Now, a health cover for autism

While Star Health's policy for children is a step forward, it has a low sum insured and comes as a group cover

Star Health and Allied Insurance has launched a group insurance policy for children with autism spectrum disorder (ASD). It has so far covered 241 children from a Chennai-based NGO called Sankalp. The product is ground-breaking because children with autism and other mental diseases are generally declined health insurance cover.

Star’s policy will provide an individual sum insured of Rs 1 lakh to each child. It will offer coverage for in-patient management of medical and surgical complications associated with autism, such as seizures, soft tissue and bone injuries, medical and surgical procedures for muscle spasms and for all infectious diseases.

Besides covering conditions related to autism, the policy will act as a routine mediclaim policy. It will also cover other general medical and surgical therapies that require hospitalisation.

Most health insurance policies have an initial waiting period of 30-90 days. They also don’t cover certain conditions for a year or two, and they don’t cover pre-existing diseases for four years.

Says S Prakash, executive director of Star Health and Allied Insurance: “In this policy, there is no waiting period, no first and second-year exclusions, and pre-existing diseases are covered from day one.”

To prevent misuse, the insurer has decided not to cover expenses for rehabilitation and physiotherapy.

Children with conditions such as ASD are prone to sprains and fractures. The policy also covers 405 daycare procedures for which hospitalisation might not be essential. In case of the children from Sankalp, the premium cost came to Rs 2,987 (plus tax) per individual.

Experts are of the view that Star’s policy is a step forward. “It will act as a support system for parents who want proper treatment and care for their children suffering from ASD,” says Naval Goel, chief executive officer and founder of Policyx.com. The only alternative to Star’s policy is a government scheme called Niramaya, which, too, offers a sum assured of up to Rs 1 lakh.

While Star’s policy is a laudable initiative, it suffers from a couple of shortcomings. One, it is not an individual insurance cover. “An autistic child or his parents cannot buy this cover off-the-shelf. A group of autistic children will have to come together, say, through a self-help group, and then approach the insurer. This may not always be an easy thing to do,” says Kapil Mehta, founder and CEO, Secure Now Insurance Broker. Its other shortcoming is the low sum assured of Rs 1 lakh.

Currently, parents of children with such conditions depend largely on their own resources. They should build a medical emergency corpus as part of their financial plan. Another alternative is to buy a personal accident cover worth Rs 5-10 lakh. Many of these children are prone to accidents. Generally, companies tend to have less stringent conditions for issuing personal accident covers. In this case, while the cover will be high, the insured will only be insured for injuries or disabilities caused by an accident.

Finally, as with all insurance policies, check the terms and conditions in the policy document to make sure that you fulfil them and to save yourself and your child the hassles of claims rejection, suggests Goel.