Genetic disorders need umbrella under insurance policies

Context:

• In a ruling that will benefit hapless claimants, Delhi high court recently said that companies cannot deny health insurance to those suffering from genetic disorders.

What is genetic disorder?

• A genetic disorderis a genetic problem caused by one or more abnormalities in the genome, especially a condition that is present from birth.
• Most genetic disorders are quite rare and affect one person in every several thousands or millions.
• Genetic disorders may be hereditary, passed down from the parents’ genes.
• In other genetic disorders, defects may be caused by new mutations or changes to the DNA.
• In such cases, the defect will only be passed down if it occurs in the germ line.

Present status of genetic disorder in India:

• India is a country with many communities where there is high load of genetic disorders.
• In some community the load of genetic disorder is relatively high due to consanguineous marriage practiced in the community.
• Common genetic disorders in Indian population are chromosomal disorders such as Down Syndrome, Thalassaemia, Hemophilia and Duchenne muscular dystrophy.
• Genetic and congenital abnormality is the second most common cause of infant and childhood mortality and occurs with a prevalence of 25- 60 per 1000 births.
• The higher prevalence of genetic diseases in a particular community may, however, be due to some social or cultural factors. Such factors include tradition of consanguineous marriage, which results in a higher rate of auto-somal recessive conditions including congenital malformations, stillbirths, or mental retardation.

Court’s ruling:

• The ill-defined and “all-encompassing” clause about genetic disorders that health insurers regularly cite to deny mediclaim is unconstitutional and arbitrary, Delhi High Court ruled.
• The verdict came on an insurance claim by one Jai Prakash Tayal against United India Insurance Company Limited. Tayal, who was suffering from hypertrophic obstructive cardiomyopathy, was suddenly denied his insurance claim on the ground that the said condition was genetic, and genetic diseases were not payable as per the policy.
• The verdict could open up a large number of ailments as claimable under medical insurance.
• The court directed the Insurance Regulatory Development Authority of India to re-look at the exclusionary clauses in insurance contracts and ensure that insurance companies do not reject claims on the basis of exclusions relating to genetic disorders.
• The court highlighted that there are different types of genetic disorders and even common diseases like diabetes and cardiac diseases could be included in the broad definition.

Significance of this verdict:

• The verdict could open up a large number of ailments as claimable under medical insurance.
• A person suffering from a genetic disorder will be given medical insurance.
• It will ensure right to avail health insurance, which is an integral part of the Right of Healthcare and the Right to Health, as recognized in Article 21 of the Constitution.

Impact of exclusion:

• If large swathes of population would be excluded from availing health insurance which could have a negative impact on the health of a country.
• Exclusionary clause of ‘genetic disorders,’ in the insurance policy, is ambiguous and discriminatory and violative of Article 14 of the Constitution.
• It will be violation of article 21. Right to health care is a fundamental right under Article 21 (life and liberty).
• This blanket exemption covered several “speculatively genetic” conditions and gave “too much freedom and arbitrary power to the insurance companies to reject genuine claims”.

Way ahead:

• A protocol need to be established to clearly define “genetic disorder”, identify which conditions fall under the category.
• Carry out tests on claimants to make sure their ailments were attributable solely to genetic conditions.
• There is a need to bring in a policy for collection of genetic data, analysis and preservation of confidentiality, and for a precise definition of genetic disorders.
• There is urgent need to frame a proper framework to prevent against genetic discrimination as also to protect collection, preservation and confidentiality of genetic data.
• Deliver affordable diagnostictesting of genetic disorders to India’s urban and rural communities for a better quality of life.
• To ensure future progress, there is a need to establish additional departments of medical genetics in medical schools.