Despite his chronic condition and ongoing health vulnerabilities, Mahoto has never been able to purchase health insurance. The primary barrier is affordability; the premiums for health insurance policies remain out of reach. When he attempted to register for an Ayushman Bharat card at a local Common Service Centre, he hoped it might finally offer him some financial protection. Instead, he was told he was ineligible because his name did not appear in the Socio-Economic Caste Census (SECC) list of 2011. His name had also been removed from the Below Poverty Line (BPL) card, while only his wife’s name remained. With three daughters, two sons, and his own medical needs rising, Mahoto continues to live in Uttar Pradesh without any safety net, constantly balancing health costs with the daily costs of survival.

Mahoto’s experience is one of countless stories across India that reveal a consistent pattern of exclusion. A new report released this week by the National Centre for Promotion of Employment for Disabled People (NCPEDP), titled “Inclusive Health Coverage for All,” confirms this reality. The White Paper highlights how India’s 16 crore persons with disabilities remain largely locked out of both public and private health insurance systems, even as rising medical expenses continue to push millions into poverty each year.

India’s insurance landscape is already complex for the average citizen, marked by dense paperwork, confusing procedures, and limited awareness. For persons with disabilities, these challenges multiply several times over. While disability is often included in group insurance policies offered by employers, individuals seeking insurance independently face restricted options shaped by inadequate sensitisation within the sector, structural biases, and the routine exclusion of disability from policy design.

Private insurance premiums remain prohibitively high for many, effectively placing essential coverage out of reach. At the same time, flagship public schemes such as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) do not explicitly recognise disability as an eligibility criterion. As a result, a large portion of India’s disabled population remains excluded, without meaningful financial protection against health emergencies.

Why do persons with disabilities remain excluded from health insurance? 

The NCPEDP white paper draws on a nationwide survey of more than 5,000 persons with disabilities from 34 states and Union Territories. Its findings reveal a stark, systemic failure: over 80 per cent of persons with disabilities in India have no health insurance at all. Even among those who apply, more than half—53 per cent—are rejected, often without clear reasoning or transparent communication.

The rejection rates were particularly high for individuals with autism, psychosocial disabilities, intellectual disabilities, and blood disorders such as thalassemia. Many were denied coverage due to pre-existing conditions, despite legal protections under the Rights of Persons with Disabilities Act (2016) and directives issued by the Insurance Regulatory and Development Authority of India (IRDAI). These denials, the report notes, represent more than administrative oversight; they reflect systemic discrimination.

“These exclusions are not accidental. They are embedded in the design of the system itself. This is not just a policy gap, it is a violation of rights,” said Arman Ali, Executive Director at NCPEDP.

The report highlights an important contrast. Earlier this year, the government expanded PM-JAY coverage to include all citizens aged 70 and above, acknowledging their heightened vulnerability and need for medical care. Yet millions of persons with disabilities, who often experience equal or greater health risks, continue to remain outside the scheme’s eligibility criteria.

What happens when persons with disabilities are denied health insurance? 

Financial vulnerability remains one of the most devastating consequences of this exclusion. One study cited in the report found that nearly one-fifth of a household’s monthly expenditure went toward disability-related needs. Medical expenses routinely push families into catastrophic spending, with more than 57 per cent of households sliding into severe financial distress. Some families that were originally above the poverty line fell below it solely due to treatment costs.

Beyond affordability, a lack of awareness continues to be a major barrier. Only 59 per cent of respondents were aware of Ayushman Bharat, while 41 per cent had never heard of India’s flagship health insurance program. The report attributes this information gap to inaccessible public messaging, weak implementation by states, and an absence of disability-focused outreach.

“Ayushman Bharat packages need to expand their scope from only treating to also caring. It primarily covers hospitalisation and serious illnesses to protect households, whether or not they include persons below the poverty line, from catastrophic health expenditure. Ayushman Bharat supports persons with disabilities, but it does not cover the full spectrum of health-related expenditures they face. While universal health coverage does not mean free health services for everyone, it must ensure equal access to quality and affordable healthcare. Persons with disabilities definitely face higher out-of-pocket health expenditure and are as vulnerable as senior citizens above the age of 70,” said Dr Indu Bhushan, former CEO of the national health insurance scheme.

In states such as West Bengal, where Ayushman Bharat is not implemented, persons with disabilities reported repeated rejections by private insurers. This occurred even when insurers advertised disability-inclusive policies on their websites, in line with IRDAI’s 2023 mandate. Several respondents said agents told them such policies “did not exist,” reflecting a disconnect between policy announcements and ground-level implementation.

Digital inaccessibility further prevents many persons with disabilities from enrolling in insurance schemes or filing claims. Insurance portals and mobile platforms often fail to meet accessibility standards, shutting out those with visual, hearing, or cognitive disabilities from essential services.

Recommendations from the report  

In response to these structural gaps, the NCPEDP white paper lays out a comprehensive roadmap aimed at building a rights-based, inclusive health insurance ecosystem for persons with disabilities. The white paper emphasises that, “The Government of India must include persons with disabilities (as recognised under the Rights of Persons with Disabilities Act 2016), in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) without any income and age criteria.” Universal coverage for persons with disabilities would acknowledge their higher healthcare needs and ensure that vulnerable groups are no longer excluded from essential services.

Accessibility lies at the heart of the report’s recommendations. It calls for all public and private healthcare facilities to comply with the Harmonised Guidelines 2021 and internationally recognised digital accessibility standards. This includes making hospital infrastructure, insurance forms, online platforms, and communication systems fully accessible to persons with diverse disabilities. The report recommends revising insurance application formats in collaboration with IRDAI, the National Health Authority, and disability experts to ensure that forms and procedures do not exclude any disability type.

The white paper also underscores the need for widespread sensitisation and capacity building. It recommends mandatory training for insurance agents, healthcare providers, and service personnel to ensure they understand disability-specific needs and provide respectful, inclusive support. This should be accompanied by targeted outreach campaigns to educate persons with disabilities about available insurance options and their rights within the healthcare system.

A key component of the recommendations concerns equity in pricing and policy design. The report calls for IRDAI to standardise premiums for disability-specific insurance products and to require insurers to justify low coverage caps using real data on healthcare costs for persons with disabilities. This would help prevent arbitrary pricing practices that currently make insurance unaffordable.

Regulation and accountability form another crucial pillar. The report recommends periodic accessibility audits of healthcare infrastructure, stronger IRDAI monitoring of private insurance companies, and regulatory penalties for insurers who fail to comply with guidelines. It further recommends that IRDAI include disability-disaggregated data in its annual reports, covering enrolment, claim approval, and grievance resolution rates. The creation of a dedicated Committee on Disability Inclusion within IRDAI would help ensure long-term oversight and continued responsiveness to the needs of persons with disabilities.

“We have made it mandatory for all our schemes to be integrated with the UDID system. At ALIMCO, we are working extensively to produce quality assistive products. While we have not yet reached very high-end technology, we are progressing steadily. With IRDAI’s role and the involvement of the Department of Empowerment of Persons with Disabilities (DEPwD), strong convergence is essential moving forward,” said Manmeet Kaur Nanda, Additional Secretary at the Department of Empowerment of Persons with Disabilities.

Also insurance: Senior citizens 70 and older to get up to Rs 5 lakh in free health insurance coverage