Can we buy health insurance cover for mental illnesses?

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After the recent demise of a beloved celebrity Sushant Singh Rajput, the nation was left with a dawning realization on the importance of mental health. A lot of mental health activist have attempted to create awareness about mental illnesses, especially as with Covid-19 takes over the world, we can see an increasing pattern of anxiety and depression among people. 2020 has brought into light that it’s high time we start valuing mental illness as much as any physical injuries. If you are one of those wondering if your health insurance can cover mental illness, you are at the right place and at the right time.

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Mental Healthcare Act (Law) in India or Mental Illness Law in India

Until 7th April, 2017, Mental illnesses were not covered under any insurance policy. It was only until Mental Healthcare Act (2017) came into force on 7th July, 2018 that Mental illness found its rightful place in the health insurance industry. Section 21 (4) of the act states that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness”.
In August 2018, IRDAI, directed all companies to comply with the provisions of the Act and include ‘mental illness, stress or psychological disorder, behavioural and neurodevelopment disorders’ into the guidelines of policy-making.

Know about Current Scenario of Mental Illness in India

Recently on 16th June 2020a notice was issued by the Supreme Court to the IRDAI and Central Government on a plea to provide directions and guidance to all insurer companies to comply with the Mental Healthcare Act (2017) and cover treatment of mental illness in health insurance policies. Yet there is a lot of obscurity and non-compliance in providing medical cover for mental illnesses.

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Health Insurance Risk Assessment & Pricing

This emerges from the fact that it is still an embryotic product and insurers are struggling with actuarial problems of assessing risks and pricing of the product. On one hand, insurers are unable to access the costs involved since most mental illness treatments are out-of-pocket expenses endured by individuals at private medical institutions. While on the other hand, only when the companies offer covers for such medical illness, will the affected people actually avail the treatment and shed more light on the expense and process. Even though, the legality of the matter does not allow insurer companies to refuse cover of mental illnesses, yet these companies have not come on the forefront to plan on the prices of product and premium for covering mental illnesses.

Ambiguity: This stems from lack of clarity around the inclusions of the product. Although insurer companies are barred from excluding mental illness from the plan, yet there are no standalone products with specific plans to cover these ailments. Although a few plans cover Autism in people in the age group of 3-25 years yet they don’t specify the estimated cover of these illnesses.

Moreover, mental illness such as anxiety, depression or for that matter to the extreme core, say schizophrenia, convoluted with physical symptoms such as respiratory (difficulty in breathing) or cardiovascular conditions (such as increased heart rate, chest pain). This is why it is complicated to have a standalone plan and mental illnesses are thus covered under a comprehensive insurance plan that often covers hospitalisation in such cases.

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Yet about 40% of people suffer from mental illness and only 10-12% require hospitalisation. The rest of the affected population seek out-patient treatment or OPD in terms of therapy or counselling. If insurance companies only cover hospitalisation without OPD benefits, it is in practicality of no use.

Where does this place you?

Firstly, if you are looking for mental illness cover, check if the illness requires hospitalization or not. In case of hospitalization, go for a comprehensive insurance plan that covers hospitalization. In cases where hospitalization is not required, you will need a plan that offers OPD benefits. There are very few standalone plans that offer medical covers for specific illnesses. Which is why in our expert advice, go for a comprehensive plan with OPD benefits, this may help you cover for medications if not individual therapy sessions.

Yet we are hopeful that because of the drastic increase in awareness of mental health, we are soon to welcome standalone products in our insurance industry, as we firmly believe that it is the need of the hour.

Get Resolutions for Insurance Complaints

If you are facing any problem while buying health insurance cover for mental illnesses for yourself or family you can contact Insurance Samadhan, our insurance experts are always ready to help you.

To reach us at InsuranceSamadhan.com –

Call us at – 844 844 0626

Mail us at – corporate@insurancesamadhan.com

Register your insurance complaint here

Virendra Suri

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