Caring for a person with mental illness is not just physically and emotionally taxing for the caregiver, but can also create a dent in their finances. A family caregiver who is employed has to find a balance between their responsibilities of caregiving and meeting their professional goals. If the person with illness is bedridden or needs constant care and attention, the caregiver has to attend to the person before and after working hours. This may force them to take additional leave from work to attend to caregiving, and in some cases, give up their profession and devote their entire time to caregiving.
Caregivers often worry about the cost of medical care and the impact this will have on their future. The biggest worries about money that the caregiver faces are:
Rise in the cost of treatment and medication
Drop in earning capacity, in the case of aged caregivers who have retired from work
Increased financial burden, if the person with illness was the earning member in the family, and is unemployed due to their illness
Unemployment or frequent long breaks from work that a caregiver needs to take
Financial help is available
Most commonly, caregivers seek to manage their financial expenses by:
Applying for pensions
Dipping into retirement funds such as Employee's Provident Fund (EPF)
Investing in mutual funds, fixed deposits and other savings
Borrowing from family and friends
Taking personal loans
This apart, if the caregiver is suffering from any physical illness themselves, caregiving can become tiresome and potentially harmful, as they tend to ignore their own health while caring for their loved one. It can be quite stressful for a caregiver to manage the finances while taking care of the person with illness. This is why it is important to know that help is available.
There are several schemes available for people with mental illness, which help in:
Bearing the cost of treatment
Provision of livelihood in the form of self-employment to those who have recovered
Rehabilitation facilities for persons with mental illness
Provision of treatment and medication
Under the District Mental Health Program (DMHP), it is mandatory for district hospitals to provide free treatment and psychotropic medication for persons with mental illness.
Who is eligible: Persons or families with a BPL card, but concessions may be awarded to other people also.
What is health insurance?
Health insurance is an insurance product that covers the medical and surgical expenses of the person who is insured. It either reimburses the expenses that were incurred due to any illness or injury or makes a payment directly to the hospital or clinic where the person has undergone treatment. For this, the person has to pay an annual sum or amount called premium. Health insurance is usually taken for future health emergencies that may or may not arise.
Do I need health insurance at all?
Medical costs are rising every year. And if a person has not saved enough money for emergencies, arranging for funds at the eleventh hour can be daunting. Health insurance helps the person to be prepared for a medical emergency that may crop up in the future, for instance, during old age.
What does health insurance cover?
Each healthcare policy has different terms and conditions. Usually, the premium covers medical costs of hospitalization, surgery and any other major medical intervention that the person may incur in the future.
If the company pays the hospital or clinic directly, it's called a cashless transaction. Alternately, the caregiver can make the payment at the hospital, and then submit bills and prescriptions to the insurance company for reimbursement.
What is not covered under health insurance?
Each health insurance lists the illnesses and surgical procedures that are covered under its terms and conditions.
There are some costs that are not covered by them, which include, but are not restricted to:
Plastic surgery procedures and dermatological procedures that improve the external appearance of a person
Expensive meals or stay for the patient or their family members
Miscellaneous charges such as needles, syringes, etc
How much is the premium?
The policy premium depends on the type of policy, life cover, the person's age and medical condition. The premium has to be paid until the policy term lasts, and renewed either annually or once in two years, depending on the policy's terms and conditions.
If the person with insurance cover forgets to pay the premium and/or if the insurance policy lapses, they will not get previous premium payments back. Moreover, the payments of premium do not mean that the person should use their insurance cover every year or that they should exhaust every rupee from it. Insurance policies are designed for potential medical conditions that may arise in the future.
Insurance coverage: Rs 1 lakh per annum
Who is it for: Persons with autism, cerebral palsy, mental retardation and multiple disabilities, with a valid disability certificate
Who is the authority: Ministry of Social Justice and Empowerment, under the National Trust Act, 1999
What does the health insurance cover for the year?
This scheme covers a range of medical treatments such as:
Corrective surgeries for existing disabilities – upto Rs 40,000
Hospitalization (non-surgical) – upto Rs 15,000
Surgery to prevent further aggravation of the illness – upto Rs 10,000
OPD treatments, including medication, pathology, diagnostic tests – upto Rs 8,000
Regular medical checkup for disabled but without an illness – upto Rs 4,000
Preventive dentistry – upto Rs 2,500
Ongoing therapies to reduce impact of disability – upto Rs 10,000
Alternate medicines – upto Rs 4000
Transportation charges – upto Rs 1000
How to enroll for this scheme?
The enrolment takes place throughout the year. Visit a registered organization near you which will help you with the application procedure. Select organizations under the National Trust Act have enrolment authority for Niramaya scheme. You can find your nearest registered organization here.
Along with the online enrolment form, a nominal processing fee will be charged. Make sure you mention your mobile number on the enrolment form as you will receive your claim ID and other claim related details on it. You also need to submit copies of:
Disability certificate issued by the district hospital or an appropriate government medical authority
One address proof – ration card, driving license, Aadhaar card, bank passbook or voter ID
BPL certificate (if applicable)
Income certificate, if family income is upto Rs 15,000 per month
One passport size photo of person with disability
The enrolment and renewal of the scheme is for one year, from the enrolment date to the end of the financial year (March 31). The renewal fee has to be paid from the beneficiary account to the bank account of National Trust by NEFT.
Bank (any branch)
'The National Trust', A/c no- 915010051091556
For BPL/Income below Rs 15,000 per month – Rs 250
Income above 15,000 per month – Rs 500
BPL- Rs 50
Non-BPL- Rs 250
It is important that the person with disability has a bank account on their name for enrolment, renewals and other transactions.
If the person is a minor, the bank account should be a joint account with a parent or legal guardian, until the person is a major and married.
If the person is above 18 years of age and married, the account should be a joint account with the spouse.
How does one claim the reimbursement?
Visit the registered office for claim forms. The claim form should be submitted within 30 days along with doctor's prescription, test reports, medical bills, hospitalization report and discharge card, in original, to the nearest Third Party Administrator's office, which is available on the Niramaya card.
Along with the claim form, the following documents should be submitted:
Copy of Niramaya card
Attested copy of disability certificate by the doctor
All the original prescriptions given by the doctor
All original, self-attested bills of hospital/medical/doctor fee/therapy fee/conveyance
Reports in original
Complete bank details of beneficiary – Account no, bank name, branch, IFSC code, name of the account holder
What if I forget to renew?
You can still renew the scheme but you wont be able to claim insurance until the renewal process is complete. The renewal of the policy can take up to 30 days. The claims should be settled by the insured on or before the last date of renewal, which is March 31.
Insurance coverage: Rs 2 lakh per annum for persons with disability and family (spouse and two children)
Who is it for: Persons with mental retardation and mental disability with a valid disability certificate. People with multiple disabilities, cerebral palsy and autism are not covered in this scheme.
Who is the authority: The New India Assurance Company Limited and Ministry of Social Justice and Empowerment.
What is the enrolment procedure?
New India Assurance conducts enrolment camps for Swavlamban scheme at various places in the state. It is conducted on every third Saturday at NIMHANS, Bangalore. You can contact the hospital authorities for more information.
The applicant has to fill in the proposal form along with submitting the following documents:
Two passport size photographs of all the family members to be covered under the policy
Proposal form with a premium of Rs 355 per person or per family per year
Valid disability certificate
A copy of any one of the valid ID cards – Voter ID, Aadhaar card, driving license
Bank details of proposer, i.e. account number, bank name, IFSC code, etc with copy of a cancelled check if available.
What does the health insurance cover?
In the event that the person with an illness is a minor, the legal guardian is also covered under the scheme
For persons with mental retardation and mental illness, OPD cover is Rs. 3,000 per annum.
Corrective surgery for existing impairment can be done with consent of insurer/TPA.
Pre- and post-hospitalization costs included, but subject to limits
How to claim reimbursement
Swavlamban provides for cashless facility in the network hospitals where the person with disability can get treatment. The list of network hospitals is provided at the time of registration for the scheme. For emergency hospitalization or hospitalization at a non-network hospital, the TPA will reimburse for the treatment after a thorough scrutiny of prescriptions, reports and bills submitted by the insurer.
Star health insurance for autism
Star Health and Allied Insurance has launched a group insurance policy for children with autism spectrum disorder. Organizations or schools working with children with autism can avail this group insurance. The policy covers in-patient treatment of medical and surgical complications associated with autism, such as seizures, soft tissue and bone injuries, medical and surgical procedures for muscle spasms and for all infectious diseases.
Who can apply: Children with autism; includes pre-existing disease diagnosis. No income cap
Amount of support provided: Rs 1 lakh per child in the group
Whom to approach: Office of Star Health and Allied Insurance in your town or city
Assistance for stay/shelter
They are special homes set up by Government of Karnataka to care of persons with mental illness. As part of the pilot project, the state government proposed Manasa Kendras in five districts: Bangalore, Belgaum, Bellary, Raichur and Shimoga. As on March 30, 2016, the Bangalore centre is up and running.
Who can apply: BPL families of persons with any mental illness
Amount of financial help: The centers provide free food and shelter for persons with illness. There are long-term and short-term rehabilitation centers available at the kendras.
Whom to approach: Contact the district disability welfare officer of your respective district to know about the nearest kendra.
Also, as per the law, the district collector is mandated to attend to the needs and issues of persons with disabilities for half a day every month. As a caregiver, you can use the opportunity by contacting other caregivers that you know, and approach the collector with your issues.
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