Insurance For Disabilities: What You Must Check And Demand

A survey by the National Centre for Promotion of Employment for Disabled People (NCPEDP), conducted across 34 states and union territories, shows that persons with psychosocial and intellectual disabilities are denied insurance coverage, resulting in 80 per cent of such people uninsured in India.

This can be a serious issue, and it means that if you have any form of disability, you need to be extra vigilant. Here is what you should do.  According to the Insurance Regulatory and Development Authority of India (Irdai), insurers must provide coverage for mental health, disabilities, etc., without discrimination, but the reality is different.

Check Exclusions, Demand Insurer's Rationale

Look for the following: permanent exclusions; waiting periods in relation to congenital or pre-existing conditions; and sub-limits on complications associated with disabilities. “Provide all medical information and reports; not providing everything is the reason for most denied claims. Purchase an insurance policy that is worded to permanently exclude congenital conditions and caps on premium loadings,” says Arun Ramamurthy, co-founder, Staywell.Health.

This may sound counterintuitive, but if an insurer is allowed to permanently exclude the condition they see as the biggest risk, they are much more likely to issue the policy.  So you will be covered for everything else, accidents, fever, unrelated surgeries, and so on. This is a better bet than having no health insurance at all.

Request a copy of the insurer's underwriting rationale in writing; they have to provide medical grounds to justify any exclusion or loading, and if the grounds look pretty generic or discriminatory, you can escalate it to the grievance cell and then the Insurance Ombudsman, who fairly frequently overturns the insurer's decision. “In a dispute over a claim, you can obtain the assessment file and demonstrate that the hospitalization was unrelated to the pre-existing disability,” says Ramamurthy.

Leverage Government Schemes And Supplement With Riders

Plans such as Niramaya and state health initiatives, as well as the Ayushman Bharat scheme, will be a great help in situations where private insurance coverage is modest. Families can prepare their basic coverage plan with a hospital cash plan, critical illness riders, and a modest medical emergency fund.

The sooner you acquire coverage, the fewer pre-existing health exclusions there will be and the less biased the underwriting result.

Remember that the legal and regulatory framework in India is increasingly pushing for inclusion. While the system is imperfect, individuals have the power to challenge discrimination.