Photo: iStock
Photo: iStock

What health insurance rule changes mean for you

From the govt launching its flagship scheme, covering 10 crore homes, to the regulator encouraging insurers to cover treatment of HIV patients and mental illnesses, India's healthcare sector has made important strides this year

Mumbai: If you want to make a prudent financial plan, a common advice given by financial planners is that you should take adequate insurance cover and protect yourself against unforeseen circumstances before investing.

If you don’t have a health cover, the rising healthcare cost can burn a hole in your pocket and deplete years of savings. However, overall insurance penetration in the country remains low. At 3.7%, India ranked 41 in 2017 in terms of insurance penetration, with life insurance penetration at 2.76% and non-life insurance penetration at 0.94%, according to Assocham, an industry lobby.

In 2018, the government and the regulator have taken measures to improve the overall healthcare landscape. But how much has it delivered? Here is what the changes are likely to mean for insured individuals.

Government-sponsored healthcare scheme

In September 2018, the government officially launched Ayushman Bharat–pradhan Mantri Jan Aarogya Yojana (AB-PMJAY). It provides an annual health cover of 5 lakh per family to 10 crore households. This include families below the poverty line: deprived rural families and those identified as ‘occupational category’ of urban workers’ families as per the socio-economic caste census (SECC) data. However, not all states have implemented it yet. “Telangana, Delhi and Odisha have not signed the memorandum of understanding (MOU)," said Indu Bhushan, chief executive of Ayushman BHARAT-PMJAY.

“Meanwhile, Kerala and Pondicherry will start soon while Punjab is exploring tenders. Rajasthan will begin after the elections. Andhra Pradesh has to still get cabinet approval on how to integrate their scheme with Ayushman Bharat," Bhushan added.

So far around 3.75 lakh patients have been supported and more than 14,000 hospitals are on board, he said.

Cover for mental illness

The regulator in August mandated that all health insurance providers should include mental health in their policies. “This will subsequently help people in India who are silently dealing with any kind of mental illness and need immediate psychiatrist attention," said Ashish Mehrotra, managing director and chief executive officer, Max Bupa Health Insurance Co Ltd.

However, insurers have not yet implemented a cover yet. Covering mental illness has been complicated for insurers, said experts. Insurers blame it on the lack of availability to track past ailment data. Also, they can be long-term illnesses treated outside hospitals which insurers don’t usually cover.

Cover for HIV patients and genetic disorder

The Insurance Regulatory Development Authority of India (IRDAI) in October asked insurers not to deny medical cover to human immunodeficiency virus (HIV)-positive individuals. “With this, insurers will provide coverage by applying waiting periods and/or sub limits. Over time, once companies are able to gather sufficient experience, products would move towards benefits related to preventive health through combination of lifestyle changes, nutrition, medication, regular doctor visits and health checks," Mehrotra said. As far as premiums are concerned, experience from international markets and reinsurers would have to be used to decide premium rates, he said. Insurance firms will have to provide cover for genetic disorders as well.

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