Health insurance options for the differently abled

Differently abled people account for a fairly significant share of India’s population. Going by the 2011 census, the count is 26.8 million, which makes up for more than two percent of the population. India has remained an underpenetrated insurance market for a long time. The number of insured gets even more minuscule when it comes to the differently abled.

The insurance industry is evolving rapidly and has experienced significant traction after the pandemic, especially in the health insurance segment. Nonetheless, several misconceptions exist and there’s a pressing need for awareness about buying health insurance products that cater to the differently abled. Insurance needs differ from person to person, and this holds even more true for people with special needs. When it comes to offering specific insurance products serving all these needs, the Indian insurance market still has some way to go. However, it still offers insurance products that promise to safeguard them financially in the event of an unexpected medical emergency. Let’s understand the options available for them and the exclusions that they need to be mindful of in choosing a health insurance policy.

Also read: Budget 2022’s tax concessions for the differently abled 

Types of disabilities

There are broadly two types of disabilities -- congenital and accidental. Congenital disability refers to a condition one is born with; accidental disability -- as the name suggests -- occurs because of an accident. Heart defects, neural defects and Down syndrome are a few examples of congenital disability.

An accidental disability may cause permanent complete disability or permanent partial disability. While most insurance plans cover only those with accidental disabilities, there are now some health insurance plans available for those with congenital disabilities. However, they are considered high-risk individuals by insurers and may entail restrictions.

Understanding conditions that apply 

Before understanding insurance coverage for disabilities, let us first understand the two types of plans that are available -- comprehensive and restrictive. Comprehensive plans provide complete coverage to the insured while restrictive plans provide coverage based on the extent of the disability and may apply certain exclusions.

These exclusions are of two kinds -- temporary and permanent. Temporary exclusions may come with a waiting period after which the disability will be eligible for insurance coverage as per terms and conditions similar to coverage of pre-existing diseases. A permanent exclusion means that the particular disability will be permanently excluded from coverage and the insured can only file a claim for other medical emergencies.

Extent of coverage for different disabilities

First, let’s start with plans for people with congenital disabilities. For instance - people with atrial septal defect and ventricular septal defect are covered by insurers like Star Health Insurance and Care Health Insurance with the permanent exclusion of these disabilities. People with certain disabilities like Down syndrome generally can’t opt for health insurance. In mental health conditions, similar restrictions may be applied. People with schizophrenia and autism can opt for Care Health Insurance with temporary exclusion. Insurers like Aditya Birla Health Insurance offer plans that comprehensively cover people with conditions like bipolar disorder, anxiety, dementia and obsessive compulsive disorder.

Next, let’s understand insurance protection for those with physical disorders. People with locomotor disabilities can opt for plans by Care Health Insurance and Aditya Birla Health insurance with the permanent exclusion of the disability. Polio-affected people with disabilities of 40-50 percent can opt for plans by Star, Care, Aditya Birla or Niva Bupa Health Insurance.

Tax benefits available 

Differently abled individuals can avail of tax benefits under 80U of the Income Tax Act, 1961 by investing in health insurance. Under Section 80U, there are two categories -- partial disability and severe disability. Individuals with at least 40 percent disability are eligible to claim tax deductions. The differently abled policyholder is eligible for a tax rebate of up to Rs 75,000 and a person with severe disability (80 percent disability) can claim up to Rs 1.25 lakh. Apart from this, Section 80DD also offers tax benefits against medical insurance premiums to family members who purchase a policy for the differently abled individual. The limit of deductions here remains the same as under Section 80U.

It has become all the more important to stay protected against unforeseen medical emergencies, especially when COVID-19 and its variants continue to pose a threat. Equip yourself with all the information you need and remember to check the specifics with your insurer before opting for a policy.