Plan Special Needs

Health Insurance is one of the larger concern for a family with a special needs child. Though life and disability risk are also the topmost priorities it’s easier to cover them through adequate insurance. This is because the cover is on the parents themselves. But it’s the health insurance where they have challenges.  Not many health insurance companies cover special needs children.  This creates a situation where, for any health emergencies, the special needs child remains without any adequate protection.

In India, we have been lagging behind in this aspect. Insurance companies in recent times only have started giving coverage to specific disabilities. Here I am reviewing health insurance options available for a special needs child family. Through these options, a special needs child can be covered under health insurance even though these policies have their own limitations.

Health Insurance Special Needs

Nirmaya for Special Needs

Nirmaya is a health insurance scheme provided by the National Trust in collaboration with ICICI Lombard General Insurance. In this insurance scheme, parents can get Rs 1 lakh coverage for their special needs child with Autism, Cerebral Palsy, Mental Retardation, and Multiple Disabilities. The benefit of this plan is that there is no premium difference as per age.  The policy covers regular medical check-up, hospitalization, therapy, corrective surgery, transportation, repetitive medical intervention as an in-patient, pre, and post hospitalization expenses.

Since this is a reimbursement policy there is no boundation of hospitalization. The premium varies from Rs 250 for BPL families to Rs 500 for Non-BPL families. Legal guardian, if opting for the disabled, do not pay any fees in this scheme.  There is no medical test and no exclusion in this policy.

Though the policy is available to all kinds of disabilities it has not received much of success considering the issues surrounding it.

Start Health Special Care for Autism

Star health a few years back rolled a specific policy for  Autism.  The policy is named as Star Health Special Care and covers for a standard policy amount of Rs 3 lakh. There is no medical test but copies of medical records have to be submitted. The policy covers the hospitalization expenses much like any other basic health plan.  The premium will vary as per age of the disabled covered in the policy.


Star Health has sub-limits in its insurance policies and so this product has them too.  The policy is available only to the age group of  5-25 years. This means adult beyond this age with ADHD will not be covered under this policy which is a huge disadvantage. This policy also has sub-limits much like in other policies. These sub-limits apply on Cost of Room Rent, Boarding, Nursing Expenses having a limit of Rs 5000 per day for individual and Rs 500 per day for shared accommodation.  Apart from this the pre and post hospitalization expense also have a capping of 7% of sum assured.

More than this there is a limit to specific treatment highlighted in the policy. Andino Tonsillectomy or seizures have a limit of Rs 25- Rs 30k.  Fractures requiring surgery have 20% as maximum payout form the company. The biggest disadvantage is the coverage for therapies where the company has put a maximum cap of Rs 1500 which is quite less when you look at the cost.

There are waiting periods for certain illness but Autism is covered from the first day. This is an annual policy which has to be renewed every year.  One can find the policy details in below link:

Star Special Care

Religare Care Freedom For Autism

Religare Health insurance has launch specific policies under the name Care freedom. Through this policy, the company covers senior citizens, diabetes, hypertension, and Autism. The policy is specifically designed for persons with any preexisting illness. The care freedom meant for Diabetes covers Autism also.  Unlike start health, this policy treats Autism an as preexisting illness.

There is no medical checkup required but all preexisting illness are covered only after 2 years of the waiting period. The policy provides coverage in 3 variants Rs 3 lakh-Rs 7 lakh and Rs 10 lakh with a restore benefit.  There is no maximum age and so policy covers people well above 25 years of age. Unfortunately, the company is treating Autism as a preexisting illness and so one will have to wait for 2 years to receive any claim from the policy.  The policy covers only hospitalization expenses and not regular expenses.


Like star health insurance company this product also has sub-limits within the policy based on the coverage opted. Like for Rs 3 lakh, coverage room rent is capped at 1% of SI per day and only twin sharing room. This limit is reducing to zero in Rs 5 lakh coverage and in Rs 10 lakh coverage private room is covered without any limit.  One of the limitations this policy has is a copayment clause wherein 20% of the claim amount will be shared by the policyholder. Then there are other limits imposed by the company on specific treatment not related to autism.

One of the larger drawbacks of this policy is that Autism is treated as a preexisting illness. It will be seen how much company has understood Autism and to what extent they will apply exclusion within it. Treating it as a preexisting illness and a waiting period for any claim is not what I have liked in this policy.   The company would have done well if the waiting period would have been enforced only on hospitalization arising from the disability.

Insurance for Mental Retardation

Mental Retardation is another disability which gets coverage from quite a few health insurance companies like New India Assurance.  There is no specific policy for it and the company covers it in their basic health plans where sub-limits will apply if any.

By and large special needs children have been excluded by the health insurance companies. What’s disappointing is that they are permanently excluded from health insurance benefits.

Though some beginning has been made its looks testing water for the companies as the policies introduced have many limitations. Also, Autism is the only one where companies have started offerings.  In my view, it’s only after a few years they will be able to judge the benefits for them and so for the insured. Till then families do not have a choice but to maintain adequate health funds from their savings.

If you have a special needs child and have gone through any experience with health insurance companies then share with me at 

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41 comments on “Health Insurance Options for Special Needs Children

    1. There are only 2 policies currently available. Star Health and Religare. Both policies have limitations. You can apply one from Religare since it has the option for higher coverage of Rs 5 lakh. But the coverage will start only after waiting period of 2 years and the policy covers only hospitalization expenses.

  1. Hi my son name is G. Bhavani an my son is name is G Sai Tapash who is a down syndrome kid. I want to purchase insurance for him.

    1. G. Bhavani,

      Unfortunately, Down syndrome child is not yet covered by health insurance companies in India. However, it is expected that sooner companies will start giving health insurance to a person with down syndrome. Will keep you posted on any new development.

      1. Hi Jitendra, I had an opportunity to listen to your presentation in India International Down syndrome Conference in Chandigarh, i think it was in 2019. I also got to read your book financial planning on special needs children. Do you know whether insurance companies have started covering medical insurance for DS children. This is Dinesh, from Bangalore. +91 9746756687

        1. Dear Dinesh,

          Though there is a clear mandate from regultor to insurance comapnies to start covering Person With Disabilities, they are taking time to start this. However there are some talks going on of few organiztaions with insurance companies. We may see soon DS children getting insurance Coverage. Till then you can ask few comanies like ICICI, National Insurance, New India Insurance. I heard from few parents that they are ready to cover their DS child but not aware if any condition is imposed.

  2. Can you pls suggest the health insurance scheme available for mentally retarded adults?

    1. Dear Vijay.

      You can check with New India Assurance. They provide insurance coverage to mentally retarded adults.

    1. Dear Neeraj,

      Yes the policy – Religare Care Freedom for Daibities have coverage for higher age too for Persons with Autism. They have not given much details in the brochure on scope of coverage so you need to check with the company.

  3. Hello Sir,

    My son is 1.6 years old and he is suffering from Infantile Spasm / West Syndrome.

    Can you suggest if any policy covers these disabilities or Any policy from Government is available .

    Can I apply for Nirmata.


    1. Safdar Khan,

      You will have to first apply for a disability certificate then only you can apply for Nirmaya.

      Check with your local district hospital for Disability Certificate.

      1. Hi my daughter who is a down syndrome kid. I want to purchase insurance for him.
        Please advise

        1. Dear Maninder Singh Negi,

          Children with Down Syndrome will soon get health insurance coverage. Few companies have come forward to cover them. You can enquire from few private ocmpanies like ICICI (some parent has informed us) or wait for few days. We will update here as soon as we get information from companies.

    1. Pawan,

      In my knowledge Health insurance companies are not yet covering children with Down’s Syndrome.

      But we may see the changes soon. Will inform as I get to know about this.

    2. Dear Pawan,

      Recently companies have started giving coverage to Down Syndrome children. Check with ICICI Lombard where one of readers have commented tat company is willing to give insurance to their Down Syndrome Child.

    1. There are limited policies available for Autism. Star health insurance gives coverage up to 25 years of age whereas Religare gives coverage beyond that too. If your child is still minor and less than 10 years then you can consider Star Health which is quite cheap. Else Religare is the only option covering child at higher age.

  4. My niece is a down syndrome child. Is there any option for her of medical insurance? Has any company come up with a new policy yet?

    1. Dear Mr. Amit,

      Unfortunately Down Syndrome Children have been excluded from health insurance by the companies. However with IRDA new mandate recently we may see sooner or later companies starts giving coverage.

    2. Mr. Amit,

      In comments above you would know that ICICI Lombard is willing to give health Insurance to children with Down Syndrome. You can enquire from the company. Infact others would have also started it. Check with them.

  5. Dear sir,
    My wife had undergone surgery in the year 2016 for tailgut cyst.
    But now icici lombard is not giving medical policy for my wife they are rejecting the same what to do
    Secondly my son who is 7 yrs old is down syndrome they r ready to give policy to him.
    Is it preferable to take policy for my child
    And what to do for taking policy for my wife guide me it’s urgent thanks in advance

    1. Dear Pratik,

      There are some illnesses where Health Insurance companies do not cover any person with the same. So ICICI Lombard may have permanent exclusion for people with the illness you have mentioned. Check with other companies like Religare or Star if they can cover. I don’t have much knowledge who will cover. We will have to enquire from companies.
      For your son yes I would recommend to take health insurance if ICICI Lombard is willing to give.
      For your wife let us check with companies and I will revert on it.

  6. I need life insurance policy for my 14 years old down syndrome child . Please help us if any option.

    1. Dear Anjani Kumar Sharma,

      There is no specific life insurance policy for special needs. You can buy a term insurance for yourself which will fund your child financial requirements after your lifetime. Within your lifetime you can choose other options for investments which can accumulate money for your child financial requirements. Can you elaborate more on what you are looking in an insurance policy?

  7. Sir, my newborn son is a baby with downs syndrome. We are looking for health insurance but we haven’t found any. Sir please guide us through this.

    1. Dr. Nazneen,

      Health insurance for downsyndrome is recently introduced as per IRDA guidelines. Still specific products are not available yet. But in general companies have started giving coverage. One of the parent in comments has mentioned ICICI Lombard willing to give health insurance to his child with down syndrome. You can even check with other insurance companies.

  8. DEAR SIR,

    1. Dear Krunal,

      As per the recent guidelines of the Insurance Regulatory and Development Authority of India (IRDAI), genetic diseases or disorders will no longer be excluded in health insurance policies. Health insurance companies will now cover genetic disorders under a standard health insurance policy.
      However yet to get any confrmation from health insurance companies on covering Apert syndrome. Will have to chek with few companies to see whether they cover it or have started.

  9. My son aged 31 yrs is under treatment for Schizophrenia and is under treatment for a long time, can you please suggest an insurance policy for him please. Thank you

  10. Hi Sir,
    My son is suffering from cerebral palsy. He is 3 years old..
    is he eligible for any private insurance.

    1. Dear Mamta,

      Now health insurance comapnies have to cover person with disabilities and so children with Cerebral Palsy should get health insurance coverage. You can enquire form few private companies like ICICI, Religare and PSUs like New India Assurance, National Health Insurance.

  11. Greetings Mr Solanki,

    I checked with ICICI Lombard incase they have any policy for Down Syndrome kid. Unfortunately, they denied. Any other provider do you recommend?

    Regards – Tushar

  12. I have a son, 7 years old, and has a rare genetic disease, Syngap1. The symptoms include, seizures, traits and manifestation of ASD, non verbal, and a few other issues. I am unable to find a proper insurer. Would you please help identify one?

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