Niramaya Health Insurance Scheme

1. Health insurance coverage: Up to ₹1,00,000/- for various expenses.1. Outpatient department (OPD) treatment: Covers medicines, pathology, diagnostic tests, etc.1. Regular medical checkups: For non-ailing individuals with disabilities.1. Dental care: Preventive dentistry services.1. Surgery: To prevent further disability worsening or for existing disabilities (including congenital).1. Non-surgical/hospitalization: Coverage for non-surgical treatments and related stays.1. Ongoing therapies: For managing disability and related complications.1. Alternative medicine: Coverage for alternative treatment options.

> Health insurance coverage: Up to ₹1,00,000/- bifurcation for various expenses.

• Section I: Hospitalization : The overall limit for hospitalization expenses is ₹55,000/-. This includes:

• Corrective Surgeries for existing Disability including congenital disability (Under SECI(A)a maximum capping of ₹15,000/- For other than the corrective surgeries for Existing Disabilities, which is include in the overall limit of ₹40,000/- of Sec I(A))
• Non-surgical or hospitalization costs are covered up to ₹15,000/-.

• Section II: Outpatient Department (OPD) : The overall OPD treatment limit is ₹19,000/-, broken down as:
• OPD treatment, including medicines, pathology, diagnostic tests, etc., is covered up to ₹15,000/-.
• Dental preventive dentistry is covered up to ₹4,000/-.

• Section III: Ongoing Therapies

• A total of ₹20,000/- is allocated for ongoing therapies aimed at reducing the impact of disability.

• *Section IV: Alternative Medicine (AYUSH)*

• Treatment under AYUSH systems of medicine is reimbursable up to ₹4,000/-.

• Section V: Transportation

• Transportation costs related to medical treatment are covered up to ₹2,000/-.

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• All the disable person who have at least one of the disabilities under the National Trust Act, 1999 with valid disability certificate.

> Enrolment process:

Step 1: Parents/ guardian of the PwD will visit the nearest Registered Organization (RO) for Niramaya enrolment with required documents.

Step 2: RO will fill up the Niramaya application form online and upload the scanned documents as required after verification of the originals.

Step 3: On successful enrolment and approval, Health ID No. /card will be issued to each beneficiary or can be downloaded by the beneficiary online or through RO.

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> Scheme Renewal process:

Step 1: The parent/guardian of the beneficiary can renew the scheme with the required documents online by logging on to the Niramaya website through providing below details: Policy Period, Beneficiary ID, UDID No/Enrollment no, Date of birth.

Step 2: RO to verify the validity of documents

Step 3: Pay the application fees online.

Step 4: After receipt of payment, the RO/beneficiary will be notified of the renewal for another year through the website.

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> Scheme Claim Process:

All claims for settlement under Niramaya have to be submitted to the canters of the insurance provider in the prescribed Claim Form along with relevant vouchers/bills, etc. (preferably within 30 days of treatment) or discharge from hospital.

Step 1: Log on to https://portal.mediassist.in - MediAssist Employee portal. (Your username will be as &lt;application_id&gt;@NATIONALTRUST.Com and password will be your date of Birth of Beneficiary e.g. DD-MM-YYYY)

• You can also download the Mediassist App from Android/Apple/Window store in a phone [Username - &lt;application_id&gt;@NATIONALTRUST.Com and password will be DD-MM-YYYY (Date of Birth of the Beneficiary]

Step 2: Click on Submit claim option and fill the details to generate the claim form.

Step 3: Click on “Save and Next” once all the details are filled.

On 3rd Page, employee KYC documents are to be updated (one time activity).

Step 4: Upload relevant documents.

Step 5: After Moving to the final Page ”Declaration and Claim Submission” select the ailment type.

Step 6: Upload the softcopy of the documents.

Step 7: Acknowledge the declaration and Click submit to successfully generate the claim form.

Step 8: An Auto-generated mail will be triggered to your registered Email ID containing the claim form.

> Dedicated helpline for claims : 040-68178569/71326135.

> To register or track your Claim, please contact MediAssist at:

> Phone: 040-68213648 | Toll Free – 1800 572 9792

> For any query regarding reimbursement of claim, email to MediAssist TPA on – niramaya[at]mediassist[dot]in

> PROCESS FOR OFFLINE CLAIM SUBMISSION:

Step 1: Visit: https://mediassisttpa.in

Step 2: Click on “Download Claim Form” or visit – https://mediassisttpa.in/#claim-forms

Step 3: Click on “Claim Form Insured (Part A)” to download pdf file of claim form.

Step 4: Fill Claim form, attach required documents and send to Mediassist TPA on following address:

MEDI ASSIST INSURANCE TPA PRIVATE LIMITED,

1st Floor, Block D, Noida Sector 3, Noida, Uttar Pradesh, PIN- 201301

Phone: 040-68213648, Toll Free – 1800 572 9792