Niramaya Health Insurance Scheme - National Trust

NIRAMAYA - Health Insurance Scheme (Revised Scheme w.e.f. April, 2015)
(For further clarification you can reach us at here)

Objective

In order to enable and empower persons with developmental disability to live as independently and as fully as possible, health services and their access to persons with developmental disabilities assume a very significant role. In this context, the health insurance facility becomes important but presently such products are not easily available for persons with developmental disabilities. In such a situation, a health insurance scheme "Niramaya" is conceived with the following objectives.

• To provide affordable Health Insurance to persons with Autism, Cerebral Palsy, Mental Retardation & Multiple Disabilities.
• To encourage health services seeking behavior among persons with developmental disability.
• To improve the general health condition & quality of life of persons with developmental disability

Scheme & Its coverage
The scheme envisages to deliver comprehensive cover which will

• Have a single premium across age band
• Provide same coverage irrespective of the type of disability covered under the National Trust Act.
• Insurance cover up to Rs.1.0 lakh.
• All persons with developmental disabilities will be eligible and included and there will be no 'selection'.
• The scheme will be available in the entire country except J&K.

The scheme further envisages that there shall be -

• No exclusion of Pre-existing condition
• Same cover as that for other persons
• Services ranging from regular Medical Check-up to Hospitalization, Therapy to Corrective Surgery, Transportation.
• Conditions requiring repetitive medical intervention as an in-patient.
• Pre & Post hospitalization expenses, subject to limits.
• No pre-insurance medical tests.
• Reimbursement of claims in case of OPD services from any Qualified Medical Practitioner and for IPD treatment can be taken from a Hospital anywhere in the country.

 

Enrollment of Beneficiaries, (through registered organizations)
Any eligible person can apply for enrollment under the Scheme in the prescribed format given on the website and submit it to the nearest organization registered with the National Trust or to any other agencies specially entrusted in this regard by the National Trust. On successful enrollment and approval, Health ID No. / card will be issued to each beneficiary and then can print Ecard through the website.
There will be a nominal processing fee as determined from time to time which shall be payable to the National Trust.

Fresh enrollment may be done throughout the year through our registered organizations.
Both the fresh enrollment and renewal will be from the enrollment date with the Insurance Company to the end of the financial year. Any beneficiary enrolled during any month of the financial year will be covered upto 31st March. The enrollment / renewal fee will be full and will be eligible to claim upto Rs.1 lakh.

Implementation
The entire scheme may be implemented & monitored by the National Trust through registered organization (RO) with the active participation of the Local Level Committees (LLC). The registered organization (RO) shall liaise with the Insurance Company, health service providers, LLCs, State Nodal Agency Centres (SNAC) of the National Trust, State Govt. and all the stakeholders concerned for awareness generation, enrollment as well as for the speedy settlement of claims.

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Prevailing Attitudes, Practices, Misconception in the Field of Mental Retardation (Part-1)

Residential Student At Dr. AnnieBesant School enjoying in Garden

Prevailing Attitudes and Practices in the Field of Mental Retardation

Yes it is true that, many of the present attitude toward the mental retardation is due to earlier  misconceptions and negative attitude in the society. 

The Problem of Definition

Over the years, there have been many definitions of mental retardation which attempted to differentiate between the intellectually sub-average and those persons having "normal" intelligence, but most of them have been very critical and negative in nature.

Mental deficiency is a state of social incompetence obtaining at maturity or likely to obtain at maturity, resulting from developed mental arrest of constitutional origin; the condition is essentially incurable through treatment and unremediable through training except as a treatment in training instills habits which superficially or temporarily compensate for the limitations of the person so affected while under favorable circumstances and for more or less limited periods of time. (Doll, 1941).

Mental defectiveness represents a condition of mental non development, arrest, deficiency, or deterioration which is very grave and permanent, which dates from early life, and which always effects the intelligence, judgment, or understanding and the capacity for social and economic adjustment (Wallin, 1949).

A mentally defective person is a person who is incapable of managing himself and his affairs, or being taught to do so, and who requires supervision, control, and care for his own welfare and the welfare of the community (Benda, 1954).

Mental retardation refers to a condition of intellectual inadequacy which renders an individual incapable of performing at the level required for acceptable adjustment within his cultural environment (Masland, 1963). 

In addition to these general definitions, a number of terms have been used to define varying degrees of mental retardation. Such unfortunate misnomers as "idiot", "imbecile", "moron", "lowgrade", "high-grade", "custodial", "trainable", and "educable" were once, and in some cases still are, used to describe the retarded.

These terms not only set the mentally retarded apart from other members of society, but convey a picture of subhuman status, prolonged dependence, and a seriously restricted ability to develop or learn. Such images have all been employed as justifications for isolation from the community, custodial care and over-protection.

A Widely Used Definition  

A generally accepted definition of mental retardation accepted by many . This definition (Heber, 1961) states that:

"Mental retardation refers to sub-average intellectual functioning which originates during the development period and is associated with impairment in adaptive behavior."

The terms used in this definition may be explained as follows:

SUBAVERAGE GENERAL INTELLECTUAL FUNCTIONING: Falling below 97% of the population on standardized tests of global intelligence (i.e., tests which attempt to measure vocabulary, comprehension, memory, reasoning, judgment and visual-motor functions).

DEVELOPMENTAL PERIOD: From conception to about 16 years of age.

ADAPTIVE BEHAVIOR: The ability to adapt to and control one's environment, usually defined in terms of maturation, learning and social skills.  

It should be noted that the definition is based upon a dual concept of mental retardation. That is, mental retardation is defined in terms of reduced intellectual functioning which, in turn, is associated with deficits in maturation, learning and the development of social skills. Even though this definition is more general than earlier statements and does not emphasize the deficienciesand disabilities of the mentally retarded, it still does not adequately stress the learning, growth and developmental potentials that exist for mentally retarded persons.  

More will be discussed in our next post

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Developmental Disorders Series

Where to Start Seek Help

Mental Retardation

I. What is Mental Retardation? (More Details Here)

Mental retardation (MR) is a developmental problem manifested during a child’s years of development (i.e. 0-18 years old). It is a condition whereby a child’s intelligence and adaptability are significantly below the average level of his peers.

II. What causes Mental Retardation?

Genetic factors
-- Hereditary factors or chromosomal abnormalities
Pregnancy and birth factors
-- e.g. misuse of drugs or excessive alcohol intake during pregnancy, complication of birth, prematurity
Infancy and childhood
-- Infections and brain injuries, e.g. meningitis, brain trauma, etc.
Unknown factors
-- The cause in most cases is unknown

III. How does Mental Retardation affect the child?

Developmental aspects affected by MR:

• Attention
• Memory
• Language ability
• Gross and fine motor coordination
• Learning and problem-solving abilities
• Social and self-care skills
• Ability to control emotion and behavior

As the child’s abilities in the above aspects are significantly lower than children of comparable age, his/her adaptability in daily life would be affected.

• Ability to communicate
• Self-care
• Housework
• Social skills
• Working and learning
• Community life 

IV. How is Mental Retardation diagnosed?

The diagnosis of MR should be made through professional assessment by psychologists or
pediatricians.

V. What are the different grades of Mental Retardation?

According to the prevailing international classification system, MR can be classified into the
following grades according to its severity:

• Persons with “mild” to “moderate” MR face relatively fewer obstacles during their development. They can acquire general daily living and self-care skills with proper training and assistance.
• Persons with “severe” to “profound” MR require intensive training and support in various aspects to cope with basic needs in daily life

A “three-tier system” is normally used for operational classification, i.e. MR is classified into “mild”, “moderate” and “severe” (including severe and profound) grades for the provision of special educational and training services.

VI. What are the general achievements of persons with Mental Retardation? 

	Pre-school phase (0-5 years old)	School age phase (6-15 years old)	Adolescence and adulthood (16 years old or above)
Mild MR	● Overall development is slower than peers. Developmental problems may not be easily identified until the child starts primary school.	● Can master basic learning skills (e.g. writing, reading and numeracy skills) ● Can acquire proper pre-vocational skills	● Can integrate into community with assistance ● With assistance, can be employed in simple work, and lead a social life in community
Moderate MR	● Overall development is obviously slower than peers ● Can acquire basic communication skills and simple self-care abilities	● Can learn some practical skills for daily living ● Can live independently to a certain extent in familiar environment and with proper support	● Can learn to perform simple tasks in specially designed working environment
Severe / Profound MR	● Significant discrepancy in overall development when compared with peers ● Some children may also have physical disabilities ● Limited communication abilities and response to the environment	● Delayed development in motor abilities ● Can learn limited communication skills and simple self-care tasks	● Possess simple communication skills ● Can master limited basic self-care skills with special support

VII. How can parents help their child with Mental Retardation?

• Arrange early assessment for the child so as to understand and accept his/her developmental problems
• Involve in the child’s training so as to master the training methods and communicate with the instructors
• Join parent self-help groups and make good use of community resources
• Share feelings with others to relieve negative emotion and stress 

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