Here Are the Health Insurance for Children with Special Needs

Oct 28, 2022

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Parenting a child with special needs is a huge responsibility that has never been easier. Nowadays, with both parents working, it is becoming even more challenging. While it is necessary to be physically and emotionally available for at least one of the parents or guardians to cater for the needs of a child with special needs, not everyone's work allows them to work from home or offer a flexible work environment. This is why parents of children with special needs are more concerned about their child's health and financial future, which is quite normal. These parents work hard and try their best to provide a secure future for their children with special needs. However, health insurance for children with special needs is often neglected.

The number of children living with developmental disabilities is on the rise. Down syndrome occurs in approximately 1 out of 830 births in India, and Autism Spectrum Disorder (ASD) is diagnosed in 1 in 68 children globally. While Down syndrome, autism, Attention Deficit Hyperactivity Disorder (ADHD), learning disability, intellectual disability, etc., is very common, there are hardly any health insurance policies that provide coverage to these children with special needs. The expenses for the medical treatments of these disorders are very high, and generally, the parents pay for these expenses out of their own pockets. Apart from the medical expenses, parents have to build a corpus for the child's future as these kids might not be able to work and earn their living. This article elucidates two popular health insurance plans that can be bought for children with special needs.

Niramaya Health Insurance Scheme:

'Niramaya' is a health insurance scheme introduced by the Government of India for children with special needs. The plan provides health insurance cover up to Rs 1 lakh to children with developmental disabilities like autism, cerebral palsy, etc.

Niramaya Health Insurance Scheme is available across the country and has a single premium across the age band. Any person with at least one of the disabilities under the National Trust act with a valid disability certificate can benefit from the plan. The applicant does not need to do any pre-insurance medical tests and can only take treatment from any hospital on a reimbursement basis.

Here Are the Health Insurance for Children with Special Needs
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The Niramaya scheme is available at an affordable enrolment fee of Rs 250 for those Below the Poverty Line (BPL) and Rs 500 for Non-BPL. It is advisable to check the latest fees on or the nearest organisation registered with the National Trust. The scheme remains valid till March 31st of the financial year in which enrolment is undertaken. Beneficiaries are expected to submit the renewal applications three months prior to expiry to continue availing of the scheme.

The plan typically covers the following:

  • - A facility for OPD treatment, including medicines, pathology, diagnostic tests, etc.

  • - Regular medical checkups for-ailing disabled

  • - Dental preventive dentistry

  • - Surgery to prevent further aggravation of a disability

  • - Non-surgical/ hospitalisation

  • - Corrective surgeries for existing disabilities, including congenital disability

  • - Ongoing therapies to reduce the impact of disability and disability-related complications

  • - Alternative medicine

  • - Transportation cost

While the Niramaya scheme is affordable, the question arises of whether the cover of Rs 1 lakh is sufficient for a child with developmental disabilities. These disabilities/disorders affect a child's development in his/her speech, non-verbal or gestural interaction, and social interaction with peers. This further affects the child mentally and emotionally, and he/she also needs to undergo therapy. So, the multi-disciplinary treatment that includes regular visits to a paediatrician, psychiatrist, counsellor, special educator, speech therapist, etc., can be quite expensive. Moreover, children with ASD are accident-prone, which can further add to the expenses. This is why the cover of Rs 1 lakh might not prove to be sufficient for the medical treatment of a child with special needs.

Aadvik Child Insurance Plan:

In May 2022, Mom's Belief launched Aadvik Child Comprehensive Health Insurance Plan in association with Care Health Insurance. Mom's Belief is one of the largest mental health companies for kids and adults in Asia-Pacific. The company focuses on child development and takes care of children with special needs suffering from Down Syndrome, autism, ADHD, learning disability, intellectual disability, or any other developmental delay. Mom's Belief conducts around 30,000 sessions per month on therapies and counselling of persons between 0-15 years of mental age.

The Care Child Health Insurance Plan for children with special needs is a 360-degree insurance product underwritten by Care Health. It is a business-to-business (B2B) product. So, the parents will have to become the customers of Mom's Belief to buy this product. The Insurance Regulatory and Development Authority of India (IRDAI) does not allow the company to sell it directly to the parents unless they are Mom's Belief's customers. While the company is trying to get approval for business-to-customer (B2C), it is a long process, and it may take a few years to get it approved.

The policy can also be purchased as a family floater health insurance plan. So, if the cover is not utilised for the child with special needs, it can be utilised to cover the parent's or sibling's medical expenses. Besides, many parents nowadays suffer from mental stress, anxiety, depression, etc., and the Aadvik Child Insurance Plan can cover the expenses of counselling or therapy.

Here are a few important things you should know about the plan:

  • - Aadvik Child Insurance Plan is group insurance launched under the B2B model

  • - The plan offers coverage from Rs 1.5 lakhs to Rs 4 lakhs

  • - It covers inpatient department (IPD) in 16,000 hospitals and outpatient department (OPD) in therapy at over 100 centres

  • - It offers the cashless facility

  • - It can be bought as a comprehensive family floater health insurance plan to cover the entire family (parents and children) under the same policy

  • - The premium can go up to approximately Rs 45,000, depending on the age and coverage opted for

To conclude:

While the Aadvik Health Insurance Plan has wider coverage compared to Niramaya Health Insurance Scheme, the policy's premium might not be affordable for all income groups. Apart from these two, many other insurers, like Star Health Insurance, have also started offering insurance coverage for children with special needs. However, these plans can come with a co-pay clause, and coverage may vary from insurer to insurer. Hence, it is crucial to check the policy terms and conditions, inclusions, exclusions, etc. and make an informed decision.


Warm Regards,
Ketki Jadhav
Content Writer

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