Niramaya Health Insurance: FAQs

What is Niramaya?
A health insurance policy for person with developmental delay (Autism, CP,MR, & Multiple disabled) by
the National trust. It is one of the best social impact schemes of the country.

What does it cover?
It provides the coverage of up to Rs 1.0 Lac per annum (reimbursement only) for a range of medical
treatments like Surgery, Therapy, OPD, Hospitalization & Conveyance as per the sub limits.



Is there any age, caste or Income limit to cover the beneficiaries?
No. The Niramaya health insurance scheme is available for all eligible people of the country (Except J &
K) without any discrimination of age, caste or income.

How much contribution beneficiary is required to make & where to deposit?
The contribution for enrollment & renewal is based on Income group as given below

SN Income(Rs/month) Contribution amount
(Rs/Annum)
A/C no & Bank Details for Payment
Payable to
NIRAMAYA, National Trust at New Delhi
Enrollment Renewal Corporation Bank A/c. No.
CLSB/01/090021 (Branch Code - 2099) 1 BPL 250.00 Nil
2 Upto Rs 15000.00 250.00 250.00 State Bank of India A/c. No.
30396764585 (Branch Code -5943) 3 Over Rs 15000.00 500.00 500.00

Overall Limit for Hospitalization 1,00,000/-
Hospitalization 1,00,000/-
Corrective surgery 50,000/-
Non Surgical 15,000/-
Preventive surgery 15,000/-
Overall Limit for Out Patient Dept (OPD) 10,000/-
OPD treatment including tests 5,000/-
Regular medical checkup 5,000/-
On-going Therapies 10,000/-
Dental Preventive Dentistry 2,500/-
Alternative Medicine (IPD and OPD) 4,500/-
Transportation Costs (IPD and OPD) 1,000/-
ANNUAL INSURANCE COVER 1,00,000/-



What are the documents needed for Enrollment along with form?
The documents required along with the enrollment form are based on Income Group.

SN Documents Income Group (Rs/ Month)
BPL Upto 15000.00 Above 15000.00
1 Address Proof (Ration Card/ Drv.Lic/
Aadhar Card/ Bank passbook/ Voter ID)
Yes Yes Yes
2 Disability Certificate by District Medical
Board
Yes Yes Yes
3 Income Certificate BPL Card Yes No
4 Passport Photo Yes Yes Yes

Where can we get & submit the form?
The enrollment form is available on www.niramayascheme.com which can be filled by applicant and
submitted to the any Registered Organization (RO) with the National Trust. The list of the RO (state &
district wise) is available on the website of the National Trust. The RO submits the application online.
Renewal can be done by the applicant himself also online through www.niramayascheme.com. The
renewal process starts 3 months prior & stop 1 month prior to the expiry of policy.
What is the enrollment & renewal cycle?
Enrollment application can be submitted any time during the year. The policy is issued twice in a year.

Renewal can be done by the applicant himself also online through www.niramayascheme.com. The
renewal process starts 3 months prior & stop 1 month prior to the expiry of policy.

Cycle Policy Coverage Period Enrollment application
submission period
Renewal application
submission period
I 2
nd
April to 31
st
March

1
st
Oct to 28
th
Feb 1
st
Jan to 28
th
Feb

II 2
nd
October to 30
th
September

1
st
Mar to 31
st
Aug 1
st
July to 31
st
Aug


Where will I get my NIRAMAYA E-Card?
In case of enrollment the NIRAMAYA E card will be given by the RO through which you enrolled.
Alternatively if you get the application Id from the RO, you can also print the same at your own from
www.niramayaschem.com by clicking on Print Ecard.

How can I get the reimbursement of the expenses made?
You can download the claim form from www.niramayascheme.com. Please fill the claim form properly.
Enclose the doctors prescription, test reports, medical bills, hospitalization report, discharge card etc in
original and send it to the following address which is mentioned on the Ecard also.:

ICICI Lombord G.I.C., ICICI Bank Tower, Plot no. 12, Financial
District, Nankrani Guda, Gachibowli, Hydrabad 5000032 (AP)
Toll Free Nos: 1800-209-8888, 1800-233-4505, 1800-233-1166,
Tel: 011-66310689 & 66310600
email id: ihealthcare@icicilombard.com
ayushi.sharma@icicilombard.com

What are the important points to get the claim fast?
1. Fill your complete details along with Mobile number as you will be updated by SMS on the
progress of the claim on that.
2. Mention your address correctly & clearly along with your city, district, state & PIN code no.
3. Keep a complete set of photocopy with you of all the papers sent to ICICI Lombord.
4. Do not forget to mention your application ID & health ID no on claim form..
5. Please ensure that the address provided in the hospital should be same as given in Niramaya E
card. In case of change of address inform immediately to the National Trust.
6. Provide the complete bank details of beneficiary (account no, Bank name, branch, IFSC code) to
get the reimbursement directly into your account.
7. Check your claim ID no. from www.niramayascheme.com & then check the claim status on the
same website.
8. If you find any quarry in claim status, then send the desired info to the insurance company.
9. The claim amount cheque will be issued in the name of beneficiary so there must be a bank
account or post office account in the name of beneficiary. It may be a joint account with first name
of beneficiary.

Can I get the claim info online?
Yes. Please login to www.niramayascheme.com and click on Claims tab. Then click on the claim ID.
Give the application Id of beneficiary to know the claim ID. Then go to claim status and provide the claim
Id no to know about the claim status.

Can I get the claim info on my mobile?
Yes. If you mention your mobile number in claim form then receipt of your claim form, claim Id, any quarry
about the claim, claim settlement, and courier details are being sent by the insurance company on the
mobile number.

Can RO mention their mobile number if applicant is not able to understand?
Yes. RO can mention their mobile number on claim form to get the info about the claim to guide the
beneficiary.

What is the time limit to submit the claim form?
The claim form must be submitted within 30 days from the date of discharge from the hospital or from the
date of last bill (OPD/Therapy) to the insurance company.

How much time does insurance company takes to settle the claim?
It depends on the correctness of claim form & supporting documents. Based on the statistics available of
Jan to Jun 2013, 92.3% of the claims were settled within 30 to 60 days of the submission.

Can I talk to Insurance company directly for my claim status and where?
Yes. You can talk to the insurance company directly on following toll free nos.
Toll Free Nos: 1800-209-8888, 1800-233-4505, 1800-233-1166, Tel: 011-66310689 & 66310600

People generally use to say that that insurance company generally rejecting most of the claims. Is
it like so?
No. Not at all. Specially in case of NIRAMAYA the rejection rate is only 4.82%, which indicates that 95
claims are being settled out of 100 claims received. This is the outcome of the National Trust efforts which
is keeping track of all the claims received with insurance company. This is the reason NIRAMAYA is
awarded with one of the most prestigious award The Best Social Impact Scheme of the Country by the
Times of India group. During 2012-13 5880 claims of Rs 1,98 Cr were settled. In 2013-14 till June 2013
the claims of Rs 1.65 Cr. have been settled.

How does RO can do the enrollment and renewal?
ROs are required to go to www.niramayascheme.com. Go to NGO login. Each RO has been provided
username & password to login. Once login, update the complete info of RO including address, phone nos,
email Ids etc. When you click on the renewal tab, then based on the renewal period, list of all the
beneficiaries to whom RO enrolled will be visible. Click on the submit now button to update the info of
beneficiary & submit the form. For enrollment of new beneficiary click on the enrollment tab and fill the
form.



Is username & password for www.niramyacheme.com is same which is provided for login to
www.thenationaltrust.in? What to do to get new username & password?
No. The username & password for both the sites are different. The National Trust has sent the username
& password to all ROs but if RO didnt receive it then they may contact snehnagda@gmail.com or
rajni@nationaltrust.in.


Can RO deposit the contribution of its entire beneficiary together?
Yes. The RO can do that & use the can copy of same deposit slip in all the beneficiaries proof of
payment. RO is required to send a separate mail to the National Trust (rajni@nationaltrust.in) stating
about the same with scan copy of deposit slip & the list of beneficiaries.

Is National Trust paying any honorarium to the Registered Organization (RO) for enrollment/
renewals?
Yes. National Trust is paying Rs 40.00 per beneficiary for enrollment/ renewal.

How does RO get the honorarium?
The honorarium is payable twice a year based on number of beneficiaries enrolled/ renewed. The
honorarium is directly transferred to the ROs bank account. ROs are required to update their bank
account details also in the details of NGO under www.niramyascheme.com.

Who will do the renewal if a beneficiary shifted from one city to another city?
The beneficiary himself can do the renewal online. If he can not do himself, he can approach any nearby
RO which can also do the same. The address of the beneficiary can change while submitting the renewal
form.

How can ROs contribute more to NIRAMAYA?
Based on the population of 2011 the estimated eligible people which can be covered under NIRAMAYA in
the country is approx. 26.30 lacs while people covered under Niramaya is less than 40000. ROs are the
key link between beneficiaries and National Trust for enrollment/ renewal/claim settlement. Looking to the
financial burden involved in the implementation of the scheme, National Trust is paying handsome
honorarium to ROs. Hence ROs must act aggressively to enrolled as many people as possible.

How can ROs get contribution if BPL people are not able to pay contribution?
ROs can approach to the state govt. to make the scheme compulsory at least for BPL people by paying
the contribution by the state govt. Alternatively ROs can approach to the donors for sponsoring the BPL
people or can also approach the corporate to sponsor the BPL beneficiaries under their CSR scheme.










If you still have any quarry on Niramaya please contact

Er. Pankaj Maru
Founder & President
SNEH
Special Need Education Home
Nagda Jn Dist Ujjain (MP)
snehnagda@gmail.com
+91-94251-95626