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Is Mental Illness be Covered in Medical Insurance?

29 June 2022, 3:53 PM

Talking and discussing mental issues have been taboo in our country for a long. People facing such issues do not openly talk about these problems which can worsen the situation even more. However, there has been a shift in the scenario these days and people are gradually opening up about any kind of mental issues that they are facing. This gradual shift in the attitude and approach of people towards mental illness will also have a great impact on the framework of the health insurance policies in India.

The introduction of the Mental Healthcare Act of 2017 has made it mandatory for health insurance providers to give an equal amount of importance to physical and mental problems. The problems related to mental illness were not considered within the scope of health insurance coverage until April 2017. The Mental Healthcare Act (2017) stated that “every insurance provider would make provisions for the medical insurance coverage for the treatment of mental illnesses on the same basis as that of the coverage available for any other physical illnesses.”  The IRDAI had released guidelines by which the exclusions of the health insurance policies can be standardised. By these guidelines issued on 30th September 2020, the treatment of mental illness, stress, or psychological disorders would not be considered as exclusions for health insurance plans anymore.

Current Status of the Medical Cover for Mental Illness

Few health insurance companies have exhibited a positive approach to this change. Some of the insurance providers have started the launch of specialised health insurance products which would provide cover for various issues related to the mental health of people. It is quite obvious that the premium of health insurance plans would increase since mental health coverage would be included. But, this initiative by the Insurance Regulatory Authority is a commendable one for the mental well-being of people.

However, there are a large number of health insurance companies that still do not consider the coverage of mental illness as a serious matter. Several health insurance companies do not show compliance with the guidelines issued by the IRDAI as well.  

The major causes which can be listed for the non-compliance of various health insurance companies regarding the cover for mental illness can be listed below.

  1. The assessment of the risk involved – 
    The medical insurance coverage for mental illness would be a nascent insurance product and the health insurance providers find it problematic in assessing the risk involved. The mental illnesses were being mainly covered out of the pocket of the policyholder. So, it is quite a challenging task for the underwriters to estimate the price of the health insurance policy covering mental illness.
  2. No stand-alone plans – 
    Another important problem is that even though mental illness coverage has been removed from the plethora of health insurance exclusions, there is no stand-alone plan. There are a few health insurance companies that provide stand-alone health insurance plans for the coverage of mental illness. Mental illness would include several other health conditions just like cardiac or respiration and are mainly covered under a comprehensive indemnity plan.
  3. Hospitalisation and OPD – 
    Mostly, health insurance providers would provide in-patient hospitalisation coverage. On the contrary, the out-patient hospitalisation and counselling is not offered under the health insurance policies covering mental illness or would only be covered if the policy has OPD benefits. But, a majority of the patients having mental disorders do not need in-patient hospitalisation. So, if a policyholder does not require in-patient hospitalisation due to mental illness and has a basic indemnity plan without the OPD benefit then there is no use for that insurance plan.

Viewpoints of Insurance Advisors

  1. According to insurance experts, the rule introduced for introducing mental health coverage within health insurance is the right initiative taken by the IRDAI. By this, the policyholders who are having any mental issues can now lead a respectful life.
  2. Many other insurance experts have also given the opinion that this move was a long-awaited one and would be helpful for those dealing with mental illnesses.

What You Should Do in This Scenario?

If you are in a situation in which you are searching for options to provide mental illness cover, it is necessary to check if the disorder would need hospitalisation. If there is a need for hospitalisation, then you can prefer a comprehensive indemnity plan which provides cover for hospitalisation. However, if you need only therapy for dealing with mental sickness, then you can opt for a health insurance plan which would provide OPD coverage.

If you are undergoing any kind of counselling or therapies for mental health, you must choose an adequate cover. The charges related to every psychiatric session can be quite high and paying these charges from your pocket can drain all your savings.

Exclusions of Health Insurance Plans Covering Mental Illness

The health insurance plans which cover mental illness would have the below-mentioned exclusions.

  1. Health insurance plans would not offer any coverage for any kind of mental retardation.
  2. The adverse impacts on mental health which can occur due to any kind of drug abuse or alcohol abuse are not included in the scope of the health insurance plan.

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So, the impact of this Act related to mental illness coverage is gradually being incorporated by various insurance providers. From the top, the changes might not appear to be much but internally there would be the implementation of certain changes. The premiums would also see changes and you must do research, compare, and then purchase your policy wisely.

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