Things to consider before buying insurance for mental health

WHO has stated that about 7.5% Indians suffer from some mental disorder and predicts that by end of this year, roughly 20% of India will suffer from mental illnesses. WHO has also noted that the mental health providers in India are not adequate and there is a huge shortage of psychiatrists and psychologists in the country for the population suffering from mental health issues.

According to WHO, there are 0.3 psychiatrists, 0.12 nurses, 0.07 psychologists and 0.07 social workers in India per 100,000 population. The desirable number is above 3 psychiatrists and psychologists per 100,000 population. India also accounts for 36.6% of suicides globally, up from 25% in 1990.

In accordance with UNCRPD (United Nations Conventions for Rights for Persons with Disabilities) guidelines, Mental Healthcare Act 2017 was passed, which stipulates mental healthcare for everyone without discrimination and decriminalised attempts to die by suicide.

Following this, IRDAI issued a directive to all insurers to cover mental health illness under the health insurance umbrella.

Mental illnesses in India have been on the rise among all age groups. Mental disorders can be attributed to many causes like genetics, stressful and abusive family environment, childhood trauma, lifestyle and dietary factors, drugs and alcohol abuse and negative thought patterns. There are socio-psychological factors also at play. In last few decades, there has been a significant change in our social milieu. Nuclear families, loss of supportive networks, increased stress due to work, long hours, high expectations and demands of a fast paced lifestyle, loneliness, all contribute to long term mental stress and manifest mental disorders.

Elderly people are more prone than ever, to mental illnesses. Higher life expectancy, chronic diseases, disability, increasing inflation, erosion of retirement income due to low fixed income returns, lack of any social security or medical benefits, increasing cost of healthcare, loss of a loved one, lack of social support structures, all go on to impact emotional and physical health.

There are increasing cases of crime against elderly reported, also abuse, alienation and abandonment by near and dear ones. In India, over 5.3 million people suffer from dementia and Alzheimer’s is the main cause. The number is expected increase to 7.6 million in 2030, according to the Dementia in India Report 2020 published by the Alzheimer’s and Related Disorders Society of India (ARDSI).

The current Covid crisis is unleashing a mental health crisis world over. Experts predict a jump in long term mental health repercussions in general population and those who suffered Covid.

Quarantine, social distancing, isolation from family members & friends, fear and anxiety of getting the infection, global economic crisis and loss of income and jobs, emotional disturbances due to lockdown and change in routines, alcohol abuse, anger, uncertain future and sense of helplessness are going to have long term psychological implications.

In this scenario, it is high time and pertinent to create an infrastructure for mental illness treatment. Bringing metal illnesses under insurance cover is a crucial step towards this. With the directives given by IRDAI, mental health illness insurance has become a subject much talked about. The Insurers are now committed to treat mental illness on par with physical ailments. The standard exclusions in health policies, which earlier clearly specified mental illness as excluded, have now been modified.

Let us see what has changed on the ground. Currently, most health insurers offer cover for hospitalisation due to mental illness, including treatment, tests, medicines etc. just like a standard cover for physical ailments.

It requires 24-hour hospitalisation to claim the expense. Most insurance offerings in the market do not cover out-patient consultation or counselling charges. The Pre-existing Illness clause with waiting period of 2-3 years is applicable for mental illness too. Most mental health conditions like Acute Depression, Anxiety Disorders, Psychotic Disorders etc. are covered. Mental health conditions caused by substance and alcohol abuse are not covered.

Unlike physical ailments, majority of mental illnesses require out-patient 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.

For example, Digit Insurance’s OPD Policy provides OPD cover to a limit and brings a cover of Rs 5 lakh to 10 lakh. Digit Health Plus policy covers pre-hospitalisation, post-hospitalisation, day care and domiciliary treatment. It provides cover for psychiatric illnesses like depression, dementia, bipolar disorder, anxiety disorders.

Insurers like Future Generali are going a step further and taking steps to build awareness and initiate conversations around mental health. They recently launched an online campaign to identify early manifestations of mental health issues and urging people to seek help.

HDFC Ergo’s My Health Suraksha Plan covers Mental illness hospitalisation under its disease cover umbrella. Max Bupa, Manipal Signa, Reliance General Insurance have introduced mental health in their health insurance cover offerings.

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

Due to social stigma, discrimination and tendency to hide mental health issues, mental health care in the country is at a nascent stage. The emphasis by regulator and steps taken by insurers will go a long way in creating a conducive environment and bring relief to those suffering in silence. This is also going to increase the health insurance penetration in the country, with a range of physical and mental illnesses being covered by insurers.

(The writer is director and founder of RIA Insurance Brokers. Views expressed are personal)