Does Health Insurance for People with Disabilities Include Co-payment?

If you or a family member has a disability and you are looking at health insurance, understanding co-payment is essential. Yes, most health insurance policies designed for persons with disabilities (PwD) in India do include a co-payment clause, though the specifics vary depending on whether you choose a private plan or a government scheme.

What is co-payment and why does it apply?

Co-payment means you share a portion of the hospital bill with your insurer. For example, if you have a 20% co-pay and your bill is ₹50,000, you would pay ₹10,000 while the insurer pays the rest. A co-payment of 20% on all claims is mandatory when buying health insurance for disabled people through PWD-specific private plans. This clause exists because insurers view disability-related coverage as higher risk.

The good news is that some plans provide the option to waive co-pay on payment of extra premiums. So if you are willing to pay a higher annual premium, you may be able to avoid out-of-pocket costs at the time of a claim.

How government schemes differ

Government-backed schemes for persons with disabilities work differently. The Niramaya Health Insurance Scheme provides coverage up to ₹1 lakh on a reimbursement basis, with no pre-insurance medical tests required and a single premium across all age bands. This scheme, run by the National Trust, does not impose a standard co-payment like private policies do.

Various schemes such as the Niramaya Health Insurance Scheme and Ayushman Bharat PM-JAY have been launched by the Central Government. Niramaya provides affordable health insurance for PwD, offering up to ₹1 lakh coverage without pre-insurance medical tests.

Comparing your options

Key points to remember

• Health insurance for persons with disabilities covers pre-existing disabilities after a waiting period of 2 years.


• IRDAI has asked non-life insurance companies to introduce health covers that cater to persons with disabilities, mental illness, or those who are HIV positive.


• Always check the policy document for exact co-payment percentages before purchasing.

When choosing a plan, weigh the co-payment requirement against the sum insured, waiting periods, and your family's budget. If a 20% co-pay feels burdensome, explore government schemes or ask about co-pay waiver add-ons with private insurers.