Redefining Coverage: Menstruation And Women’s Health Insurance

In India, standard medical insurance generally only applies to conditions related to menstruation and reproduction if the condition requires medically necessary treatment under a defined hospitalisation or daycare procedure. “Conditions such as endometriosis, polycystic ovary syndrome (PCOS), and other causes of anemia may be covered if the women are taking these types of treatments in accordance with the terms of their policy, for example, via a consultation and investigation, surgery, and hospitalisation,” says Arun Ramamurthy, co-founder, StayWell. Health.

Traditional Menstruation Coverage Limits

Many factors decide whether or not a condition, such as endometriosis, infertility, or anemia, will be covered by a standard health insurance plan, i.e., wait times when the insured discloses their pre-existing condition, whether the patient is eligible for coverage, etc. Most traditional indemnity-style policies cover complications that require an invasive intervention better than they do outpatient treatment or long-term prescription medications, with preventative care receiving even less coverage. For example, while the patient may be eligible for coverage of endometriosis-related surgical procedures, there is a strong possibility that they will not get coverage for ongoing hormonal treatment.

Similarly, if a woman is receiving a course of anemia treatment due to a medical condition that is explicitly outlined in the policy, she will receive coverage for treatment related to her anemia, but likely will not receive coverage for any related treatment associated with fertility. “Most health insurance plans specifically exclude all fertility-related care except for situations where the health insurance plan specifically provides coverage for such treatment via a rider or expands coverage for such treatment through other specialized products,” says Ramamurthy.

Women-Specific Plans Expand Coverage

Health insurance plans tailored to cover women and menstruation are beginning to broaden their scope from treatments often being provided in the form of hospitalisation and treatment. “However, new types of health insurance policies are not being introduced only as a means of covering inpatient treatments but also as a comprehensive form of healthcare that includes addressing other conditions and health needs that are not usually covered under traditional forms of healthcare coverage,” says Ramamurthy.

In addition to covering medically necessary treatment, some of these types of health insurance plans also cover consultation with a doctor, diagnostic testing, pharmacy and medication assistance, routine health monitoring, and wellness services.

Some insurance products also cover reproductive health concerns and provide maternity-related benefits, fertility testing, and ongoing condition monitoring for conditions such as PCOS and endometriosis. This represents a shift in the larger industry of re-evaluating how to integrate preventative medicine, early detection, and outpatient services into the overall health insurance model.

While the specifics of each plan may differ from one insurance carrier and product to another, the fundamental concept is that these plans attempt to better reflect how women obtain healthcare in their day-to-day lives, where some level of physician visits, diagnostic testing, or disease management may have the same importance as being admitted to a hospital. “Therefore, this should allow for women to have more meaningful and potentially more equitable access to health insurance than would otherwise be possible with traditional forms of health insurance,” says Ramamurthy.

While there are new insurance products designed to specifically address the needs of women, there are still many gaps between what insurance covers and what the healthcare needs of women really are.

One of the biggest barriers is that traditional health insurance policies continue to place a strong emphasis on hospital coverage; however, for menstrual and reproductive health issues, many of the care needs include outpatient visits, laboratory tests, prescriptions, and ongoing monitoring. In addition, fertility and assisted reproductive treatments, as well as a variety of preventive and/or elective treatments, are typically excluded from traditional health insurance plans.