Disability Coverage: 5 Disabilities Insurance May Cover

Disability is broader than we realise. In India, the Rights of Persons with Disabilities Act (RPwD), 2016, formally recognises 21 different types of disabilities. The Insurance Regulatory and Development Authority of India (IRDAI) has progressively expanded its mandates to push insurers to make their health care plans more inclusive. Most policyholders are simply unaware of what their plans cover and therefore fail to avail themselves of disability insurance plans.

What Qualifies As A Disability?

When you hear the word 'disability', you, like most people, tend to picture someone who has lost a limb in an accident or has been paralysed. While these situations do qualify as disabilities and definitely have insurance coverage, modern providers define disability in a much wider sense.

Disability coverage, from an insurance perspective, generally falls into two categories: 

1. Total disability: when you’re completely unable to work or carry out any of your usual daily activities
2. Partial disability: your ability to function is significantly reduced but not entirely gone.

5 Disabilities That You Probably Didn't Know Are Covered By Health Insurance Policies 

You might have a health condition that you don't even consider a disability and therefore don't know whether it’s covered under disability insurance or not. Here are 5 disabilities you might not know are covered by your insurance:

1. Mental Health Conditions

Historically, mental health has been the biggest blind spot in Indian health insurance. For decades, conditions were quietly excluded from policies. These include:

• bipolar disorder, 
• severe depression and 
• schizophrenia

This changed when the Mental Healthcare Act, 2017, was introduced, clearly stating that insurers must make provisions for insurance of mental health conditions. The IRDAI followed this up with a circular. reinforcing compliance.

In practicality, this means that all inpatient hospitalisations for mental health conditions are covered under general health insurance plans. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana scheme also updated its Health Benefit Package to include cashless healthcare services across 22 procedures specifically related to mental health treatments.

2. Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is a lifelong neurological and developmental condition where a person’s ability to interact, communicate, learn, and behave is affected.

ASD falls under two frameworks in India, namely the National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999, and the Rights of Persons with Disabilities Act (RPwD), 2016, both of which recognise it as a disability warranting institutional support and coverage, ensuring autism insurance coverage in India.

The Nirmaya Scheme is a reimbursement policy launched that provides the following:

1. Affordable health insurance coverage of up to Rs 1 lakh across the nation for hospitalisation costs, 
2. OPD treatment, 
3. Ongoing therapies, 
4. Any alternative medications

3. Intellectual Disabilities

Intellectual disabilities are lifelong neurodevelopmental conditions that affect:

• Cognitive functioning, like learning, problem-solving and judgement 
• Adaptive functioning, such as communication and social skills

The  RPwD Act, 2016, regulatory framework ensures that insurers cannot reject an issue based solely on a disability diagnosis. This standard approach now mandates individual underwriting.

This implies that families with a child diagnosed with an intellectual disability can go one of two ways:

• The first is that you can add their child to a family health insurance plan, which many insurers are now mandated to accept.
• Secondly, you can avail yourself of the Nirmaya scheme, which is a government-launched scheme providing affordable insurance coverage for both in-hospital treatments and OPD plans. 

4. Hearing And Visual Impairments

Visual impairment is the lack of visual senses, while hearing impairment is the loss of auditory function. These sensory disabilities affect:

1. Communication
2. Mobility 
3. The overall quality of life of a person

 You can ensure coverage through the following schemes:

• The Swavlamba Health scheme: A government-backed scheme specifically designed to provide affordable health insurance to individuals with hearing and visual impairments, with a cover of Rs 2 lakh per annum. 
• Private insurers: They are expected to cover both complete and partial sensory disabilities under the RPwD Act. Many plans offer specialised plans with limited coverage for assistance tools like hearing aids and prosthetics.
• Personal accident insurance: Sensory disabilities can be covered, as loss of vision in one eye and hearing in one ear qualifies as a permanent partial disability. 
• Health insurance and personal accident insurance: They cover different aspects of sensory disabilities. Health insurance covers hospitalisations and treatment costs, while personal accident policies provide lump-sum compensation for permanent disability. 

5. Locomotor Disabilities

Locomotor disabilities are a restriction in a person’s ability to

• move, 
• coordinate 
• control their body or limbs. 

The disability arises from nervous system damage and limits the independent functionality of an individual. Locomotor disabilities are perhaps the most misunderstood category. 

Many families with a member who has:

• cerebral palsy, 
• muscular dystrophy 
• paralysis 

tend to assume that their insurance will not cover the extensive treatment and care that is required for these conditions and convince themselves that they are bound to be rejected. 

The actual picture is much more nuanced. 

1. Nirmaya scheme: It covers all medical expenses, surgeries and therapy costs without requiring any pre-insurance medical tests. 
2. Private insurers cover locomotor conditions directly under the RPwD framework.

The regulations ensure that the disability does not become grounds for rejecting an individual's treatment for an unrelated claim. Some private insurers also include alternative treatments that fall under AYUSH treatments. 

What Documents Do You Need To Submit To Claim Disability Coverage?

Across all the above-mentioned categories, there are a few requirements that you need to fulfil to avail the benefits of disability coverage

Conclusion

Disability coverage in India has expanded meaningfully in the past decade. Legislative changes and increasingly firm IRDAI mandates have helped create inclusive health care policies, assisting a wide range of people. Government-run schemes like Nirmaya and Swavlamban provide accessible and low-cost coverage for various disabilities.

And trusted private health insurance plans like Niva Bupa’s health insurance do not treat disability insurance like a footnote, but provide comprehensive coverage plans that assist you in navigating your treatment costs more efficiently.

The gap now is not in the law but in its awareness. If you have a disability or a disability dependant, make sure not to assume rejection and research your condition before choosing a plan that suits your needs. To apply for a private or government policy, make sure your paperwork is in order.

Frequently Asked Questions

How do I know my disability is covered? 

You should always confirm whether your condition falls under the 21 legally recognised disabilities under the Rights of Persons with Disabilities Act, 2016. If you are on the list, which you likely are, then insurers are legally obliged to consider your application

Can my application get rejected solely based on the fact that I have a disability?

As per the new IRDAI regulations that are compliant with the RPwD Act, no private or government insurer can reject your application based on your disability. You should also read the policy carefully to ensure that it provides inclusive coverage for your entire treatment process.

Do I need a UDID card to apply for disability insurance?

Yes, to apply for an insurance plan, you will need your UDID card at the time of enrolment and renewal. Some private insurers may accept a certified disability certificate from a government authority, but it heavily depends on the rules and regulations of your policy. Ensure you read the fine print of your scheme to make sure what the specific requirements are.

How do I apply for a UDID?

The application process for a UDID is fairly straightforward.

1. Go to the official website and click Apply for UDID.
2. Fill out the online application form 
3. Upload all required documents
4. Select a medical authority in your district for the physical assessment
5. Once the medical board clears you, your UDID will be issued