Does your health insurance cover sexual health?



As I sit on my patio, reading article after article on Sexual and Reproductive Health (SRH) on Hidden Pockets, I wonder if we are financially sound to improve this aspect of our healthcare system. Having worked in the field of Healthcare financing for the past couple of years, I understand the importance of Health insurance in making Healthcare affordable and accessible to the common man, and when I say common man, I mean the population in the Lower- and Middle-income groups in our Country. So, I decided that maybe it was time to take a look at how affordable, Sexual and Reproductive Healthcare is in India.

What is Sexual and Reproductive Health?

According to the United Nations Population Fund (UNFPA), good sexual and reproductive health is a state of complete physical, mental and social well-being in all matters relating to the reproductive system. This definition is similar to the definition of Health as defined by the WHO and implies that SRH is a vital part of overall Health of an individual. Simply put, it means that, people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.

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To have optimum SRH, what is needed is Access to:

  1. Appropriate and Accurate Information: Information to Empower and protect against Sexually Transmitted Diseases (STDs) and unhealthy and severe repercussions of unplanned pregnancies and improper abortions.
  2. Safe, Effective, Affordable and Acceptable methods of contraception
  3. Services: If and When a woman decides to have a baby, she must have the necessary services available to her, to help have a healthy pregnancy, safe delivery and healthy baby (Antenatal, Natal and Post-Natal care)
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All this said, is Sexual and Reproductive Health given the importance it deserves in India? Yes, the Government of India does recognize the importance of Sexual and Reproductive health to have included it as a component in the National Health Policy, 2017. However, is financial aid available for Access to the necessary Sexual and reproductive healthcare?

Role of the Government & Health Insurance

The National Health Policy in 2017 noted that “There will be enhanced provisions for reproductive morbidities and health needs of women beyond the reproductive age group (40+)” yet focus on public health standards such as sanitation, water, food safety etc., alone may not suffice in terms of ensuring sexual and reproductive health standards in the country.

In terms of National Health Programmes in reference to sexual and reproductive health, the National Health Policy,2017 includes:

RMNCH+A services (Reproductive, Maternal, New born, Child, and Adolescent Health) which would address the social determinants affecting Maternal health and child survival through developmental action in all sectors. There is however no mention of how these services would be made affordable or if there might be any financial aid available to the population in need. Also, with reference to child and adolescent health, the Policy recognizes the need to expand the scope of reproductive and sexual health in order to address other issues as well, like, inadequate calorie intake, nutrition status and psychological problems etc.,

Health Insurance, Public and Private: What is Available Out There?

After a detailed study of the various policies provided by Health Insurance companies in India, both Public and Private, it is apparent that Sexual and Reproductive health is not sufficiently covered by health insurance. The only aspect of SRH that is covered is Maternity, especially delivery and is called Maternity Insurance.

Maternity Insurance is typically provided as an add-on or as an additional rider with a fundamental health insurance policy. This insurance covers costs for both delivery options namely- caesarean and normal delivery. This however is only provided by some Insurance Service Providers to prevent you from burning a hole in your pockets. Some corporates offer their women employees the advantage of maternity protection along with the routine health insurance coverage.

Health Insurance companies provide this benefit with stringent underwriting of the policy as well as set sub-limits. Some benefits they provide include pre-hospitalization and post-hospitalization costs. Some policies cover pre-hospitalization of up to 30 days prior to date of admission. Expenses such as nursing and room charges, surgeon fee, doctor consultation and anaesthetist consultation may be covered as well.

In general, maternity insurance by and large has a 3 to 4 year waiting period before the benefits can come into play.

Apart from the Maternity cover, till date, there seems to be a lack of financial aid available to make Sexual and Reproductive Healthcare affordable to all. To my understanding, while the Government understands the need for improved Sexual and Reproductive health, there is a long way to go in achieving this.

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