No discrimination

No discrimination

Context:

• Recently, Delhi high court has said that companies cannot deny health insurance to those suffering from genetic disorders.

Case involved:

• 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.

Court’s ruling:

• Most health insurance policies have a clause excluding “genetic disorders” as grounds for reimbursement, but the court said this blanket exemption covered several “speculatively genetic” conditions and gave “too much freedom and arbitrary power to the insurance companies to reject genuine claims”.
• It asked the Insurance Regulatory Development Authority to have a “re-look” at such exclusionary clauses and nudged lawmakers to amend the law, saying the right to health care was a fundamental right under Article 21 (life and liberty).
• “The exclusionary clause of ‘genetic disorders,’ in the insurance policy, is too broad, ambiguous and discriminatory — hence violative of Article 14 of the Constitution,” Justice Singh said.
• “In effect, it would mean that large swathes of population would be excluded from availing health insurance which could have a negative impact on the health of a country,” .

What is genetic disorder?

• A genetic disorder is a genetic problem caused by one or more abnormalities in the genome, especially a condition that is present from birth.

Health insurance in India suffers from lack of scale:

• Several studies have pointed out that health insurance in India suffers from lack of scale, covering only about 29% of the households surveyed under the National Family Health Survey-4, that too in a limited way.
• The health-care system also lacks regulation of costs.
• There is asymmetry of information, with the insured member unable to assess the real scope of the policy or negotiate the terms with the provider.
• India’s health insurance and hospital sectors closely follow the American pattern, and are in need of strong regulation.

Way ahead:

• Necessary to define costs, curb frauds and empower patients.
• As the Delhi High Court has observed, exclusions cannot be unreasonable or based on a broad parameter such as genetic disposition or heritage.
• Insurance law has to be revisited to also ensure that there is a guaranteed renewal of policies, that age is no bar for entry, and pre-existing conditions are uniformly covered.
• Problems of exclusion will be eliminated if the payer-insurer is the state, the financing is done through public taxes, and coverage is universal.
•  The short-term priority is to remove discriminatory clauses in policies and expand coverage to as many people as possible.