Does your health insurance policy cover mental illness? Here’s what insurers say

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Few insurers offer products offering holistic health coverage for mental illness.

COVID-19 has not only affected the physical health of people, but has also led to higher levels of stress, anxiety and even depression across the world. According to the results of a World Health Organization (WHO) survey released in October, the coronavirus pandemic has disrupted or interrupted essential mental health services in 93% of countries around the world as demand for health mental increases. The survey, covering 130 countries, highlighted the impact of COVID-19 on access to mental health services, highlighting the urgent need for increased funding.

Surveys carried out late last year reveal a significant increase in mental illness cases in India after the world’s largest lockdown was imposed on March 25.

With the passage of the Mental Health Care Act in 2017, the Insurance Regulatory and Development Authority of India (IRDAI) – the country’s insurance regulator – made coverage for health issues mandatory. mental health insurance in the same way as physical health problems. (Read also: What changes in your health insurance policy from October 1: 5 points)

In a circular published in June last year, the regulator asked insurers to include mental illness in regular health insurance coverage. According to IRDAI, all insurers must offer insurance coverage to people diagnosed with mental illnesses. IRDAI has asked all insurance companies in the country – whether life, health or general insurers – to comply with the instructions by October 1, 2020.

In accordance with regulatory guidelines, some insurers have already customized their products to meet the specific needs of people with mental illnesses.

Private insurer ICICI Lombard General Insurance, for example, offers plans to cover mental health issues. The company’s flagship product, ICICI Lombard’s comprehensive health insurance product, provides hospital coverage for all reported and accepted mental health issues. In the event that the client has opted for outpatient coverage by paying an additional premium, OPD benefits will also be available up to the OPD sum insured.

“Mental illnesses should now be covered in the same way as physical illnesses, provided they were declared and accepted at the time of issue,” says Sanjay Datta, Head of Underwriting, Claims and Reinsurance , ICICI Lombard General Insurance. has standardized the wording of its policies “with regard to definitions, exclusions and general conditions … and the language used is simple and clear”, he adds.

While most insurers recognize that treatment for most mental health problems takes place outside of a hospital, there are few products that offer holistic health coverage.

The private sector insurance company Star Health and Allied Insurance offers plans that cover the hospitalization of patients for all mental disorders requiring hospitalization.

“We cover all mental disorders requiring hospitalization in all of our health insurance policies. For example, schizophrenia, manic-depressive illness, bipolar disorder, severe depression, severe anxiety neurosis, electroconvulsive therapy, etc. ”said Dr S Prakash, Managing Director, Star Health and Allied Insurance Some company plans cover both inpatient and outpatient care.

According to the healthcare platform Practo, online queries for psychiatry increased by 50% in the first two weeks of the lockdown, with most queries coming from the 21-30 age group. Online consultations for mental health issues have increased by 180% in the six months of the COVID-19 pandemic, according to Practo.

However, some insurers say mental health is still seen as a stigmatized concept in different parts of the country.

“It is important to understand that the issue of mental illness is stigmatized in India and for any health coverage to work effectively we must first standardize the concept,” said Max Bupa, a private sector health insurer. “Some time ago, our partner Bupa launched a campaign called ‘Is this normal? “, which has largely focused on efforts to normalize the problem of mental health and has encouraged more people to see a doctor,” he adds.

Pre-existing conditions

According to private insurance broker Marsh India, pre-existing mental health issues are covered by tailor-made health plans, in which the underwriter receives the same treatment as for pre-existing physical illness.

“Although hospitalization is the most common benefit, insurers are prepared to purchase outpatient care coverage as well as therapy sessions when prescribed by a psychiatrist. / flexible approach that requires employee contribution on a voluntary basis, ” said Sanjay Kedia, Country Manager and CEO of Marsh India Insurance Brokers.

“The ability to tailor mental health benefits to individual client needs based on demographic needs and budgets has dramatically increased the prevalence of this coverage,” he adds.

Max Bupa began covering mental health illnesses with the launch of his product, GoActive, in early 2018. “We have introduced coverage for mental health illnesses as part of some of our products such as than GoActive, ReAssure and Health Premia, well before the regulator’s standardization circular. is out, ”says the insurance company, which claims to have a non-discriminatory approach to physical and mental health.

“Most common mental health issues are accepted and covered by our products … Many mental health related consultations can be treated through OPDs, which are also covered by GoActive, which offers behavioral counseling for Clients receive telephone advice from leading psychiatrists, psychologists and mental health professionals in the comfort of their own homes, ”said Dr. Bhabatosh Mishra, Director of Underwriting, Products and Claims at Max Bupa Health Insurance.

How to choose a health insurance plan with coverage for mental illness

Your standard health insurance plan may not cover mental illness. Therefore, it is prudent to know the key characteristics to keep in mind when selecting the most suitable insurance policy, experts say.

“If a person wants to invest in mental illness coverage, they need to check whether the disorder requires hospitalization or can be treated with therapy and medication. In the first case, the person can opt for a full compensation plan that covers hospitalization, and in the latter case, the person will need a plan that also offers OPD ”, explains Naval Goel, CEO and founder of PolicyX.com, an IRDAI approved insurance comparison portal.

“If a person is diagnosed with a mental illness as a result of purchasing a health insurance policy, the insurer cannot reject the claim,” he explains.


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