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Insurers refuse cover for infertility treatment-The Times of India

Posted Nov 18 2008 12:14am

Insurers refuse cover for infertility treatment-The Times of India: " Early this year, Tata Consultancy Services, which has more than 90,000 employees, approached New India Assurance Company with a proposal. It wanted New India to devise an insurance package for its employees based out of India which would cover procedures like in vitro fertilisation and artificial insemination. The proposal was prompted by an internal survey's finding that about 15% of TCS employees, both men and women, had fertility problems. Sources say TCS wanted New India to cover each of its employees for Rs 1 lakh. This was meant to be over and above the regular health insurance benefits the company offered. On its part, the insurer examined the proposal and declined to prepare the package TCS wanted. New India argued that these procedures were expensive and did not require hospitalisation. More significantly, the argument went, infertility was not a disease as in such cases it could be a result of, among other things, stress. TCS is not the only company in India to approach insurers for customised packages to cover infertility treatment. Sources in the insurance business say companies such as outsourcing firm Evalueserve, Computer Sciences Corporation and GE have all approached insurers at some point in recent times to seek similar cover for their employees. And all of them have been turned away."

This is actually a big opportunity for a clever and innovative health insurance company in India ! Insurance has now become privatised in India, which means it is no longer just a seller's market. Huge IT companies such as TCS and Infosys employ a large number of young employees who are in the reproductive age group. Many of them get so caught up in the rat race that they tend to put off child-bearing in order to pursue a lucrative career - which means that by the time they are settled and want to start a family, many of them find that their biological clock has ticked on, leaving them infertile. Now these are smart young driven employees, who are used to being successful and getting their own way. They have become senior in the company and can exercise quite a bit of clout ! If they need IVF treatment ( which they feel is partly a result of the overtime and long hours they had to pay in order to advance in the company), they want the company to pay them back by covering for their fertility treatment. Companies are going to start feeling the heat - and they are going to pressurise insurance companies to provide this coverage !

The good news is that many studies done in the US have proven that providing this additional coverage does not increase the cost of insurance cover by a significant amount , so that this is a very cost-effective option insurance companies should be happy to provide. Not only will this be a valuable differentiator for them and a great USP, they can also project themselves as being pro-family and employee-friendly. It's my prediction that infertility coverage is an option insurance companies in India will soon provide to corporates, if they don't want to lose their business. Health insurance is a "hot area" in India right now - and infertile couples will benefit from this.

Of course, if the carrot approach does not work, I think infertile couples need to use the stick option. Many of them are smart and successful executives and entrepreneurs, and they can get together to lobby and advocate for making infertility coverage compulsory for all insurance companies. This is exactly what Resolve did in the US many years ago, as a result of which infertility coverage is compulsory in 13 states in the USA.

Hopefully a group of infertile couples or an infertility support group in India will file a PIL ( public interest litigation) in the High Court, based on the grounds that it's unfair for insurance companies to discriminate against infertile couples by refusing to cover their medical treatment. Infertility is a disease caused by medical problems ( such as blocked tubes); and modern treatment is very successful and cost-effective in providing a solution !

The right to have a baby is something most of us take for granted, and we often lose sight of the fact that 1 in 10 married couples will not be able to have the child they want. Infertility is a very common problem, and if you stop to think about it, you will realise that you know at least one person who is infertile amongst your own group of friends or relatives. However, it remains one of those taboo topics which no one wants to talk about, even though it interferes with one of the most fundamental and highly valued human activities – building a family.

Millions of infertile couples in Indian cities today face many obstacles in their attempts to build a much-wanted family, and one of the most frustrating is the lack of insurance coverage for medical treatment. What this means is that while infertility specialists in India can provide even the most advanced reproductive techniques to solve extremely complex infertility problems, at a level of sophistication which is comparable with that in the West (and at a fraction of the price), most couples cannot avail of these techniques because these are not covered by their insurance policy. So near – and yet so far, would sum up the situation for most couples!

The financial burden that some of the treatments may place on couples can be large, and adding this on to the emotional and physical consequences of experiencing infertility can literally be the last straw which breaks the camel’s back. The strong desire to build a family gives many the strength to face these obstacles, but infertile couples also need additional support from their employers and insurance companies.

While most diseases and medical conditions are covered by insurance, the disease of infertility is often singled out for exclusion, and such discrimination is unfair! Thus, to add further insult to injury, infertile couples not only face the emotional pain associated with not being able to have a child, but also face obstacles put in front of them by their health insurance and employers for reimbursement of the medical expenses they incur on their treatment.

Unfortunately, insurance companies in India still do not provide health insurance coverage for infertility. This is a very archaic attitude, but because the insurance industry in India is still a monopoly, this situation is unlikely to change, until the field gets privatised, or Indian companies fall in line with their Western counterparts.

Insurance companies have traditionally denied claims for infertility on one of the following flimsy pretexts.

  • Infertility is not an illness;
  • Treatment of infertility is not medically necessary;
  • Treatment of infertility is experimental.
  • Infertility treatment is too costly for a country like India to offer
However, it has now been well established that infertility is an illness, which is caused by various medical causes which result in the abnormal functioning of the reproductive systems (such as blocked fallopian tubes or a low sperm count); and that these can be successfully treated in most cases.

Medically necessary is usually defined by insurance policies as medically appropriate for treatment of an illness under professionally recognized standards of health care – and treatments such as IVF are now universally acknowledged to be standard medical treatments, which are no longer experimental.

While certain infertility treatments can be costly, most are quite inexpensive, and only about 5% of all infertile couples will need expensive treatments like IVF. Moreover, if expensive medical procedures like bypass surgery can be covered, then why should treatment for an abnormally functioning reproductive system be excluded?

Why this discrimination against infertile couples in India? Ironically, this is because of the high premium Indians have always placed on the family unit! The major role of the woman in Indian society was seen to be to have children to propagate the family name. Therefore, if a woman could not have children, she was singled out, ridiculed, ostracised and stigmatised.

In fact, given the value Indians have placed on having children, infertile couples should actually receive even more tender loving care from others – and be helped in their quest to complete their family!

However, because of centuries of misconceptions and myths regarding infertility (for example, "a barren woman has been cursed by God, and being punished for the sins of a prior life"), it will take a long time for social attitudes in India to change. Infertile couples are an easy and soft target for everyone –

Ranging from:

  • friends ("life is incomplete without a baby!");
  • in-laws ("when will I become a grandmother?");
  • relatives ("what do they want to earn money for – they do not have any children to leave it to!"),
  • neighbours ("they may have a lot of money, but what’s the use, they don’t have any children");
  • acquaintances (" no good news yet? Go see this doctor my sister-in-law’s cousin went to – he’s the best!") ;
  • co-workers ("you don’t have any kids, so can you stay on a little longer to finish this job – I need to go back to take care of my children!");
  • right to servants (" the reason she shouts so much is because she doesn’t have any children – serves her right!)
(Gentle reader, if you recognise yourself here, please suffer a pang of guilt, and promise to improve your behaviour the next time round!)

Many otherwise enlightened people take the attitude that infertility treatment is elective – and even compare it to cosmetic surgery. However, infertility is a serious medical condition – it is both a disease and a life crisis.

Others pontificate that these couples should just adopt a baby, rather than take treatment. While adoption is an excellent method of building a family for some couples, it is not acceptable to everyone– and forcing couples to do so when they don’t want to is very unfair.

A major problem is that infertile couples in India are too ashamed to stand up for their own rights – with the result that they often suffer in silence. However, infertility exacts a high toll! Not only do many marriages break up, many women are abused for being infertile as well. Also, infertile employees, because of the emotional stress they are under, are often not as productive in the workplace as they could have been if their problem was successfully resolved.

Fortunately, this discriminatory attitude is now being challenged by advocates for infertile couples – at least in the US. The pathbreaking Americans with Disabilities Act (ADA), provides protection against discrimination for Americans with a disability – a disability being defined as" a physical or mental impairment that substantially limits one or more major life activities."

The US Supreme Court has clearly ruled that reproduction is a major life activity. Since infertility is a physical impairment that substantially limits the ability to reproduce, this means that if an individual experiences discrimination because of his or her infertility, a claim can be made that this is illegal under the ADA. Thus, a police woman employed by the city of Chicago sued the city recently because it did not provide infertility insurance coverage. The Court ruled that infertility is a disability under the ADA, and today the city of Chicago covers the cost of infertility treatment incurred by all its employees.

Many employers in India are not still aware of the issues and concerns facing those with infertility. Employers need to be more understanding of the special needs of those of their employees who are infertile, and be willing to make workplace accommodations for those undergoing infertility treatments – for example, allowing the employee to change her work schedule or to take some time off. Employers, insurance companies, and legislators in India also need to take steps to recognize that reproduction is a major life activity – and that infertile couples need all the help we can give them.

Unfortunately, most infertile couples in India do not feel comfortable speaking publicly about this very private struggle, even though they represent all racial, religious, socio-economic and ethnic groups, as well as both sexes.

We all need to remember that infertile couples are our neighbors, co-workers, friends and relatives - and they just want to experience the joy of raising a family - an experience that so many of us take for granted!

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