IRDAI bars insurers from rejecting health claims due to genetic disorders

Till now, claims arising from genetic disorders in health insurance were rejected.

March 19, 2018 / 06:54 PM IST

Following a Delhi High Court judgement that had, in February 2018, said that excluding genetic disorders from health insurance is discriminatory, the insurance regulator today barred insurers from doing so.

“All insurance companies are directed not to include ‘genetic disorders’ as one of the exclusions in new health insurance policies issued in respect of all their existing health insurance products and also in the new products launched or filed under the provisions of guidelines on product filing in health insurance business,” said the Insurance Regulatory and Development Authority of India (IRDAI) in a statement today.

However, the regulator has not given any directions on the pricing of these products post the inclusion of genetic disorders. Insurers whom Moneycontrol spoke to said that they will have to increase the price of the products by at least 20-25 percent to include them in the coverage.

In February 2018, in a matter involving United India Insurance, the Delhi High Court said that the exclusionary clause of ‘Genetic Disorders’, in the insurance policy, is too broad, ambiguous and discriminatory, hence violative of Article 14 of the Constitution of India that deals with equality before law. The court had also directed IRDAI to re-look the exclusionary clauses in insurance contracts and ensure that insurance companies do not reject claims on the basis of exclusions relating to genetic disorders.

The regulator said that in pursuance to the directions the court, no claim in respect of any existing health insurance policy shall be rejected based on exclusions related to genetic disorder. A genetic disorder can be defined as a condition that is caused due to one or multiple abnormalities in the individual’s genomes and is existent since birth.

Some of the common genetic disorders include sickle cell anemia, schizophrenia and haemophilia as also certain forms of cancer. Currently, health insurance products exclude genetic disorders meaning if there is an insurance claim linked to these ailments, they will be rejected.
Moneycontrol News
first published: Mar 19, 2018 06:54 pm

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