IRDAI has barred insurers from denying a medical cover for mental health, genetic disorders and hazardous activities. But the real issue is health covers are not available for a series of conditions
Kolkata-based artists Abhik Barman and his wife were denied medical cover by an insurer on September 25. The reason? That the couple had used an anti-depressant which had side-effects.
What the insurer did not mention to the proposed policyholders is that they, in fact, had no relevant products to cater to their needs.
Ironically, just two days later the Insurance Regulatory and Development Authority of India (IRDAI) brought out guidelines barring insurers from denying a health insurance policy for mental health procedures.
As part of its regulations on standardising exclusions in health insurance, IRDAI listed out several instances where a health cover cannot be denied.
Take mental health care for instance. The Mental Healthcare Act 2017 came into force from May 29, 2018. This Act mandates every insurer to ensure medical insurance for mental health ailments.
Law had said that this would be similar to the regular health insurance available for physical illnesses. However, the number of products available are far and few in between.
IRDAI has also gone deeper and said that even if the use of a drug, stimulants or anti-depressant impact intellectual facilities of an individual, they are entitled to get covered. However, the point to focus is how there are not enough variants of health policies to cover this procedure.
Due to a lack of adequate data, it is likely that these niche covers will cost at least 25-30 percent more than a standard health insurance policy.
Let us take another example. IRDAI has said that those with disorders of speech and language including stammering and dyslexia should also be provided health covers.
Dyslexia, for instance, does not require surgery but will require multiple sessions of counselling psychology with a trained practitioner. No retail health policy in the Indian market caters to this requirement.
The intention of the regulator is to enable a number of people to avail health insurance policies. However, what is needed is to nudge insurers to cater to the emerging needs of the customers.
Those employed in a coal mine or a construction site may have different health needs than a person in a 9-to-5 desk job. Unless there are niche products for each segment, standardisation of exclusions does not serve a real purpose.Rather than having one insurer sell five different products for cancer and heart disease, the real need is to have health plans that can help manage the different life-style conditions in a better manner. And a push from IRDAI is the only way these products will available in the Indian market.