In what you may regard as additional comprehensive health insurance policies for patients, the insurance regulator has removed about 10 items that comprises the procedures such as dental, infertility, stem cell and psychiatric treatment, from the list of “optional cover” for health insurance plans.
In a notification, IRDAI, the Insurance and Regulatory Authority of India said that in a partial amendment of strategy on standardization of health insurance business a number of items have been rubbed out from the list of “items for which optional cover may be offered by insurers”.
These include hormone replacement therapy, dental treatment that does not require hospitalization but is extensively availed of, subfertility, infertility, obesity treatment, assisted conception procedures, psychosomatic and psychiatric procedures, treatment of sexually transmitted diseases, corrective surgery for refractive error, stem cell implantation, any expense for retro virus or suffering from HIV AIDS, etc.
IRDAI has made it clear that the main purpose of taking out these covers from the optional health insurance coverage to including them in the main product is because they believe covering more procedures in health insurance will fix anomaly. The same was stated by the Industry executives that the move to comprise more medical procedures in insurance is intended at correcting an anomaly. An industry analyst and researcher commented that previously these items were optional and this is why they were not covered by most of the insurance providers in India. But now, the insurers can design their products with the inclusions of these items.
More light into this matter could soon be provided by the insurance regulator by the issuance of separate order making it compulsory for all companies to include these procedures within their medical insurance plans. Another possibility of doing so could be due to the fact that the insurance penetration in India is very low.
Only 34% of the India population or 43 crore individuals were covered under any health insurance plan in the year 2016-17, as per the National Health Profile 2018, brought together by the Central Bureau of Health Intelligence.
Regardless of the increase of private coverage, expansion in health insurance is largely driven by government-funded schemes or social insurance. The private sector coverage is, for the most part, limited to urban households. Even among those who have some health insurance coverage, 79% of them are under public insurance companies.