Epilepsy Exclusion Challenged: Supreme Court Seeks Answers From Centre, Irdai

Recently, the Supreme Court (SC) sought responses from the central government and the  Insurance Regulatory and Development Authority of India (Irdai) regarding the exclusion of epilepsy treatment from health insurance coverage. The public interest litigation was put forward by the  Sanvedana Foundation, which challenges a 2020 rule that allows such exclusions. 

List Of Permanent Exclusions To Be Reviewed 

Irdai’s 2020 guidelines let insurance providers have a list of permanent exclusions, with epilepsy being one of them. Says Surbhi Kapoor, senior associate, SKV Law Offices, “This runs the risk of inadequate care and can further lead to complications stemming from such inadequate care. It stands the risk of infringing on the right to health as enshrined in Article 21 of the Constitution and denies equitable access to healthcare, along with potential conflict under Article 14.” 

Insurers and Irdai have made an argument that some standard exclusions are necessary for effective risk management. However, critics have pointed out that they lack transparency and affect individuals with specific or genetically predisposed health conditions in an unfair manner. 

More Comprehensive Insurance Coverage 

Says Anchal Singh Khushwaha, associate, PSL Advocates & Solicitors, “The provision in question allows blanket exclusions without the need for a personalised actuarial assessment. This approach contradicts global insurance best practices and may infringe upon constitutional principles of equity.”

The potential ripple effect of the SC’s deliberation extends far beyond just epilepsy. As Surbhi Kapoor suggests, she says, “The core issue in the Sanvedana Foundation case could trigger a broader reassessment of all such exclusion clauses in the context of health insurance policies.” Should the SC determine that the Irdai’s regulatory powers are indeed bound by constitutional constraints, future exclusions, particularly for chronic or mental health conditions, would demand rigorous justification under Articles 14 and 21 of the Constitution. Khushwaha says, “An order in favour of the petitioner can initiate a chain reaction that would necessitate a reassessment of exclusions for large vulnerable groups.”

The SC’s review of epilepsy exclusion in health insurance highlights an important factor.  In this case, commercial policies and constitutional rights do not go together. If manageable chronic conditions like epilepsy are excluded, it puts a financial strain on individuals and also stigmatises them. It is also against the basic tenets of human dignity. A successful petition could mean that going ahead, insurance policies may see a comprehensive review. This could lead to health insurance polices being more inclusive and covering individuals with chronic health conditions.