Updated on 1 Dec 2025
Autism, or Autism Spectrum Disorder (ASD), covers a wide range of conditions affecting social skills, speech, behaviour and communication. Some children with autism need help every day, while others might need only a little support or even live on their own.
Autism has no known cure yet. However, there are lots of therapies and treatments that can help reduce symptoms and make life better for those with autism. The government offers a individual health insurance scheme called ‘Niramaya’, which offers a sum assured of up to ₹1 lakh for the treatment and care of children with developmental disabilities like autism, cerebral palsy and so on.The scheme covers outpatient treatments including those for pre-existing ailments, and expenses for corrective surgeries and non-surgical hospitalisation. However, the question arises is whether the amount this scheme offers is actually enough.
Currently, there are very few policies in the health insurance market that cover autism-related expenses.
Benefits of getting insurance for autistic kids
A health insurance policy for children with autism provides definite health coverage. The benefits of some of the plans include:
- The policyholder can claim for daycare procedures.
- If covered under outpatient care, the insured receives compensation for occupational, speech, behavioural and physical therapies.
- Hospitalisation costs up to a specific amount (according to the policy terms) per day are covered. This includes boarding fees, nursing charges, room rent and more.
- Some plans include costs for medical services such as seizures, botox injections, tonsillectomy, physiotherapy, speech therapy and similar treatments.
- Some plans also offer teleconsultations and lifetime renewability.
Limitations of basic health insurance options for autistic kids
There are certain limitations to the health insurance policy coverage for autistic kids. SOme of the common exclusions include:
- Expenses from gender change, plastic surgery, skincare procedures and similar treatments.
- Minor charges such as hospital registration and phone usage.
- Alternative practices like naturopathy.
- Unless pre-approved, high-cost treatments such as stem cell therapy, immunotherapy, bone marrow transplant and psychological therapy are not available.
- Some therapies may be included only with a doctor’s permission. For example, stem cell therapy.
Need for customised autism health cover in insurance.
Special autism insurance is important for three main reasons. First, the number of children diagnosed with autism is increasing, making ASD the second most common serious developmental disability after intellectual disability. Second, autism treatments are complex and expensive. ASD affects a child’s development, including his/her speech, gestural, non-verbal and social interaction with his/her peers. So, it’s not just paediatrics that needs to be taken care of with ASD; therapy for all the above also becomes necessary. Third, families of children with autism frequently face difficulties accessing quality services and report less satisfaction compared to families of children with other health issues. For these reasons, autism care demands multi-disciplinary treatment along with improved financial support through specialised insurance.
Health insurance coverage required for autistic kids
An autistic child would require multi-disciplinary treatment. So, along with regular visits to a paediatrician, they would need assistance and care from a psychiatrist, a counsellor, a special educator, a speech therapist and an occupational therapist. Consulting all of these people is quite expensive, and can lead to the annual cost of treatment being as high as ₹2-3 lakh.
Moreover, children with ASD are accident-prone, and the treatment and care for these accidents further add to the cost of treatment. Therefore, one would require a coverage of a minimum ₹4-5 lakh to cover the complete cost of treatment for autism.
Conclusion
Proper insurance for children with autism can ease the financial burden for families. While government schemes offer some support, a customised health insurance policy with higher coverage limits helps reduce out-of-pocket expenses for therapies, hospitalisation and other treatments. As awareness about autism and its costs grows, more insurance companies are expected to introduce better policies tailored to the needs of autistic children.
Early planning and the right insurance cover can provide peace of mind and ensure continuous support for the child’s well-being. To learn more about suitable insurance options and find the best plan for your child, fill out the form on this page now and get personalised assistance.
FAQ
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Does typical health insurance cover treatments like speech or occupational therapy for autistic children?
Some basic health insurance plans cover therapies such as speech, occupational and behavioural therapy only partially and some not at all. Special add-ons or customised plans may be needed to adequately cover these expenses.
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How much insurance coverage is recommended for a child with autism?
Given the cost of multi-disciplinary treatment, experts recommend insurance coverage of at least ₹4-5 lakh annually.
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