Executive Summary:
This document is the official response from the Minister of State in the Ministry of Health and Family Welfare to questions raised in Lok Sabha regarding health insurance provisions for persons with disabilities (PwD) under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY). The response clarifies the inclusion of PwD, the extent of coverage, and enrollment processes. It also addresses the possibility of a dedicated health insurance scheme for PwD. The response was provided on August 8, 2025.
Key Points / Main Content:
Inclusion of PwD under ABPMJAY:
* ABPMJAY includes poor and vulnerable families identified in the Socio-Economic Caste Census (SECC) 2011.
* SECC 2011 considers "Disabled member and no able-bodied adult member" as a deprivation criterion for rural areas, thereby including some PwD.
* States have the flexibility to expand the beneficiary base to include similar socioeconomic profiles under ABPMJAY.
* Beneficiaries under ABPMJAY are not categorized based on disability, so specific data on PwD beneficiaries is not available.
Health Insurance Coverage Mandates:
* The Insurance Regulatory and Development Authority of India (IRDAI) has mandated all general and health insurers to offer specific covers for PwD, complying with Section 3 of The Rights of Persons with Disabilities Act, 2016.
* Insurance product design and pricing are based on insurers' board-approved underwriting policies, considering actuarial principles and parameters like age, morbidity data, and interest rates.
ABPMJAY Scheme Details:
* ABPMJAY provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization.
* It targets 12 crore economically vulnerable families, representing the bottom 40% of India's population.
* Eligible disabled individuals are entitled to healthcare services under the scheme.
Enrollment Process:
* Enrollment can be done through the Ayushman App, the web portal beneficiary.nha.gov.in, empanelled hospitals, or Common Service Centers.
* Self-registration is available on the Ayushman App.
* The national toll-free helpline 14555 assists beneficiaries with queries.
Dedicated Health Insurance Scheme:
* The response does not explicitly state the launch of a dedicated health insurance scheme for PwD, but emphasizes the existing coverage available through ABPMJAY and the IRDAI mandate.
Impact Analysis:
Beneficiaries (PwD and their Families):
* Impact: PwD belonging to eligible families as identified in the databases used under ABPMJAY are entitled to healthcare services under the scheme, and all general and health insurers are mandated to offer specific covers for PwD.
* Action Required: PwD and their families should enroll through the Ayushman App, web portal, empanelled hospitals, or Common Service Centers and utilize the toll-free helpline for assistance.
Insurance Providers:
* Impact: All general and health insurers are mandated to offer specific covers for PwD. Insurance product design and pricing are based on insurers' board-approved underwriting policies, considering actuarial principles and parameters like age, morbidity data, and interest rates.
* Action Required: Insurance providers must comply with the IRDAI mandate to offer specific covers for PwD and ensure their underwriting policies align with actuarial principles.
Government (Ministry of Health and Family Welfare):
* Impact: The government is responsible for ensuring the effective implementation of ABPMJAY and monitoring the provision of health insurance coverage for PwD.
* Action Required: Continue monitoring the scheme's impact on PwD, address any gaps in coverage, and ensure accessible enrollment processes.
Key Entities Referenced
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana ABPMJAY: A health insurance scheme providing health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization.
Persons with Disabilities Act, 2016: An act related to the rights and provisions for persons with disabilities.
Insurance Regulatory and Development Authority of India IRDAI: The regulatory body that mandated insurers to offer specific cover for Persons with Disabilities (PwD).
SocioEconomic Caste Census SECC2011: A census used to identify poor and vulnerable families for inclusion in the Ayushman Bharat scheme.
SHRI ASADUDDIN OWAISI: Member of Parliament who raised a question about health insurance for persons with disabilities.
SHRI P.C. MOHAN: Member of Parliament who raised a question about health insurance for persons with disabilities.
SHRI PRATAPRAO JADHAV: The Minister of State in the Ministry of Health and Family Welfare who provided the answer to the parliamentary question.
Common Service Centre: A location where enrollment for ABPMJAY can be done.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 3248
TOBE ANSWERED ON 08THAUGUST,2025
HEALTH INSURANCEFORPERSONS WITH DISABILITIES
3248. SHRIASADUDDINOWAISI:
SHRIPCMOHAN:
Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:
(a) whether the Government has made any provisions to extend Ayushman Bharat–Pradhan
Mantri Jan Aarogya Yojana (AB-PMJAY)benefitstopersons with disabilities inthe country;
(b) if so, the number of persons with disabilities availing health insurance under the said
scheme,disability/gender-wise andState/UT-wise;
(c) whether any guidelines have been issued by the Government to ensure universal health
insurance coverage,including private andpublic sector schemes, for persons with benchmark
disabilities, if so, the details thereof;
(d) the number of physically disabled persons currently covered under Ayushman Bharat or
otherGovernment-sponsored healthinsurance schemesinthe country, State/UT-wise;
(e) whether the Government has taken steps to simplify the enrolment process and
documentationfor PwDsunderthese schemes, if so, the detailsthereof; and
(f) whether the Government proposes to launch a dedicated health insurance scheme for
persons with disabilities to address their specific medical and rehabilitative needs, if so, the
detailsthereof?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a) to (d): Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) beneficiary
base includes poor and vulnerable families identified in the Socio-Economic Caste Census
(SECC-2011). The SECC-2011 incorporates deprivation criteria for rural areas, one of which
is “Disabled member and no able-bodied adult member”. Consequently, Persons withDisabilities (PwD) in rural areas are included under the scheme. Further, based on the
flexibility provided to States, the beneficiary base has been expanded toinclude beneficiaries
from similar socio-economic profile under AB-PMJAY. The beneficiaries under AB-PMJAY
are not categorized onthe basis of disability andhence thisinformationisnot available.
In accordance with the provisions of Persons with Disabilities Act, 2016, the Insurance
Regulatory and Development Authority of India (IRDAI) mandated all general and health
insurers to offer a specific cover for PwD in compliance with the provisions of Section 3 of
The Rights of Persons with Disabilities Act, 2016. The insurance product design and pricing
are based on board-approved underwriting policy of insurers which considers actuarial
principles in determining the price, based on parameters like age, morbidity data, interest
rates, product featuresetc.
(e) and (f): AB-PMJAY is a flagship scheme of the Government which provides health cover
of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to 12 crore
families constituting economically vulnerable bottom 40% of India’s population. All the
disabled individuals, belonging to eligible families as identified in the databases used under
the scheme, are entitled for availinghealthcareservices underthe scheme.
Under AB-PMJAY, enrollment can be done through mobile phone application (Ayushman
App), and web portal (beneficiary.nha.gov.in) or at the nearby empanelled hospital or
Common Service Centre. The feature of self-registration is also available in the above-
mentioned application. Further, National toll-free helpline (14555) assists the beneficiaries
for theirqueries.
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