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Mental and Genetic Disorders Can’t Be Excluded from Health Insurance Coverage: IRDAI

The Insurance Regulatory Authority of India has asked health insurers to offer coverage to those suffering from mental and genetic disorders.

  • 24 Feb 2019
  • 2 min read

Insurers can no longer deny coverage to those suffering from mental illness and genetic disorders

In a major move that could boost health insurance penetration in India, the Insurance Regulatory and Development Authority of India (IRDAI) has said that mental illness, genetic disorders and menopause can’t be excluded from insurance coverage.

As a part of an exposure draft on standardisation of exclusions of a health insurance policy, IRDAI also said that any ailment contracted after taking the plan must be covered.

Also, health insurance plans which don’t comply with these regulations have to be withdrawn by 1st April 2020. It must be noted that by law, it’s mandatory for health insurers to offer coverage to people suffering from mental illness.

However, insurers were pretty selective in providing such covers. But now, following IRDAI’s diktat treatment of mental disorders, stress, neurodegenerative and psychological disorders will have to be covered.

Additionally, use of drugs or anti-depressants prescribed by doctors would be a part of the health insurance coverage. At the same time, failure to follow medical advice or treatment can’t be used as a clause to deny insurance.

The insurance regulator also said that in the case of artificial life maintenance, expenses incurred till the date of confirmation by the treating doctor stating that the patient is in a vegetative state would also be covered. Also, expenses incurred on robotic surgeries and oral chemotherapy will be covered.

Having said that, pre-existing diseases (with a maximum waiting period for 2 years), infertility treatment, weight control, plastic surgery and diagnostic tests will remain in the list of health insurance exclusions.

Also, the waiting period for lifestyle conditions like hypertension, cardiac conditions and diabetes is not allowed for more than a month (30 days), in case they are pre-existing at the time of purchasing a policy. It must be noted that some of the diseases including HIV/AIDS, Alzheimer’s disease, Parkinson’s disease, Hepatitis B, chronic liver and kidney disorders are permanently excluded from coverage.

*Source:Money Control

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