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Not under the insurance umbrella

Health insurance is a segment that has seen the launch of several niche insurance covers

M Saraswathy 

Health insurance is a segment that has seen the launch of several niche insurance covers. However, there are still a lot of areas in health and medical illnesses which are excluded from the ambit of insurance. Here are some of the ailments which are currently not covered in India:

HIV/AIDS: Caused by the HIV virus that is communicable through blood transfusion, infected syringes or contact with body fluids of the infected person, no concrete medicine has been discovered to completely cure a person. Though insurers say that it is not fatal if discovered in the initial stages, these individuals are considered high-risk and are not offered insurance for life or health

INFERTILITY: Not able to conceive a child among women is an area which is not covered by insurance. This involves several rounds of treatment for investigating the causes and also involves manual injections and in-vitro fertilization (IVF); procedures which are considered risky to be covered by insurance. Though these treatments are costly, they are not covered.

GENETIC DISORDERS: Medical conditions related to genetic issues are excluded from health insurance since they are considered as high-risk pre-existing medical conditions. These may include some forms of anaemia, thalassemia and Down's Syndrome among others.

TOBACCO USE AND RELATED COMPLICATIONS: While each individual is asked to disclose his or her tobacco usage to determine the insurance premium, those addicted to tobacco and having signs of associated ailments like throat cancer are not covered. Even if somebody fails to disclose his or her tobacco usage and later claims for a related ailment, such claims are rejected.

ADVANCED STAGES OF CANCER: While cancer policies are available in the market and are available for people to purchase to act as a buffer if they contract cancer in the future. But those who already have cancer or are in the advanced stages of cancer are not offered health insurance policies, since there is an imminent risk of high claims and threat of anti-selection. Anti-selection occurs when an individual aware of ailments takes a medical policy and takes it on favourable terms than what would have been offered if she had disclosed her conditions.

Since insurance works on the principle of pooling where the pooled premium from all policyholders is used to pay claims, insurers wish to avoid those customers with a morbid condition, who would claim higher amount and would impact the claim payments to otherwise healthy customers

First Published: Sat, August 01 2015. 22:12 IST