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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- http://www.bankexamstoday.com/2016/12/swavlamban-health-insurance-scheme-all.html