Irdai: Irdai asks insurers to design covers for mental illness, HIV

MUMBAI: The Insurance Regulatory and Development Authority of India (Irdai) has made it mandatory for non-life companies to introduce health covers that cater to persons with disabilities or mental illness, or HIV-positive persons. The regulator has provided insurance companies with a model policy, setting out the minimum scope and parameters for product design. While insurers can widen the scope of this product, they cannot narrow down the benefits.
Legislation had been introduced to ensure that people from these segments are not discriminated against, but many insurers have not introduced products that comply. While some have not explicitly excluded these segments, general exclusions regarding pre-existing conditions make it difficult for people to get coverage. “Every general and standalone health insurer who has been issued a certificate of registration to transact general and/or health insurance business shall mandatorily launch and offer their respective product immediately,” Irdai said. In the case of mental illness, section 21(4) of the Mental Health Care Act (MHCA), 2017 states that every insurer shall provide medical insurance for the treatment of mental illness on the same basis as has been available for physical illness.

In July 2018, Irdai had asked companies to comply with the law with respect to mental illness. Last year in October, following customer complaints, the regulator reiterated the need to cover mental illness. With companies still not introducing specialised products, the regulator has issued a diktat.
According to industry officials, the fact that health insurance in India is centred around hospitalisation makes it difficult to cover mental illness under the regular policy, particularly if the proposer is already suffering from it. For families that have members requiring treatment, a large part of the cost is related to therapy.
In the case of persons with disabilities, the law states that there won’t be any discrimination on the grounds of disability. The HIV Prevention & Control Act of 2017 states that no protected person will be subject to the denial of, or unfair treatment in, the provision of insurance unless supported by actuarial studies. Irdai has said that insurers must have a board-approved underwriting policy that ensures that no proposal from the mentioned categories of the population is denied for the reason of the stated disabilities and/or illnesses.
Companies will be free to determine the pricing of loans for the policy, which will be a one-year contract like all health plans.