Genetic, mental ailments eligible for health cover under new norms of IRDAI

The Insurance Regulatory and Development Authority of India (IRDAI) has amended health insurance policy to cover genetic and mental disorders. A new norm has been added wherein the neuro-developmental disorders, mental illness problems, psychological disorders, genetic diseases, puberty-and menopause-related disorders are included. IRDAI said that, any disease contracted after taking the policy has to be mandatorily covered referring to the recent amendment.

With the increasing number of health insurance companies in the Indian marketplace, IRDAI wants the industry to practice a uniform approach while defining the exclusions in the respective insurance policies.

As per the new plan, all health covers filed and cleared after April 1, 2019, have to adhere to the guidelines issued. However, all existing health covers which are not in adherence with the new guidelines would not be offered and promoted from April 1, 2020, onwards and have to be withdrawn by March 2020.   

What can be covered under new health insurance plans?

  1. Health issues in women: The disorders related to puberty and menopause which include menopausal bleeding or flushing.
  2. Mental illness: Treatment of mental illness, stress, psychological disorders, neurodegenerative disorders.
  • The use of drugs/anti-depressants shall be a part of health insurance coverage. Failure to follow the treatment cannot be a reason for the particular company to deny the medical insurance.
  1. Use of life support machine: The use of life support machine in patient’s vegetative state (Absence of responsiveness and awareness due to overwhelming dysfunction of the brain), oral chemotherapy and robotic surgeries will be covered by insurance.

Which policies will remain unchanged?

  1. Pre-existing diseases with the maximum waiting period: Infertility treatment, diagnostic tests, weight control surgeries or plastic surgeries initiated two years before a claim is filed won’t be covered.
  2. Lifestyle diseases: Diseases like hypertension, diabetes, cardiac conditions with waiting period of more than 30 days. However these can be covered, if these diseases are pre-existing and diagnosed while buying the policy.
  3. Treatment of health issues caused during adventure sports: The treatment required to cure injuries arisen out of the participation as a professional in hazardous sports like rock climbing, mountaineering, scuba diving will not be covered.
  4. Illnesses which are permanently excluded: Treatments of epilepsy, Hepatitis B, Alzheimer’s disease, Parkinson’s disease, chronic liver and kidney diseases and HIV/AIDS would not be the part of health cover policy.

Also Read: How to Plan Finances for the Treatment of Parkinson’s Disease

No insurance policy claim can be denied after completion of eight continuous years under the policy. An exemption is the proven case of fraud.

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  1. I have been suffering from a chronic Parkinson disease since 2007 and DYSKINESIA disease since 2013 Can I get benefits for such disease ?

    • Hi Mr. Khan, as mentioned in the article, Parkinson’s Disease is still excluded from the policy benefits.


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