Inequities Uncovered: Examining Exclusion in Indian Health Insurance Policies

Objective: This study identifies specific patterns of exclusion in health insurance policies in India, based on age, gender and pre-existing ailments. Method: For its purposes, extensive primary research was conducted across different levels of the health insurance infrastructure, spanning the national health insurance scheme, 14 state health insurance policies, and individual and group health insurance policies offered by four government and five fourteen state health insurance policies as well as individual and group health insurance policies offered by four government and five private companies. In addition, a secondary literature review was conducted on topics such as health insurance, health financing, universal access to healthcare, and legal and regulatory frameworks. Results: The findings reveal that health insurance policies fail to address the distinct health needs of specific groups, such as women, children, and older people, and the concerns about their access to healthcare. Age-based exclusions demonstrate that the mere existence of specific policies for “seniors” is not sufficient to achieve the goal of universal health coverage in India. Health insurance policies for women lack coverage for reproductive and other health services, including gender affirming procedures. These exclusions can signify that such health services are unimportant and can be ignored in the insurance policies being offered by both the government and private companies, exacerbating the discrimination faced by groups such as persons with the capacity for pregnancy, as well as transgender persons. Finally, most health insurance policies covered in this study exclude congenital external anomalies as “pre-existing ailments”, while others impose specific waiting periods before coverage begins. Conclusions: This study identifies specific patterns of exclusion in both private and public health insurance policies in India, including those based on age, gender, and pre-existing conditions, to assess how these exclusions affect access to healthcare for specific groups.