Urgent Need for Enhanced Regulations to Safeguard Children with ADHD and Autism from Health Insurance Discrimination

Recently, media reports have highlighted the difficulties children with autism and ADHD (Attention Deficit Hyperactivity Disorder) faced in buying medical or critical illness insurance, sparking public discussion. In fact, 10Life has also received numerous cases on social media of children with autism and ADHD being denied insuring. To understand the underwriting criteria of insurance companies for children with autism and ADHD, 10Life conducted research and inquired with 14 insurance companies including AIA, AXA, BOC Life, Bowtie, Bupa, China Life, Cigna, FT Life, FWD, Generali, HSBC Life, Manulife, Prudential, Sunlife, 11 of which responded.

The findings showed that many insurance companies lack a unified, standardized set of criteria for accepting or rejecting applications. Among the responding companies, seven provided clearer answers, with some accepting applications for mild to moderate cases for critical illness and medical insurance applications (see table below). Additionally, four companies (Bupa, Cigna, FT Life, HSBC Life) stated they would conduct assessments for each case. The remaining three companies (AXA, BOC Life, China Life) did not respond.

As seen in Table 1, AIA, Manulife, Prudential, and Sunlife indicated that applications from children with mild to moderate autism or ADHD may be accepted, with some considering the applicant's age. FWD indicated it generally accepts mild cases.

Bowtie and Generali assess the applications based on medical history, with Generali having an age limitation. However, it is important to note that even if an insurance company accepts an application, there may still be additional premiums or exclusions. Generally, medical insurance has stricter underwriting requirements than critical illness insurance does.

Is it discriminatory for insurance companies to deny coverage to children with autism and ADHD? According to the Disability Discrimination Ordinance, anyone who treats another person worse based on their disability (i.e., less favorably than non-disabled individuals) is considered discriminatory. However, if an insurance company bases its assessment of the risks associated with a disability on actuarial or other reliable data, it may be exempt from liability. This means that if an insurance company has data indicating that the risks of insuring children with autism or ADHD are too high, it would not be treated as “discriminatory”.

Amanda Fok, founder of the Hong Kong Let's Talk ADHD organization, mentioned that foreign studies have shown similar genetic variations among mental illnesses, which are highly correlated with PTSD and anxiety disorders. However, there is currently no clear evidence linking ADHD with critical illnesses like cancer.

Wallace Lau, founder of the Autism Life Development Society, believed that the denial of coverage for children with autism is discriminatory. He pointed out that Hong Kong insurance market is well developed and should be mature enough to provide coverage for children with autism or ADHD. Furthermore, Wallace emphasized that the symptoms of autism exist on a broad spectrum, thus the insurance companies should not treat all children with autism with the same restriction.

Dennis Lun, 10Life Co-founder and CEO stated, "We have asked insurance companies whether they have data showing that children with ADHD and autism are at a higher risk for critical illnesses, but many companies couldn't provide an answer! So, is the justifiable for insurance companies to refuse applications?"

Considering the above situation, 10Life has reached out to the Insurance Authority, the Department of Health, and the Equal Opportunities Commission.

The Insurance Authority did not provide a direct response to the difficulties faced by children with autism and ADHD in obtaining insurance. However, it noted some insurance companies have recently launched products related to mental health and neurodiversity that cover autism, ADHD, and some emotional disorders. It also encouraged companies to continue innovating products for underprivileged consumer groups. However, these products are only available to individuals who have not been diagnosed, that means children with confirmed autism and ADHD may not benefit.

The Equal Opportunities Commission stated that if it receives complaints about insurance companies refusing coverage, it will assess how the companies justify their decisions (for example, by citing reasonable data) to determine if they can be exempted under the Disability Discrimination Ordinance.

The Department of Health did not respond directly, stating only that the Food and Health Bureau (FHB) launched the " Pilot Scheme on New Service Protocol for Child and Adolescent with Attention Deficit Hyperactivity Disorder and Comorbidity (“ADHD+”)" in 2021, collaborating with five NGOs to create a cross-disciplinary community service platform to provide early and timely assessments, support, and intervention services for 1,007 children and adolescents with mild to moderate ADHD.

Dennis added, "Insurance companies should bear social and moral responsibilities, calculate risks, and provide coverage for diverse customer groups, ensuring fair protection. Moreover, regulatory authorities could be more proactive in encouraging insurance companies to insure children with autism and ADHD. The FHB could also consider including coverage for these patients in Voluntary Health Insurance Scheme (VHIS)."

1. Buy Insurance Early: Autism and ADHD are generally diagnosed after age 3. If insurance has been purchased before a child is diagnosed or shows symptoms, the insured can obtain more comprehensive coverage more easily.
2. Honestly Disclose Health Records: Some advisors may claim that there is no need to disclose autism and ADHD histories during the application process. However, even if the application is successful, the insurance company may still review the insured’s past medical histories, especially if claims occur within the first two years of coverage; as such, when any concealment during the application was discovered at the claim stage, insurance companies may deny claims and cancel the policy. Therefore, parents should uphold the “utmost good faith” principle to answer all questions honestly when applying insurance for children with autism or ADHD.
3. Apply for Different Companies if needed: Insurance companies have different underwriting policies leading to different underwriting results. In fact, 10Life has assisted some children with autism and ADHD in buying insurance, but this required inquiries with multiple companies.
   
   Lastly, if parents have any insurance needs or claim questions, they are welcome to contact 10Life. Our insurance advisors are familiar with various insurance products and will help clients find appropriate coverage and negotiate for fair compensation.
    

Last updated date of this article: 17 January 2024