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
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
