Swavlamban Health Insurance Scheme: All You Need To Know

Introduction

Swavlamban Health Insurance Scheme was launched on October 2, 2016, exclusively for People with Disabilities (PwD).


Implementing Agencies

  • New India Assurance Company is the implementing agency 
  • Ministry of Social Justice is the ministry concerned with Swavlamban Scheme 
  • Department of Empowerment of Persons with Disabilities under ministry of social justice is the monitoring agency

Objectives of Swavlamban

  • To give low cost and affordable health insurance to PwD (includes people with low vision, Blind, hearing impairment, mental illness, leprosy, mental retardation, loco-motor disability) 
  • To improve quality of life of PwD
  • To improve PwD condition of general health

Features of PMFBY

  • Uniform premium of 357 rupees (which is 10% of the actual premium + Service Tax) per PwD person throughout the country 
  • Sum insured is 2 lacs for a year 
  • Swavlamban will cover PwD people in the age group of 0 to 65 years 
  • PwD must carry the PwD certificate issued by PwD Act, 1995 to get enrolled 
  • PwD family including spouse and up to two children are covered by this scheme 
  • In case of minor PwD, parents of PwD are also covered 
  • PwD with family income not exceeding 3 lacs p.a are eligible 
  • There are no premedical tests involved before enrolling into the policy 
  • OPD benefits include 10000 p.a per PwD and 3000 p.a for mentally retarded people

Claim and Redressal

  • New India Assurance in the nodal agency for Swavlamban 
  • New India Assurance has created a network of hospitals for the beneficiaries of Swavlamban to get free treatment under the policy 
  • PwD getting treatment outside the network must get the consent and approval of New India Assurance 
  • However, in case of emergency, PwD insured can be admitted in another hospital outside the network without prior approval 
  • Claims must be made to New India Assurance with PwD certificate 
  • Grievances must be lodged to New India Insurance authorised person for resolution 
  • Grievances are monitored by a Dispute resolution committee consisting of representatives from the Department of Empowerment of PwD and New India Assurance

Advantage of Swavlamban

  • Cashless treatment for PwD in the designated hospital networks identified by New India Assurance 
  • Free OPD treatment up to 10000 rupees also included in the health insurance scheme 
  • Family of PwD is also covered which is an additional benefit of the scheme 
  • Swavlamban helps people with PwD to be recognised in the society and live with self-esteem
  • Treatment is offered to PwD for preexisting medical problems also 
  • Claim settlement is done in a transparent manner 
  • Redressal mechanism is efficient until the PwD concerned is satisfied 
  • Enrollment procedure made simple through the New India Assurance network

Limitations of Swavlamban

  • Swavlamban excludes people with
           Autism
           Cerebral palsy and 
           Multiple disabilities 
  • Swavlamban emergency procedures and provisions must be enhanced further 
  • Awareness about Swavlamban health insurance scheme is limited among PwD

Way Forward

  • Swavlamban is a sign of progress for the welfare of PwD
  • Awareness about the scheme must be enhanced and more PwD must be enrolled in the scheme 
  • GOI has introduced a slew of welfare measures for PwD in this fiscal year including Swavlamban but the implementation and monitoring must be enhanced further 
  • Initial steps to be taken to cover all PwD’s working in the formal sector 
  • Identification of beneficiaries is a key challenge 
  • Overall, the scheme is a positive measure in utilising the PwD talent and recognising them as respectable individuals in the society

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