No Sex please - we are IndiansThe Apnainsurance research results point to an interesting fact: no health insurance policy covers hospitalisation expenses caused due to any sexually transmitted diseases including AIDS. More from the company's CEO.
26 May 2009
We all know about our hypocritical attitude to sex despite the fact that we are the second most populated country in the world (and on course to the dubious honour of being the first). Whilst this attitude has its fall out primarily in the cultural and social arena such as films, drama, music, television, advertisements, etc. it also has an impact on our financial lives.
One such significant impact is on the health insurance industry. As per our research every single non-group mediclaim policy issued in this country permanently excludes any hospitalisation expenses caused due to any sexually transmitted diseases including AIDS (although AIDS can be caused by myriad factors other than unprotected sex - in the popular Indian imagination it is the sexual motif that dominates). It does not matter for how many years you have been renewing the policy. Even if you have been a loyal customer of the insurance company for 10 years (and have not made any claims) and contract HIV in the 11th year for the first time you will still not be covered for any hospitalization expenses incurred due to this.
Off course to be fair to the Insurance companies there are valid reason for the exclusions of HIV/Aids. HIV/Aids as a disease is relatively new at around 25 30 years and there is still no certified cure and the expenses required for treatment and the eventual outcome is uncertain. The insurance industry depends on statistics about how many people get affected by the disease as well as the average cost of treating such a disease and eventual outcomes to price its product appropriately and since no reliable data is available on this it is excluded from the scope of coverage to avoid making the cost prohibitive. In fact one of the insurance companies we spoke to while doing research on this subject gave the interesting example of diabetes and its coverage in health insurance plans in western countries.
- Pre-1950's: no treatment for diabetes, not insurable
- 1960- early 70's: treatment protocols established, outcomes uncertain, insurance expensive
- Mid to Late 1970's onwards: treatment improved, compliance good, outcomes more predictable, insurance affordable.
If we look at this example then clearly we should be ready to at least move to the second stage where at least expensive insurance is available. As per a newspaper report the labour ministry is reportedly gathering data on this before approaching IRDA to request them for some regulations in this regard. Since HIV/Aids is such a big issue the government would do well to create some kind of a common re-insurance pool just like it has done for Terrorism cover without which the cost of covering this risk is likely to be prohibitive. Hopefully some portion of the government funds being spent on fighting this scourge will see its way to the creation of such a pool. Meanwhile the Insurance industry is doing its bit by launching low value group schemes targeted at the most vulnerable sections of the society through a network of NGOs. Project Concern International an NGO has done pioneering work in this regard. With Star Health it has launched Star Health HIV Care Policy which provides some relief (Rs. 15,000/- p.a.) towards hospitalisation expenses as well as a one time benefit of Rs. 15,000/- when the disease becomes full blown AIDS. Mr. Ravi Subbiah of PCI said Star Health already had a HIV care product but it was not being taken up well. We worked extensively with them to provide on the ground data to fine tune the program as well as to roll it out. They have also launched an innovative mutual insurance program called JEEVODHYAM . However these are baby steps (very welcome ones though) in the right direction but can hardly dent the huge problem that we are increasingly being faced with.
However when we checked on the reasons for the permanent exclusion of other sexually transmitted diseases the reasons for their exclusion are less clear. Statistical data on these diseases is widely available and treatment protocols and outcomes are reasonably reliable like any other non sexually transmitted disease. Most insurance companies we spoke to told us this is possibly just a hangover from the original mediclaim document that has been around for around 20+ years now. This document was framed in a different era where perhaps this attitude that somehow sexually transmitted diseases were immoral and hence anybody getting hospitalised due to them deserves not to be covered for the expenses (or perhaps it was very expensive at that time to treat other sexually transmitted diseases) was perhaps acceptable. In the current day and age clearly this is a fit subject on which IRDA regulations would be welcome.
It would be fitting if we could have regulations on the entire subject of permanent exclusions (those that will not be covered irrespective of how long you have been insured) with standard permanent exclusions such as congenital defects, cosmetic or obesity treatments, non allopathic treatments, allowed under the regulations. If any Insurance company wishes to expand the list it should be allowed to do so as long as an easily understandable communication is made to a prospective consumer and his prior informed assent obtained.
In fact IRDA has been very pro-active and with its recent circular of March 31, 2009 has laid down several welcome measures to bring in transparency in the health insurance sector. So the chances of regulations in this vital area are quite high. Whilst this may lead to an increase in premiums in the near term it will re-inforce the consumer's faith in the insurance policy and bring more customers in the health insurance net. Prices will also stabilise once the insurance companies get some claim experience. An example is the steep fall in term insurance prices (presumably due to the low claims experience) as compared to when the product was initially introduced in 2001.
Hopefully pro-active regulation by IRDA will make the health insurance industry so big that one day further improvements in health insurance sector will be a major national election issue. Can you imagine a debate on their respective party's plans for the health insurance industry between BJP and Congress spokespersons on prime time national TV. Let us all look forward to that day.