A World Health Organization survey released in October 2020 pointed out the disruption in the treatment of mental health issues due to the COVID-19 shock. Another 2020 survey conducted by the Indian Psychiatry Society observed that more than 40% of the respondents have complained of mental health issues. The back-to-back bouts of pandemic waves and lockdowns could have only further worsened the numbers. Thus, COVID-19 provided a much-needed backdrop to renew the discussions on the topic of mental health coverage in health insurance.
Mental health coverage – a timeline
By 2017, India had recognised the perennial presence of mental health issues in its society. The Mental Healthcare Act 2017 was passed, which made insurance cover mandatory for mental illnesses.
In June 2020, the Insurance Regulatory and Development Authority of India (IRDAI) released a circular directing all insurers to ensure the coverage of mental illness in all standard health policies. It further pronounced a deadline of 1st October 2020 for all life, health and general insurance companies to comply with this requirement.
Since then, the health insurance products of many companies have been customised to accommodate mental health treatment coverage. For example,ICICI Lombard General Insurance declared that mental health ailments would be covered in the same manner as physical illness provided the same was declared and accepted at the time of policy issuance.
Insurers and mental health coverage
By providing health insurance for mental issues, the insurance companies were wary that they maybe sailing into uncharted waters with it. It posed a unique factual and financial risk for the insurers. Nevertheless, like all other illnesses, mental health coverage also falls into two broad categories—the OPD cover would cover consultations, medications and therapies, and the hospitalisation would cover long-term treatment and rehabilitation.
Inclusions and exclusions
Insurers are supposed to provide hospitalisation cover on all declared and accepted mental health issues.Accordingly, all mental health issues like schizophrenia, bipolar disorder, clinical depression, personality or neurodegenerative disorders, anxiety, sociopathy and psychopathy etc. are covered under the scope of health insurance. The IRDAI guidelines mandate the inclusion of psychological disorders, stress and neural problems under the scope of health insurance coverage. Problems like obsessive-compulsive disorder, attention-deficit/hyperactivity syndrome, mood upheavals etc. are also covered.
If the customer has opted for OPD cover, the regular OPD benefits as applicable to medical issues would apply to mental health issues as well. You may be aware that most OPD inclusive plans may call for a higher premium amount.
It is assumed that existing mental health issues, if any, are declared at the time of policy issuance and accepted by the insurer. Treatment for any mental illness, if diagnosed after a health insurance policy is bought, cannot be rejected by the insurer. However, before selecting a health insurance policy, you must ensure that it covers mental health as well.
Going by the definition of mental illness, two broad categories are excluded from the scope of health insurance. Firstly, mental retardation is not covered under health insurance. Secondly, treatment for any mental illness resulting from drugs or alcohol abuse is also not covered.
Coverage provided
A health insurance policy is typically required to cover the following expenses arising out of mental health treatment:
- Diagnostics costs, medications, therapy and consultation costs, ambulance charges, room rent etc.
- All expenses under the in-patient treatment and care of a mental health patient.
- Outpatient counselling, therapies, rehabilitation programs etc.
- Some of these costs fall under OPD care while others are covered under in-patient care. Policy buyers may need to consider a health insurance policy with OPD cover.
Ensuring mental health coverage
When you check health insurance online, try to find out the extent of coverage. If it is not clear from the policy wordings, you should contact a representative of the insurance company to confirm the same. For instance, while the Corona Kavach Policy covers COVID-19, there may be policies that provide no or limited coverage against the dreaded disease. Simultaneously, you should also check the treatment required for the mental health condition(s) that you want coverage for. Certain mental health issues are addressed through OPD consultations, therapies and medications. If so, then your health insurance coverage should include OPD coverage as well. On the other hand, if your mental health condition warrants the need for hospitalisation, you should ensure that the policy has coverage for the same.
Other important things to know
Mental health patients – People with mental health ailments, too,can purchase health insurance policies, including people who have used antidepressants or opioids. All they need to do is to declare it as a pre-existing disease.
The waiting period in mental health issues –Pre-existing mental health problems are subjected to a waiting period, just like any other disease. To raise a claim against the treatment of a pre-existing mental issue, the policyholder will have to wait for 2-3 years depending on the waiting period stipulated by the insurer.
Who should opt for mental health cover –People with a family history of mental illness should consider having a mental health cover as experts believe that certain mental health issues may pass on from one generation to the next. People who have undergone any traumatic experience in their life may also opt for health insurance with mental health coverage.
Let us hope that mental health issues are no longer suppressed and stigmatised. With its coverage under health insurance, mental health will be getting the much-needed attention and support.