India: Healthcare: Compliance: High Court Rulings Impact Health Care Coverage for Genetic Disorders, Mental Health, LGBT People, and HIV/AIDS

Effective dates: March 2018, July 2018, and September 2018

Asinta thanks Prudent, its Partner in India, for providing this information.

India’s highest courts recently passed a series of mandates that impact employee benefits. They include laws regarding coverage for genetic disorders, mental health care, the LGBTQ population, and people with HIV/AIDS.

Delhi High Court on Genetic Disorders

As of March 2018, Genetic disorders must be covered, but the Supreme Court has yet to define what constitutes a “genetic disorder” and what exactly is “pre-existing.” Alda Dhingra of Prudent recommends for the time being that employers customize this benefit for their company, and notes that insurers are watching this definition closely.

The Mental Health Act

Beginning July 1, 2018 The Mental Health Act makes discrimination in mental health care illegal, and requires that mental illness be treated on par with physical illness as insured benefits. Insurers can charge an additional premium. Anyone not following the law faces jail and fines.

Ms. Dhingra says, “Employers should consider providing this benefit and define it broadly to include rehabilitation and outpatient therapy. Mental health awareness and treatment should be included with employers’ wellness initiatives. Instituting an Employee Assistance Program can support employees and their families through challenges, reducing the chance of deterioration in the situation such that the employee can no longer work, or becomes less productive.”

The following is a summary of the law’s implication for employers as reported by the United States National Institutes of Health:

• Does the law make provision for the protection of persons with mental disorders from discrimination and exploitation in the work place? YES
• Does the law provide for “reasonable accommodation” for employees with mental disorders, for example by providing for a degree of flexibility in working hours to enable those employees to seek mental health treatment? YES
• Does the law provide for equal employment opportunities for people with mental disorders? NO
• Does the law make provision for the establishment of vocational rehabilitation programs and other programs that provide jobs and employment in the community for people with mental disorders? YES

There is significant stigma about mental illness in India, and health insurance policies have traditionally excluded psychiatric treatment. Since most benefits focus on inpatient treatment, and mental illness is generally an outpatient service, what is an “outpatient” service needs to be defined. Dhingra reports rarely ever seeing a claim for inpatient mental illness, when an employer has extended this benefit. Meaning it is possible stigma dissuades people from availing this benefit.

This article further details the law’s implications

 

Homosexuality Decriminalized

On September 6, 2018 India’s Supreme Court ruled to decriminalize homosexuality, and modified the colonial era law Section 377, opening the door to further legislative changes that extend more rights to the LGBTQ community. For employers this means same sex domestic partners can be covered by insured benefits effective immediately.

“This means employers have legal standing to extend benefits to LGBTQ domestic partners and their diversity programs can better address the needs of the LGBTQ community.

 

HIV/AIDS Act

As of September 10, 2018 the HIV/AIDS Act criminalizes discrimination due to HIV infection or AIDS in the areas of employment, education, insurance coverage, medical care, use of public facilities, property rights, and holding public office. Companies who violate the law with a “propagation of hatred” offense face anywhere from three months to two years in jail, and a fine of INR 100,000.

In addition the law states that receiving anti-retroviral treatment is a right, and free treatment must be given at a government hospital. Consent for testing, treatment and research is mandatory, and the right to confidentiality about HIV-related information is protected.

Employers should consider offering this coverage so it is in line with their non-discrimination policies, and know that insurers cannot discriminate against a person with HIV/AIDS.