Genetic diseases mental illness cannot be excluded from health insurance coverage: IRDAI

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According to the insurance regulator, any kind of genetic disorders, even illnesses cause by menopause in women and mental illnesses are some of the health issues, which can be excluded from being covered by health insurance. In an exposure draft which was meant for the standardization of such exclusions, the Insurance Regulatory and Development Authority of India or IRDAI has opined that any diseases that has was contracted after the policy was taken, had to be covered compulsorily. It had also opined that in keeping with the new regulations, all the older health insurance products that did not follow the new rules would have to be withdrawn from the market by the 1st of April, 2020. The good news for women is that any kind of puberty related disorders, or problems caused by bleeding during menopause or even flushing, will now be covered under these plans.

It should be noted that although insurance companies were always required to cover mental illnesses, they have always been very selective about it and those who needed them the most during difficult times were often left without any assistance. Thanks to IRDAI, stress and psychological disorders, as well as all kinds of neurodegenerative disorders, will have to be covered by the companies.

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In that case, among all the other aspects of treatment, now the drugs and anti- depressants prescribed by the doctor or psychologist will also be covered by the health insurance. In the same way, if a patient fails to seek medical advice or does not follow the treatment plan, he or she would be denied medical insurance on those grounds and such clauses would be added to the insurance certificate.

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It should also be noted that in the case of the artificial life support, which includes life support machines and its related equipments, the IRDAI has ruled that the expenses up to the day the doctor said the patient would be in the vegetative state, would be covered. Other cases include oral chemotherapy as well as robotic surgeries and they will be covered by insurance as well.

However, certain other illnesses would still be excluded and they mostly include pre- existing diseases like diagnostic tests, infertility treatment, optional surgeries like plastic surgeries and weight control surgeries. As required, there would be a minimum waiting period of two years in case of pre- existing diseases.

Those who are suffering from lifestyle conditions like diabetes, cardiac problems, hypertension and other lifestyle condition will not be allowed a waiting period of more than 30 days, except if these problems were already pre- existing and had been disclosed during the time of buying the policy. On the other hand, those who are involved in hazardous sports like rock climbing, scuba diving, mountaineering or are in professions which are really hazardous, will not get the benefit of being covered by health insurance.

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Moreover, IRDAI has selected a set of diseases that will be from now on permanently excluded from any coverage and these include illnesses like HIV AIDS, Hepatitis B, Epilepsy, Parkinson’s Disease, liver and kidney disease and others. It has been ordained that after completing eight consecutive years under a policy, no claim can be contested, except where a case of fraud has been proven.

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Shailesh Kumar

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