and households in advance for need based services. Only the sick availed of services. Therefore, in such financing schemes risks were shared between the healthy and sick. Schemes will provide different level of coverage for community and hospital care, varying from partial coverage to total coverage.

The  four laws  which a person with disability should be aware of are : 

National Trust for the welfare of persons with autism, cerebral palsy, mental retardation & multiple disabilities act 1999.

Persons with disabilities equal opportunities, protection of rights and full participation act 1995.

The Rehabilitation Council of India Act, 1992.

The Mental Health Act, 1987.

Mental disorders are of many kinds: ( some of them are )

• Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and non-verbal communication, and restricted and repetitive behavior. Parents usually notice signs in the first two years of their child’s life.
• Aspergers Syndrome:  is an autism spectrumdisorder (ASD) that is characterized by significant difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development
• Bipolar Syndrome :  is a mental disordercharacterized by periods of depression and periods of elevated mood. The elevated mood is significant and is known as mania or hypomania depending on the severity or whether symptoms of psychosis are present.
• Dyslexia, also known as reading disorder, is characterized by difficulties with reading words. This difficulty is not related to intelligence and individuals across the intellectual spectrum can exhibit the condition. Different people are affected to varying degrees. Problems may include difficulties in spellingwords, reading quickly, writing words, “sounding out” words in the head, pronouncing words when reading aloud and understanding what one reads
• Epilepsyis a group of neurological diseases characterized by epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable to long periods of vigorous shaking. These episodes can result in physical injuries including occasionally broken bones. In epilepsy, seizures tend to recur, and have no immediate underlying cause. Seizures that occur due to a specific cause are not deemed to represent epilepsy. People with epilepsy in some areas of the world experience stigmadue to the condition.
• Down syndrome (DS or DNS), also known as trisomy 21, is a genetic disordercaused by the presence of all or part of a third copy of chromosome 21. It is typically associated with physical growth delays, characteristic facial features, and mild to moderateintellectual disability. The average IQ of a young adult with Down syndrome is 50, equivalent to the mental age of an 8- or 9-year-old child, but this can vary widely.
• Schizophreniais a mental disorder characterized by abnormal social behavior and failure to recognize what is real. Common symptoms include false beliefs, unclear or confused thinking, hearing voices, reduced social engagement and emotional expression, and a lack of motivation. People often have additional mental health problems such as major depression, anxiety disorders, or substance use disorder.  Symptoms typically come on gradually, begin in young adulthood, and last a long time

There are currently 554 institutions authorized by the  RCI (Rehabilitation Council of India ) for the mentally challenged , this list is updated monthly and is available at http://rehabcouncil.nic.in/writereaddata/Updated%20List%20of%20Trg%20Colleges%20February%202016.pdf

Some prominent institutions are :

Karnataka Parents’ Association for the Mentally Retarded Citizens, Regd. Office: #18, Bysandra Main Road, Jayanagr 1st Block (East), Bangalore, Karnataka – 560011 Tel. No.: 080 – 22441289, 09844043996 Fax: 080 – 22444234 Email: kpamrc@gmail.com Website: www.kpamrc.org. The mission is to actively involve parents in setting up various services, such as Portagé Programme, Inclusive Education, Vocational Training and Recreational Centers Respite Care Homes / Half Way Homes and Group Homes for rehabilitation of elderly mentally handicapped for life long care and to ensure their they also join the mainstream and live in the community as other citizens of the society.

The Spastics Society of Karnataka This institute provides various services and programs: Physical and functional assessment,  sensory profiling , infant stimulation programme (In this intensive therapy programme , parents are given guidance on stimulating and handling babies with developmental delays by qualified and experienced physiotherapists and occupational therapists.) Life skills program and a home based therapy services.

National Institute of Mental Health & Neurosciences (NIMHANS)
Asha Kirana School for the Mentally Retarded, Rotary 75th Anniversary Trust, Vidhya Nagar, Shimoga, Karnataka – 577201 Tel. no.: 08182-273236, 09448288487

Raksha Society for the Care of Children with Multiple Handicaps  Raksha has been looking after the training and therapy of children with special needs in two special schools it established in Cochin. and Vypeen Raksha now serve all congenital disabilities, with the exception of the blind and the hearing impaired. Together with the two units, Day Home, Sheltered Workshop, Institute, and Ernakulam Centre we serve the needs of 500 children and young adults between the ages of 0 to26. Apart from cerebral Palsy Raksha educate and provide therapy to children with Delayed milestones, Muscular Dystrophy, Down syndrome, Learning Disabilities, and children who are mentally and physically challenged

SAVALI Association for the Mentally Retarded & Cerebral Palsy Children Vocational Training Center has Multiple disabled children such MR & CP. Keeping in mind their disability, in the Pre Vocational Training Center they teach the students the skills which have repeated activities such as Liquid Soap, Phenyl, Candle Making, Paper Bags, etc. They have started collection of used news paper. The children go from house to house for collecting the used news papers. From this task they learn conversation skills, dealing with different type of people, they also learn stacking papers of 5 kg etc. by this activity its noted that many of the behavior problems are diminishing.