Health Insurance Options for Special Needs Children

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.

Limitations

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.

Limitations

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 Jitendra@planspecialneeds.com. 

Image courtesy: freedigitalphotos.net

About the Author

Jitendra P.S. Solanki

Jitendra is a SEBI Registered Investment Adviser (INA10000184) and has earned the much-respected professional designation of Certified Financial Planner (CFPCM ) and Chartered Trust & Estate Planner (CTEPTM). He is a post graduate from IIT - Roorkee and has spent 15 years in Financial Services Industry working with leading financial institutions & Banks, advising families on their Financial well-being. Jitendra specializes in advising families with special needs children on various financial & legal aspects.

2 Comments

    • 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.

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