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Swavlamban - Health scheme salient features

A Prestigious Health insurance Scheme for Persons with Disabilities (As Per PWD Act 1995) launched by The New India Assurance Company limited, in Association with Ministry Of Social Justice, Dept of Empowerment of Persons with Disabilities.

Launch date: 2nd October 2015

Mission

  • To Provide affordable Health Insurance to persons with Blindness, Low Vision, leprosy-Cured, Hearing Impairment, Loco-Motor disability, Mental-Retardation and mental illness.
  • To Improve general Health condition & Quality of life of persons with Disabilities

KEY FEATURES:

  • Sum insured of Rs. 2 lacs on family floater for a period of 12 months.
  • Age band 0 - 65 years.
  • Family size up to 1+3. Primary member is Person with disabilities. In case of minor being PWD, parent/legal guardian of such minor can also be covered under the scheme.
  • Available for persons with disabilities with family annual income of Rs. 3 lacs and below on declaration basis in proposal form.
  • No premedical tests.
  • Uniform premium contribution of Rs. 357 per person / family ( incl tax).
  • 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.

Premium

As per the following table:

SUM INSURED PERSONS COVERED PLAN PREMIUM
Rs. 2,00,000 PwD, Spouse & up to two Children Hospitalisation and OPD Rs. 3,100
*Service Tax will be additional
**ONLY 10% PREMIUM WILL BE COLLECTED FROM THE INSURED.

PROCEDURE FOR ENROLLMENT:

  • Proposal form duly completed and signed with Rs 355.00 ( Premium : 310 + Service tax: 45)
  • Passport size two photographs of each family member to be covered in the policy.
  • Disability certificate as per PWD act 1995.
  • Copy of valid ID i.e. Voter card, Aadhar Card, Driving license etc.

CLAIM PROCESS

New India will create a network of Hospitals, where the Insured person can get cashless treatment. If any Insured Person wants to take treatment outside network, the permission of TPA is necessary. Such permission is not required in case of emergency hospitalisations.

The policy covers pre-existing Illness. Treatment for pre-existing impairment (for the purpose of this policy, impairment relates to a condition or Illness which caused the Disability as defined in the Act) will be only at the network Hospital and only with the prior approval of the TPA.

At the time of claim, certificate of Disability by the competent authority as defined under the Persons with Disability Act, 1995; has to be submitted to the TPA.

REDRESSAL MECHANISM

Any Insured person having a grievance on any service aspect could approach a nominated person of New India. In case he is not satisfied with the process, he can escalate it to a named person in the Department of Empowerment of Persons with Disabilities. Such escalation would be addressed by a Dispute Resolution Committee comprising one representative each from Department of Empowerment of Persons with Disabilities, New India and the TPA.

PROCEDURE FOR CASHLESS CLAIMS SETTLEMENT:

Name of TPA:

  1. MDIndia Healthcare Services (TPA) Pvt. Ltd. 
    Toll Free: 1800-233-1166, 1800-233-4505
  2. Raksha TPA Pvt Ltd 
    Toll Free: 1800-180-1444
  3. Vidal Health TPA
    Toll Free: 1800-425-8885
  4. Medicare TPA
    Toll Free: 1800 345 3339
  5. Medi assist India TPA Pvt. Ltd.
    Toll Free: 1800 425 9449

NODAL OFFICE—310400: CONTACT INFORMATION:

  • Toll Free No: 1800 209 1415
  • Mr. Rajesh K. Jain, Sr. DM, 011-23411998, 23412370 (rajesh.jain@newindia.co.in)
  • Ms Manju Mittal , Dy manager 011-23412370 (manju.mittal@newindia.co.in)
  • Ms Renuka walia, AO (renuka.walia@newindia.co.in)

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