World Autism Awareness Day is celebrated every year on April 2 to raise awareness about autism spectrum disorder (ASD). Autism is a condition usually diagnosed after three years of age and the incidence worldwide is 1 in 100 children who are less than 10 years of age. It refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, among others.

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While the effects of autism may depend upon where the disease falls on the spectrum of severity, it makes sense to see if insurance in India covers it or not?

The scope of insurance

Currently, there are a few insurance schemes that cover autism, and the government has another scheme called 'Niramaya' that provides insurance coverage of up to Rs 1 lakh with single premiums across various ages, Rakesh Goyal, Director at Probus Insurance Broker told CNBC-TV18.com.

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However, the silver lining is that the scope of insurance coverage for autism in India has been expanding in recent years. While traditional health insurance policies in the country may not have covered autism treatment in the past, many insurance providers now recognise the importance of providing coverage for this condition.

The coverage

According to Sanjiv Bajaj, Jt. Chairman & MD at Bajaj Capital Insurance Broking Ltd, some policies cover the cost of behavioral therapy, speech therapy, occupational therapy, and other forms of treatment for autism.

"Some policies may also cover the cost of diagnostic tests and evaluations. The coverage offered by insurance providers can vary widely, so it is important to carefully review policy details before selecting an insurance plan," Bajaj said while talking exclusively with CNBC-TV18.com.

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The Insurance Regulatory and Development Authority of India (IRDAI) has also issued guidelines that mandate insurance providers to offer coverage for certain developmental disorders, including autism, under health insurance policies. These guidelines provide a framework for insurance providers to follow when offering coverage for developmental disorders, ensuring that individuals with autism have access to the care they need, Bajaj added.

What's required?

According to Goyal of Probus Insurance, more products are required in this category with greater coverage. "As new challenges emerge, we must be fully prepared to handle such emergencies," said.

S Prakash, MD at Star Health & Allied Insurance believes that children with autism should be reasonably doing well. So, there is no need of fear and apprehension for an insurance to cover children with autism.

"Rather, these children may be prone to self-sustained injuries. They may have a fracture fall. Self-injuries are common in this segment of people and epilepsy, seizure disorders are also relatively more compared to normal children. They are prone to accidents because usually children with autism have a lack of awareness of any danger and they may be very hyperactive," he said.

Since their lack of awareness of danger makes them more susceptible to accidents, they may require some occupational therapy or physiotherapy.

As per Prakash, some respiratory infections is also common in children of less than 10 years, anywhere, upper respiratory infection and chest infections are very common.

"I don't foresee any big problem other than self-injury, epilepsy or accident and some expenses for occupational therapy and physiotherapy happening in autism spectrum children. Insurers should come forward. It is not a major ailment and these children should have the right of a health insurance cover," he told CNBC-TV18.com.

To conclude, the scope of insurance coverage for autism is expected to expand further in the future as more insurance providers recognise the importance of providing coverage for this condition.

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