Health Insurance

Health Insurance Coverage Cannot Exclude Genetic Disease & Mental Illness: IRDAI

Health Insurance Coverage Cannot Exclude Genetic Disease & Mental Illness: IRDAI Health insurance is an insurance policy that aids in meeting the medical expenses of an individual in the for the…

Health Insurance Coverage Cannot Exclude Genetic Disease & Mental Illness: IRDAI

Health insurance is an insurance policy that aids in meeting the medical expenses of an individual in the for the treatment reimbursements when he or she is being hospitalized. In today’s time, when human lifestyles consist of sedentary jobs, junk foods, addiction to smart devices, polluted environments, etc. the chances and risks of serious illness and health concerns are considerably increasing. Moreover, the healthcare expenses are also rapidly rising, which puts a heavy financial burden on people belonging to the low-income category. Due to these reasons, it has become highly essential to buy health insurance policies to meet the medical expenses at the time of such an emergency.

What Does Health Insurance Cover?

health insurance in India includes coverage for all the pre and post hospitalization expenses of the insured, occurred during hospitalization and daycare procedure. To ascertain the type of illness covered by a health insurance, one must properly read the plan he/she is buying. The type of illness will differ from plan to plan. There are certain critical illness plans that cover expenses for diagnosis of certain critical illnesses including surgery expenses.

What Does Health Insurance Does Not Cover?

Before buying any health insurance plans, it is always advised to carefully go through the policy document. The policy documents jot down all the diseases and expenses that are not been covered. Though the exclusions will depend upon the plan you are purchasing. However, there are certain diseases, which seldom find a place in health insurance plans in India. They do not cover genetic diseases and mental illness.

The rules and regulations regarding health insurance coverage have been quite ambiguous in India. There was no standard principle in place regarding the illness that would be included in the insurance and the exclusions. This is why most of the insurance companies exclude serious mental illnesses and genetic diseases from their health policies, as their treatments are quite costly.

In order to standardize the provisions related to the exclusions, the Insurance Regulatory and Development Authority of India (IRDAI) in 2018 formed a working group which was entrusted with the task to look into this matter for preparing proposals to include mental problems, genetic diseases, psychological and neurodevelopmental disorders in health policies. The working group drafted different proposals to include such diseases in health insurance plans and submitted their recommendations to the IRDAI. On the recommendations of the above working group, the IRDAI issued a set of rules to bar all insurance providers from excluding these critical diseases in health policies.

Implications and Applicability of These New Rules

The new rules will be applicable on all General and Health Insurers offering indemnity based health insurance (excluding PA and Domestic/Overseas Travel) policies offering hospitalization, domiciliary hospitalization, and day care treatment.

Also, all insurance providers were instructed to withdraw all existing health insurance products by April 2020 that do not comply with these new rules.

Which Diseases/Expenses Will Be Covered?

Mental illness will also cover stress, psychological disorders, and neurodegenerative disorders. It will also cover the expenses for the use of drugs/anti-depressants that are prescribed by a medical practitioner. Genetic disorders will include Internal congenital diseases. Insurance providers could not deny insurance on the ground that the individual failed to follow medical advice or treatment.

What Are The Advantages of Such A Step?

This step by IRDAI will prove to be very advantageous to the public at large. India is a country with a high birth rate that is why a huge percentage of people suffer from genetic disorders, some of which are life-threatening. Also, in an environment filled with stress and tensions, mental illnesses cases are constantly on the rise. In fact, on Mental Health Day 2018, Indian topped the list of most depressed nations. Every year, news of suicide cases in the country will do the rounds on social media and other media. With an increased number of people suffering from various mental illnesses, it was about time that insurance providers provide for such coverage as the cost of treatment for such diseases very high and mostly unaffordable for middle-class people. With such a useful measure, we can expect people suffering from such diseases to get access to the required treatments.

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