Regulators Aren’t Requiring Insurance Companies to Pay for Dental, Fertility Treatments

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Aug 30, 2018

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Early this month, the Insurance Regulatory and Development Authority of India (IRDAI) reminded insurance companies their policies are required to include treatment related to mental health. Now, in a new notice dated 27 August, the insurance regulator announced that 10 ailments and medical procedures will be removed from the list of non-payable items under health insurance policies, per a Livemint report.

Some outlets have reported this as a move that requires insurers to now cover these treatments; it’s not.

Non-payable expenses are those which policies don’t have to cover. Consumables, non-medical items including toiletries, cosmetics, personal comfort or convenience items, wifi charges and certain portions of room and administrative charges are such non-payable expenses. The list seems to function as as an agreed-upon definition of what insurance isn’t — though insurance companies can offer policies that cover these items, if an insurance company is feeling particularly generous, they don’t have to — and tend not to. Before the move by IRDAI, non-payable items also included medical procedures such as outpatient dental care, hormone replacement therapy, treatment for infertility, obesity, treatment of HIV and AIDS, aesthetic surgery and stem cell implantation or surgery.

Per the IRDAI circular, these medical treatments have been nixed from the non-payable list, a move that appears to be more about good housekeeping, than any benefit to patients.

“The list of non-payable items primarily includes consumables and other non-medical items. So far this list also included medical procedures and ailments, so we have removed those from the list,” said an IRDAI official who didn’t want to be named, to Livemint.

For customers, say experts, there will be virtually no impact. “Even as the medical procedures and ailments have been removed from the list, the regulator has not explicitly asked the insurers to include them. Insurers, therefore, still have the flexibility to exclude these items,” said Puneet Sahni, head, product development, SBI General Insurance Co. Ltd to Livemint.

However, crossing these treatments off the non-payable list might herald future measures that do require insurance companies to cover the same; IRDAI has set up a committee to review exclusions in health insurance and make suggestions on how to make these policies more inclusive and transparent. Its report is expected next month.

“Medical procedures like stem cell surgery or hormone replacement therapy were seen to be experimental in nature and were therefore excluded earlier. But now they are standard medical procedures in certain conditions,” said Kapil Mehta, co-founder, SecureNow.in to Livemint.

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Written By Anubhuti Matta

Anubhuti Matta is an associate editor with The Swaddle. When not at work, she’s busy pursuing kathak, reading books on and by women in the Middle East or making dresses out of Indian prints.

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