Mental Health and Insurance
In two significant judgements, the Delhi High Court has reaffirmed that insurance companies cannot discriminate against mental illnesses and must provide coverage on par with physical illnesses. This is in line with Section 21(4) of the Mental Healthcare Act, 2017, which mandates that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.”
Subhash Khandelwal v. Max Bupa Health Insurance Company Limited
This case involved Mr. Khandelwal, who held a health insurance policy with Max Bupa. When he filed a claim for mental illness treatment, he discovered a clause limiting coverage for such conditions compared to physical illnesses. The court ruled in Mr Khandelwal’s favour, highlighting the following key points:
- Equal Treatment: The court emphasised that Section 21(4) of the Mental Healthcare Act, 2017, mandates that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.” This principle of non-discrimination applies to insurance coverage.
- IRDAI’s Role: The Insurance Regulatory and Development Authority of India (IRDAI) is responsible for regulating and promoting the insurance sector. The court observed that IRDAI should explain why it approved policies that discriminate against mental health coverage.
- Right to Equality: The court recognised the fundamental right to equality enshrined in the Indian Constitution and the United Nations Convention on the Rights of People with Disabilities, which prohibits discrimination based on mental illness.
Shikha Nischal v. National Insurance Company Limited and Anr.
This case involved Ms. Nischal, who had a health insurance policy with National Insurance Company Limited (NIC). When she sought reimbursement for hospitalisation due to schizoaffective disorder, NIC rejected her claim, citing an exclusion clause for “psychiatric disorder.” The court ruled in Ms Nischal’s favour, underscoring these crucial aspects:
- Mental Health Importance: The court acknowledged the growing recognition of mental health as equally important as physical health. This aligns with the Mental Healthcare Act’s objective of protecting the rights of individuals with mental illness.
- IRDAI’s Responsibility: The court emphasised IRDAI’s duty to ensure compliance with the Mental Healthcare Act. It held that IRDAI cannot overlook insurance companies’ non-compliance and that insurance products should have extended equal coverage to mental and physical illnesses since the Act came into effect.
- Implementation Gap: The court criticized the two-year delay in implementing the Act’s provisions and stated that the 2016 Guidelines on Product Filing in Health Insurance Business cannot be used to justify non-compliance.
Implications:
These judgements have significant implications for mental healthcare in India.
- Insurance Coverage: Insurance companies must provide coverage for mental illness treatment without discrimination, complying with the Mental Healthcare Act.
- IRDAI’s Role: IRDAI needs to ensure insurance products adhere to the Act’s provisions and take action against non-compliant companies.
- Increased Awareness: These judgements raise awareness about the importance of mental health and the need for equal insurance coverage.
Rare Disease Medicines and Treatment: No Customs Duty, Policy Roadmap
In a batch of petitions concerning children suffering from rare diseases like Duchenne Muscular Dystrophy and Hunter Syndrome, Justice Pratibha M. Singh has issued a comprehensive order laying down a policy roadmap and directives for ensuring accessible and affordable treatment.
The Court clarified that no customs duties shall be levied on medicines, drugs, and therapies imported for rare disease treatment. It directed the order’s compliance by the Central Board of Indirect Taxes and Customs.
To implement the stalled Rare Diseases Policy effectively, the Court constituted a committee headed by the Department of Biotechnology Secretary. Based on the committee’s recommendations, the Court issued key directives:
The National Policy for Rare Diseases shall be finalised and notified by March 31, 2021. It shall establish a national consortium to spearhead research, the indigenization of treatments, and the manufacture of drugs.
- Unspent rare diseases budget for 3 years shall be pooled into a ‘Rare Diseases Fund’ managed by AIIMS for treatment and research funding.
- A digital crowdfunding platform in the policy shall be linked to the fund to receive public contributions.
- AIIMS shall have a Rare Diseases Committee to evaluate treatment requests and recommend funding from the Rare Diseases Fund.
- The Consortium shall monitor R&D efforts, approve research proposals using the Fund, and oversee technology transfers and regulatory approvals.
The Court emphasised expediting indigenous and affordable drug and therapy development through public-private partnership models, research incentives, and an accelerated approval process. It permitted crowdfunding and alternative financing for rare disease treatment.
In the case of mental health, the court reaffirmed the principle of equal treatment under Section 21(4) of the Mental Healthcare Act, of 2017, ensuring that insurance companies cannot discriminate against mental illnesses. Additionally, the court highlighted the importance of insurance coverage for persons with disabilities (PWD) or those afflicted with HIV/AIDS or suffering from mental illness, as mandated by the IRDAI. This was issued after the judgment of the DHC. The emphasis on affordable treatment options and research funding for rare diseases promises a brighter future for those battling these conditions. As these policies are implemented, it will be crucial to monitor their effectiveness and address any emerging challenges to ensure their long-term success. Ultimately, the court’s interventions serve as a powerful reminder of the judiciary’s role in upholding fundamental rights and promoting a more inclusive healthcare landscape for all.
The Delhi High Court’s landmark judgements on mental healthcare and rare diseases represent a significant step towards ensuring equitable access to healthcare in India. These rulings not only invalidate discriminatory insurance practices but also pave the way for a more robust healthcare system that prioritises both mental and physical well-being. The emphasis on affordable treatment options and research funding for rare diseases promises a brighter future for those battling these conditions. As these policies are implemented, it will be crucial to monitor their effectiveness and address any emerging challenges to ensure their long-term success. Ultimately, the court’s interventions serve as a powerful reminder of the judiciary’s role in upholding fundamental rights and promoting a more inclusive healthcare landscape for all.