TomorrowMakers

The insurance regulator has removed ten medical procedures such as dental, stem cell, infertility and psychiatric treatment from the list of ‘optional cover’ for health insurance. Read more about this.

Health insurance
In a welcome move for Indian citizens, the insurance regulator has removed ten medical procedures from the list of ‘optional cover’ for health insurance. This essentially means that cover for the said medical procedures could be included in the future products designed by insurance companies.
 
The Insurance Regulatory and Development Authority of India (IRDAI) stated that it has made a partial modification of the guidelines on standardisation of the health insurance business. According to a report in The Times of India, some deletions have been made from the list of ‘items for which optional cover may be offered by insurers’.
 
“Insurers will still have the freedom to exclude or include these procedures as per provisions of the law," said an IRDAI official.
 
This list of medical procedures includes:
  • Dental work
  • Psychiatric and psychosomatic procedures
  • Infertility
  • Sub-fertility
  • Assisted conception
  • Stem cell implantation
  • Obesity
  • Corrective surgery for refractive error
  • STDs
  • HIV and AIDS

The TOI report stated that the move to include more medical procedures under health insurance is aimed at correcting an anomaly. Currently, most products offered by insurance companies only cover treatments that require hospitalisation. Even then, they do not take care of end-to-end expenses. Most of the expenses still have to be borne by patients despite being insured.
 
According to the World Health Organisation, 70% of the total health expenditure in India was paid out of pocket. IRDAI’s new step could ease the burden borne by patients.
 
Need for more clarity
 
Industry experts feel insurance players will have to wait for more clarity from IRDAI before they can design products that cater to different segments of customers. They will also have to evaluate the cost impact of these procedures before they can roll out the new insurance products. A separate order with more details from the insurance regulator is awaited.
 
Reaching the masses
 
According to the Central Bureau of Health Intelligence, only 34% of India’s population was covered under a health insurance plan in 2016-17. This is abysmally low. Of the 34% insured, the majority are in urban areas. The TOI report said that growth in health insurance is mainly driven by government-funded schemes and social insurance, with private sector coverage lagging behind.
 
There’s a need for a massive push in adoption numbers. It’s likely that more people will now opt for insurance, thanks to dentistry and treatments for infertility and HIV being added to the cover. Educating the masses and creating awareness on the benefits of health insurance is imperative.

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