Does your health insurance policy cover mental illness?

Not so long ago, there was a taboo around mental illness. People avoided talking about the subject thinking it might disgrace the family. Since then, a lot has changed as people are now much more comfortable talking in open about their mental crisis, including depression, anxiety and psychic disorders.

According to WHO, more than 264 million people suffer from depression globally. The age-adjusted suicide rate in India is 21.1 per 1,00,000 population. Aggravating the problem, there is a massive shortage of psychiatrists in the country. According to statistics, there are only 0.3 psychiatrists per 100,000 people in India.

As a country, however, we are taking significant strides towards tackling the issue of mental illness. Consider this: mental illnesses did not come under insurance purview until April 7, 2017, after which the Mental Healthcare Act (2017) was passed. It came into force on July 7, 2018, with Section 21(4) of the Act stating that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for the treatment of physical illness.” Following the Act, the Insurance Regulatory and Development Authority of India (IRDAI) directed all insurers to cover the insured’s mental health.

Health insurance coverage

Health insurance plans now have to cover hospitalisation expenses relating to mental illness. But like any other illness, it requires 24-hour hospitalisation for covering medical bills. But one should know pre-existing illnesses get covered after a waiting period of 2-4 years depending on policy terms and conditions. However, just for medication or counselling, the insured needs to have an outpatient department (OPD) cover.  

What to do?

One needs to understand the requirements before opting for a plan covering mental illness. “Unlike physical ailments, the majority of mental illnesses require outpatient care. Before buying a cover, one must check if the illness requires only OPD consultation and counselling or hospitalisation for treatment. For OPD cover, one must look at a comprehensive plan that covers OPD consultation, counselling, hospitalisation, medicine cost etc. There are specific plans that offer cover for pre-existing illnesses with a waiting period,” S. K Sethi, director and founder of RIA Insurance Brokers told Money9.

“For a buyer, the crux is to look for a policy that offers OPD cover since OPD accounts for a large part of expense in mental illness treatment. Also one must check hospitals covered for cashless facility offer mental healthcare inpatient treatment,” Sethi added.