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Health Insurance Companies to Finally Cover Mental Illness Now, HIV/AIDS Still Not Covered

Updated On Jan 31, 2020

Health insurance companies will bring some relief to the patients suffering from some mental illness, speech disorder or drug-related issue, as well as those in the necessity of artificial life support. As per the recent guidelines by IRDAI (Insurance Regulatory and Development Authority of India), many other issues in addition to these, cannot be added in the list of exclusions in health insurance contracts.  

But the patients of epilepsy, heart disease, HIV/AIDS, and several other specified ailments are to be permanently excluded from the list of coverage benefits. 

After years of decisions being taken on random choice, the insurance regulator, IRDAI has made an attempt at standardisation in insurance contracts across various health insurance companies that claim to offer cover for some specific diseases and not the rest. The new set of guidelines help in standardisation of conditions pertaining to exclusions in the insurance contracts.   

The new set of guidelines state various health issues which the insurers cannot exclude from the offering, and includes the standard language that must be used in case of mentioning any exclusion. The regulatory authority has also stated in the new guidelines some pre-existing diseases that insurers can exclude, and some modern medical treatments, cover for which must be offered. 

Coverage for the following can no longer be excluded by the insurers- 

  • Treatment of stress, mental illness, psychological disorders, or neurodegenerative disorders
  • Treatment for language or speech disorders including dyslexia, stammering, or other neurodevelopmental or behavioural disorder (inclusive of adults)
  • Treatment required if a patent fails to go by the medical advice  
  • Injuries pertaining to any hazardous activity including sports, etc.
  • Treatment for an individual’s intellect damaged because of drug intake, stimulants, depressants prescribed by the doctor
  • Artificial life support even if the treatment won’t result in the recovery of the patient to her previous state of health 
  • Treatment of puberty or menopause-related issues for women
  • Treatments of age-related macular degeneration 

Some of the diseases that are ‘permanently excluded’ from the health insurance contracts are-

  • Epilepsy
  • Hepatitis B
  • Parkinson’s disease
  • Hearing loss
  • Heart ailment, valvular heart disease, congenital heart disease 
  • Chronic liver and kidney disease, inflammatory bowel disease, and pancreatic disease

As per the guidelines issued by IRDAI, all the health insurance plans filed on or after 1st October 2019 must offer cover for mental illness. The existing policies, however, must include it from 1st October 2019. But as the Mental Healthcare Act was passed and enforced in 2017 and 2018 respectively, so the implementation of this act in health insurance products has been delayed by IRDAI by minimum 3 years.   

Also, Parliament passed HIV/AIDS Prevention and Control Act in 2017 under Section 3, which stated that “no person shall discriminate against the protected person on any ground including the denial of, or unfair treatment in the provision of insurance unless supported by actuarial studies”. The Act made it very clear that no patient with HIV/AIDS can be denied insurance coverage. 

IRDAI shares that insurers are bound by this section of the act. In case they have actuarial studies that support the denial of health insurance to people suffering from HIV/AIDS, then they can exclude the coverage features in their policies. 

So in short, it is all in the hands of health insurance companies to decide whether to allow or deny health insurance coverage to HIV/AIDS patients. Currently, Star Health’s Net Plus Insurance Policy solves the purpose for such patients. The plan is exclusively designed to offer cover to HIV/AIDS patients. People interested can connect with Insurancedekho to purchase it at the best price.

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