Supreme Court seeks response from Centre, IRDA on challenge to exclusion of epilepsy from medical insurance cover

The Supreme Court recently sought responses from the Central government and the Insurance Regulatory and Development Authority of India (IRDAI) on a public interest litigation challenging a 2020 rule that allows health insurance companies to exclude epilepsy treatment from medical insurance coverage [Sanvedana Foundation v. Union of India]..A Bench of Justices BV Nagarathna and Satish Chandra Sharma issued notice in the matter to the government and IRDA and posted it for further hearing after the respondents file their reply.The petition was filed by Sanvedana Foundation, a public charitable trust founded in 2004 which works to support epilepsy patients across India by providing medications, surgery funding and counselling services.The petitioner argued that the exclusion of epilepsy from general health insurance policies is arbitrary, medically unsound and violative of the rights of persons with epilepsy (PWE) under Articles 14 and 21 of the Constitution.“The exclusion in question, which is central to the present Petition, results in PWE facing significant restrictions in accessing healthcare. Prima facie, the decision to include Epilepsy as a disease under ‘permanent exclusion’, for which treatment is not required to be covered under general health insurance policies, is both unscientific and unconstitutional,” it was submitted..The petitioner highlighted that the IRDAI rule ignores that epilepsy is a manageable neurological condition, and studies show that up to 70% of people with epilepsy can achieve seizure remission with proper medication. Epilepsy affects 12 million Indians, and high treatment costs often force many to skip care, it was pointed out.Despite this, the circular allows insurance companies to reject coverage for treatment even where epilepsy is unrelated to the medical condition for which insurance is claimed. .The petitioner also highlighted a huge treatment gap, with 50-90% of PWE in India unable to get medicines due to cost or unavailability, as shown in a 2020 study. Another 2020 study found most Ludhiana pharmacies lacked epilepsy drugs, which often cost more than a month’s wages for low-income workers. It was further argued that the circular treats all PWE as a homogenous group and fails to recognise the diverse manifestations and severities of the condition. Even individuals with long-term seizure remission or those who have undergone successful surgery are denied insurance, it was contended..Thus, the circular violates Article 14 by creating a vague and arbitrary classification without intelligible differentia and it it fails the proportionality test, the petitioner submitted.The plea sought directions to constitute an expert committee with representation from epilepsy specialists and persons with epilepsy to develop a ‘risk-stratified’ model for assessing insurance eligibility. .The Court’s notice aligns with its hearing of a similar case in United India Insurance v. Jay Parkash Tayal on the arbitrary exclusion of genetic disorders from health insurance policies.The case will now proceed after the Centre and IRDAI submit their responses..The petition was filed through advocate Abishek Jebaraj.