Updated on - 12 Jun 2026
To prevent people from being denied treatment because of hereditary illnesses, health insurance policies have evolved to include coverage for genetic disorders. This has decreased discrimination in policy approvals and increased access to essential medical care. It boosts financial security under a standard mediclaim policy, particularly for specialised or long-term therapies. This blog discusses how genetic disorders are handled in insurance.
Can Health Insurance Claims for Genetic Disorders Be Denied?
In a landmark 2018 judgement, the Delhi High Court ruled that blanket exclusions of genetic disorders in health insurance policies are arbitrary and violate constitutional rights under Articles 14 and 21. Justice Prathiba M. Singh emphasised that access to health insurance is closely linked to the right to healthcare.
The case involved a policyholder suffering from hypertrophic obstructive cardiomyopathy whose claim was denied on the grounds of a genetic disorder. The court directed the Insurance Regulatory and Development Authority of India to review such exclusion clauses. However, the court clarified that insurers may still impose exclusions, provided they are based on reasonable, scientific, and non-arbitrary criteria rather than broad or vague classifications.
In 2019, IRDAI issued guidelines to standardise exclusions in health insurance policies, ensuring that arbitrary or broad exclusions, like those related to genetic conditions, are not unfairly applied.
Are There Any Conditions or Limitations in Health Insurance Claims for Genetic Disorders?
While insurers cannot reject claims purely on genetic grounds, coverage may still be subject to waiting periods, policy exclusions, and the type of treatment required. Some advanced or experimental treatments may not be included.
Conclusion
You can better prepare to meet future healthcare needs if you’re aware of the specifics of your policy, including its inclusions and exclusions. Carefully reviewing policy terms helps you understand the extent of coverage and maximise benefits under the best health insurance plans.
Being informed also lowers the likelihood of unanticipated claim denials and ensures more efficient claim processing.
FAQs
1. Are genetic disorders covered under all health insurance policies?
Usually, yes. That said, not all policies offer the same level of coverage. Therefore, you must review all terms and inclusions before purchasing one.
2. Is genetic testing covered by insurance in India?
Genetic testing coverage varies by policy and is only limited to tests that are deemed strictly medically necessary.
3. Can insurers increase premiums due to genetic conditions?
Premiums are generally based on overall risk factors, but genetic conditions alone cannot be used to deny coverage.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the topic featured in the article. It is advised to verify the currency and relevance of the data and information before taking any major steps. Please read the sales brochure/policy wordings carefully for detailed information about on risk factors, terms, conditions and exclusions. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.