Not Enough Insurance Cover For Autism Treatment

Signs of Autism Spectrum Disorder (ASD), a developmental condition that affects a person’s social communication and play skills, can be seen in children as young as 8-12 years of age. According to research by Centers for Disease Control and Prevention in the US, 1 in 59 children have autism in their country.

“In the absence of good research studies and official numbers, we generally look at the US numbers because it is fairly global,” said Dr Koyeli Sengupta, director of Autism Intervention Services at Mumbai-based Ummeed Child Development Center.

According to INCLEN Trust International, 475 of 3,964 children (between the ages of 2 and 9 years) had at least one Neurodevelopmental Disorder (NDD). Among children with NDDs, 21.7% had two or more NDDs and 79.6% children with ASD. It can have serious emotional and financial impact on the affected person’s families.

On World Autism Day, we look at the insurance covers available and why it is not enough:

Not enough cover

Under the National Trust Act 1999, the government offers Niramaya Health Insurance scheme for autistic patients. “When it comes to autism, the insurance policy provides coverage for Rs 1 lakh a year for Rs 250,” said Aditi Jha, case-cordinator at Ummeed Child Development Center. “The treatments are capped under this plan. For example, Rs 10,000 annually is capped for therapy sessions,” she added.

When it comes to private insurance companies, there is not enough cover. “Private insurance scenario is not good as they do not provide insurance cover to autistic patients or have a waiting period,” said Kapil Mehta, founder of SecureNow.in. Currently, Star Health Insurance Co. Ltd. is the only private insurer in the market that has an insurance plan specifically for autism. “The premium for a 20-year-old is Rs 6,284 annually and sum insured is fixed at Rs 3 lakh, it is also the maximum a company offers,” said Amit Chhabra, business head of health insurance, Policybazaar.com.

In fact, “all insurers have to cover autism by law because mental health issues cannot be excluded and autism falls very broadly in that category,” added Mehta. For example, Religare Health Insurance Company Ltd’s Care Freedom plan, covers autism along with other illnesses as well. “The plan is available for a sum insured of Rs 3-10 lakh. The premium for a 20 year-old male is Rs 5,383 for Rs 3 lakh sum insured and Rs 6,236 for Rs 5 lakh.

Limitations and exclusions

Star Health’s plan has some limits on specific treatments. For example, hospitalisation for treatment of seizures is capped at Rs 25,000 and hospitalisation for treatment of fractures requiring surgery is capped at 20% of the sum insured.

“Because of the limits, the plan may not work for some patients but an important thing to note is that Star Health’s plan can be bought only in the child’s name. Plans like Religare’s need to be family floater plans where in the child’s protection is a +1 along with the parent’s,” said Chabbra.

“Since every health insurance plan has its own limits, parents can review their affordability and requirement and check which health plan works for them,” said Chitra Iyer, chief executive officer of Mumbai-based My Financial Advisor, Trustee for Forum for Autism, who is also a mother of 20-year-old autistic child Shravan Iyer. According to Iyer, it is better that parents go for a term cover because it is cheaper and will provide sufficiently for a child after the parent’s demise.

“Parents can claim tax deduction on the medical expenses spent on their dependent children while autistic individuals themselves can claim a tax deduction under section 80 (U) for themselves,” said Chitra Iyer, founder of Forum for Autism in India, who is also a financial planner. “Monthly expenditure generally ranges between Rs 10,000-20,000 a month for a child with any special need. In fact, for autism specifically, the expenses can range anywhere between Rs 6,000 to Rs 25,000,” she said. Hence, parents should start investing very early in life because not only are they planning for themselves and their retirement but also for their child’s adult life and retirement. – HT