BENGALURU, 2 APRIL

Despite legal frameworks ensuring access to medical assistance and interventions for individuals with autism spectrum disorder (ASD) under health insurance, many families in the State are facing denials and limitations in coverage from insurance companies.
 

Autism, characterised by challenges in communication and behaviour, affects individuals differently and typically manifests by the age of 2 or 3. While individuals with autism may excel in certain areas, such as art or mathematics, they often require specialised support and interventions. However, parents of autistic children have said insurance companies are denying coverage or refusing to honour claims by violating the regulations set by Insurance Regulatory and Development Authority of India (IRDAI).

Despite obtaining disability certificates from the State government for their children, parents encounter obstacles when disclosing their child's autism diagnosis to insurance providers. The lack of clarity in policy terms and conditions leaves families uncertain about their entitlement to coverage.

For instance, Sangeetha, a Bengaluru-based parent who discovered her child's autism at the age of 10, faced insurance denials when her child required medical treatment for dengue. Despite having claimed family insurance multiple times before, the expenses incurred during her child's illness were not covered, leaving the family burdened with significant financial strain.

Similar experiences were echoed by parents who spoke to Salar News, highlighting the widespread lack of availability of insurance coverage for autistic individuals in the State and the country at large.

The parents of autistic kids are not requesting insurance companies to give coverage for neurological and developmental disorders such as speech therapies, said City-based Geetha whose autistic son Om was denied health cover by insurance companies. “We are simply asking for comprehensive health coverage to include provisions for accidents and common illnesses, just like any other individual,” she said.

Legal advisers have support the parents' claim, arguing that autistic children deserve equal access to necessary healthcare.

Rakesh Rao, an advocate at Legal Mind law firm in the City, told Salar News that health insurance coverage cannot be denied based on the presence of autism. “The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities (Amendment) Act explicitly regulates that treatment for any health complications must be covered and cannot be denied due to disabilities.” 

Rao suggested that parents facing such denial of coverage should consider filing a Public Interest Litigation (PIL), raising the issue in court to seek regulation and ensure fair treatment under the law.

What insurance firms say

When Salar News reached out, insurance companies responded with the following replies:

1. Mental health conditions are covered under the guidelines of insurance policies, but it is left to the companies if they want to consider autism in their policies.

2. The companies are in the process of developing a separate product specifically tailored for children with special needs. Although this project may require additional time, it aims to cater specifically to this demographic.

3. One challenge faced in designing such a product is the lack of sufficient data or clinical experience regarding the long-term risks associated with it.

4.  As a business, it's essential to recognise that even though only 5-6% of children are diagnosed with autism, providing coverage for autism-related services might not be beneficial.

Demand of parents

1. For companies providing health coverage for autism, please ensure that the coverage offered is fair and sufficient. Providing a meagre amount of coverage is wasteful and does not adequately support individuals with autism.

2. For companies that currently do not provide health coverage for autism, when do you plan to offer such coverage? It is crucial to extend coverage to include autism spectrum disorders, as it is a necessary aspect of comprehensive health insurance. =Salar News