Indian health insurance companies typically hesitate to cover diseases beyond the traditional list without IRDAI intervention due to life’s uncertainties and rising healthcare costs.
After mandating the insurers to pay for Covid treatments, the insurance regulator is now compelling them to pay for various contemporary treatments as well.
New regulations for health insurance policies were released by the Insurance Regulatory and Development Authority of India (IRDAI) in June 2020. These regulations compelled insurers to standardize key policy provisions, especially exclusions, for better customer understanding.
Current Conventional Health Insurance Plans In India Now Cover The Following Medical Conditions:*
- Psychiatric Conditions
The following conditions are recognised as mental illnesses under mental health insurance:
- Chronic Depression
- OCD, Or Obsessive-Compulsive Disorder
- Anxiety Conditions
- Bipolar Illness
- Trauma-Related Stress Disorder
- Psychotic Illness
- Hyperactivity Or Attention Deficit Disorder
- Mood Disturbance
It wasn’t until about 2020 that insurers filed products that covered treatments for mental disease, even though the 2017 Mental Healthcare Act was designed to cover mental illness. Health insurance, however, is truly hospitalisation insurance; as a result, claims are only paid out if you are hospitalised and not for medical visits or other non-hospitalized expenses.
- Correction Of Refractive Errors
Refractive or laser eye surgery (LASIK) is often not covered by health insurance companies. The fact that LASIK is used to cure myopia, astigmatism, and hyperopia made it a cosmetic operation that was not covered by insurance. However, other businesses offered to pay if certain requirements were satisfied. IRDAI officially mandated that LASIK should be covered by cashless treatment health insurance policies if the lens power exceeds 7.5.
- Functional Endoscopic Sinus Surgery
Sinusitis is treated by functional endoscopic sinus surgery or FESS. Most insurers cover this as a same-day nursery procedure if deemed medically necessary by an ENT. When non-invasive measures have been exhausted, and the issue persists, ENTs approve the surgery. To confirm that the surgery is medically essential, insurers will also seek scans revealing sinusitis that were performed before the surgery’s approval.
Cochlear Implant Surgery & Treatment*
Internal congenital ailments are covered by health insurance coverage. However, cochlear implant surgery is typically excluded because it is considered a treatment for an exterior congenital disease.
However, certain group health insurance plans (health insurance purchased by an existing group, such as the employees of a company), with some sub-limits, cover surgery. However, this can change. In most circumstances, the cost of the implant itself is also excluded. ^
^ Claims are subject to terms and conditions set forth under general health insurance policy .
*Standard T&C Apply
# Visit the official website of IRDAI for further details.
Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.