Selecting a health plan for kids with special needs



  • Some startups and insurance firms are now offering new health policies for children who need special care

Children with special needs such as those diagnosed with autism or Down Syndrome need special care. With increasing awareness, their requirements are being met but one area that needs urgent attention is availability of insurance. Rough estimates suggest a fixed medical treatment cost of 2-4 lakh annually that involves therapies and food supplements. Hardly any policy provides coverage in case the child gets hospitalized. However, some insurance companies and start-ups are stepping up to fill the gap.

Mom’s Belief, a mental healthcare and wellness provider, has come out with a comprehensive insurance policy—Aadvik Child Comprehensive Care Program—for children with special needs in association with Care Health Insurance, which is the underwriter of the policy.

The Aadvik policy comes with both, the in-patient department (IPD) and out-patient department (OPD) coverage. There are four options to choose from. One can have a combined (IPD+OPD) sum assured ranging between 1.5 lakh and 4 lakh for a premium in the range of 22,955 to 44,886, including GST.

Software engineer Naveen Kumar (32) from Bengaluru, who has an autistic child, Yashvi Kumar (3), faced a tough time looking for an insurance policy for his daughter. A long-time customer of Mom’s Belief, he was the second buyer of the Aadvik policy. “The policy helps me save about 20% in therapy classes. I get basic hospitalization cover for my daughter along with reimbursement for supplements and resource programs," says Kumar.


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Launched in February 2022, Mom’s Belief has sold over 200 policies in the first phase of launch, and over 500 policies in the second. “At the moment, we have close to 400 requests at various stages of closure," says Nitin Bindlish, founder & CEO, Mom’s Belief. The start-up is building capacity for at least 1,000 policies a month.

The pros and cons

In the Aadvik Child Comprehensive Care Program, the OPD cover gets activated from day one. It means parents can avail the cashless claim for the very first therapy the child undergoes after buying the policy. There will be a waiting period of 24 months for pre-existing diseases in the case of IPD claims. Another important aspect is the policy has a family floater option. The child will be the main policyholder but parents and one sibling can be added. “If you have an autistic kid at home, sometimes even parents might require counselling. Even those sessions are covered in the policy," says Bindlish.

However, there are some drawbacks. While the OPD cover gives you immediate benefit, pathology and food supplements are covered on a co-payment basis. It means parents will have to bear certain costs, depending on the tests and supplements involved. Besides, the IPD cover may not be enough and will be restricted to network hospitals under Care Health Insurance. “The Aadvik policy has many restrictions such as pre-existing diseases not being covered for 24 months and limits on hospital room rents and usage. However, it’s laudable that an insurer is offering an option to those suffering from neuro-developmental disorders. That itself is a big step forward," says Kapil Mehta, founder, SecureNow.

Other Options

Not many people are aware that the government under the National Trust Act, 1999, offers Niramaya Health Insurance to persons with disabilities. Oriental Insurance Company is the existing underwriter of the policy and Raksha Health Insurance TPA is the third-party administrator.

The claim under this policy is available on reimbursement basis for IPD, OPD, medical transportation and even health check-up requirements. The coverage limit currently is 1 lakh with defined sub-limits: 55,000 for IPD, 19,000 for OPD, 20,000 for therapies, 4,000 for alternative medicine and 2,000 for transport . The annual premium for 1 lakh coverage is quite affordable. It is 250 per person and as low as 50 for those below poverty line. Default duration is April -March every year.

Star Health Insurance has an insurance plan—Star Special Care for children aged between three years and 25 years who are diagnosed with Autism Spectrum Disorder. The policy comes with a sum insured of 3 lakh with a minimal out-patient cover. The policy also has a co-payment of 20%. It means for every claim, 20% has to be paid by the policyholder. “Under the policy, the coverage is similar to regular mediclaim health insurance policy but with a special focus on conditions that are common to children diagnosed with autism spectrum disorders like surgery for removal of tonsil / hospitalisation expenses for treatment of seizures/ treatment of fractures including those requiring surgery or botox injection," says Dr. S Prakash, managing director, Star Health and Allied Insurance.

Besides, there are networks of parents having such children who help each other with crowdfunding. “There are well-funded societies that support such parents because medical treatment is very expensive. These societies provide financial support through crowdfunding," says Shailesh Kumar, co-founder and insurance head at Insurance Samadhan.

Tax relief

So far as tax benefits are concerned, one can avail tax deduction against premium paid under section 80D of Insurance Tax Act. There is another tax benefit that parents of special children must know. Section 80DD allows tax deduction against medical expenses incurred on treatment of your child. “The tax benefit is limited to 75,000 if disability is up to 40%, and if disability is over 80% then it can go up to 1,25,000," says Kumar. “Most of the diseases being discussed fall under section 80 DD. So, parents can avail this benefit," he adds.

While the Aadvik policy is fairly comprehensive, parents should go through the benefit table in detail, including the sum insured, OPD benefits in terms of consultations etc, room eligibility in case of IPD and the waiting periods applicable, before buying the policy.

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