When restricting access to health products on the basis of pre-existing medial conditions, insurance providers across India have until now been able to set their own criteria.
But the Insurance Regulatory and Development Authority of India (IRDAI) has published a set of draft guidelines to force industry standardisation.
The draft provisions would regulate the criteria insurers use to deny health cover to people with specific illnesses.
The guidelines will come into effect from 1 April 2020.
Excluded medical conditions
According to the IRDAI, insurers will have the right to exclude people from health cover who are affected by:
- Cancerous tumour
- Epilepsy
- Congenital heart disease
- Chronic liver and kidney diseases
- Pancreatic diseases
- Hepatitis B
- Alzheimer’s and Parkinson’s diseases
- HIV and AIDS
- Hearing loss
- Physical disabilities
Exclusion doesn’t mean no cover
The watchdog added, however, that people could only be denied if they had a pre-existing condition when applying.
People will still be able to buy health cover, but they would not be insured for the conditions mentioned above.
“No person shall discriminate against the protected person on any ground including the denial of, or unfair treatment in, the provision of insurance unless supported by actuarial studies,” the regulator said in the draft document.
“While complying with the provisions of the HIV and AIDS (Prevention and Control) Act 2017, insurers shall be bound by these provisions, where the studies support the denial of the health insurance coverage.
“The approach of allowing to incorporate HIV/AIDS as the permanent exclusion at the time of underwriting, may be considered by the insurers in order to enable these sections of policyholders to get the health insurance coverage for conditions other than the conditions referred above.
“The policyholders shall be entitled to costs of treatment in respect of any other treatments, other than, the treatment directly attributable to [the conditions] referred above, subject to terms and conditions of the policy contract.”
