& What You Should Think About While Buying One
“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.”
– Section 21(4), Mental Healthcare Act, 2017
The COVID-19 pandemic has led to a catastrophic loss of human life worldwide. It has at the same time revealed gaps in the health systems around the country. As healthcare service providers recover from the shock of the pandemic, consumers of healthcare services are looking at insurance policies that can help them handle the sudden rise in medical costs. Given the unfortunate rise in mental health problems around the world due to the pandemic, healthcare users now are also looking at dynamic and more expansive health insurance policies which can cover mental health costs such as diagnostics, medications, treatment costs, ambulance charges, etc.
It’s been more than two years since the regulator, Insurance Regulatory and Development Authority (IRDA), pursuant to directions from the Supreme Court in June 2020, made it mandatory for health insurers to include mental health treatment under scope of coverage. However, multiple mental health professionals and organisations nationwide continue to push for coverage of mental health costs across the various health insurance policies to reduce the burden of rising costs on the mental health service users, especially during the ongoing pandemic.
Both within the psychiatric and psychological community and among the general public, there is little awareness about the insurance benefits available to persons seeking mental health services. There’s some evidence that health insurance policies improve service utilisation and reduce the burden on personal expenditures for individuals living in developing countries. Insurance policies can help to bridge the treatment gap. Hence, we have compiled a list of some of the insurers who have introduced or changed their health insurance policies to cover costs incurred because of mental illness in an effort to disseminate information about the same and increase public access to mental health services.
We recommend that you go through the policy wordings and prospectus put forth by each company before concluding the sales. Many companies require their customer to have received the diagnosis during their policy period in order to cover expenses. Pre-existing mental illnesses and recurrent mental illnesses therefore may be excluded from their policy, please enquire about the same.
- Ayushman Bharat
Ayushman Bharat, the National Health Protection Mission, includes financial support for screening and treating mental illnesses. Those in need of mental health services should be referred to a high-level facility, which will provide inpatient and outpatient services, counselling services to patients and their family, dispense medicines to patients with psychiatric disorders, and send patients to addiction treatment centres. However it does not cover mental health treatment at private hospitals.
- Aditya Birla Health Insurance Company
Aditya Birla Health Insurance offers its customers support for counselling, consultation as well as hospitalisation expenses. Activ Health is a product of the company that offers customers access to mental health counselling. – Source
- Digit Mental Health Insurance
Digit covers expenses that customers incur towards hospitalisation due to a mental illness including diagnostics, medication, treatment, room and ambulance charges.
- HDFC Ergo General Insurance
They cover hospitalisation expenses incurred for treating mental illnesses under the ‘My Health Suraksha’ plan.
- ICICI Lombard
The company covers hospitalisation and outpatient expenses for customers under their Complete Health Insurance and Premium customers’ plans respectively.
- Loop Health
For organizations, Loop group insurance policy offers “wellness sessions” for employees as well as unlimited consultations with their mental health counsellor. The Loop Health app provides free mental health counselling services to customers.
- Manipal Cigna
If the customer so opts, the company’s ProHealth Insurance plan provides insurance to cover in-patient treatment costs.
- Max Bupa Health Insurance
The company covers psychiatric and psychosomatic conditions, including Parkinson’s and Alzheimer’s, and clearly states that the insurance will cover expenses even if the disorder were to be caused due to accident, illness or general debility.
- Reliance Health Insurance Company
The company’s Health Infinity Insurance Policy covers costs related to treatment of mental illnesses beginning from pre-hospitalization to post-hospitalization medical expenses.
- Star Health and Allied Insurance
Mental disorders that require hospitalization are covered by the company’s health insurance policies. The Star Special Care Plan is one of the very few insurance plans in the country to cover autism.
- Different companies provide their own list of exclusions which lists the disorders that will not be covered by their policies. Refer to these.
- Enquire beforehand, the features of each policy. Only specific policies offered by each insurance company include outpatient services.
- Intellectual disability or mental retardation generally does not fall under the umbrella of mental illness and therefore may companies do not cover it in their insurance plans
- Costs related to treatment of substance use disorders are also often excluded from insurance policies.
- Preventive and aftercare services are often excluded from treatment costs. If rehabilitation, halfway home services, etc are a priority, then look for special policies that cover these service costs.
- Suicide is another grey area in insurance policies and one should enquire about the coverage of realted costs before purchasing a plan.
- Waiting periods exist for mental health coverage too and it is therefore best to purchase policies as a preventive activity, in advance.
While companies cover mental health costs, issues such as lack of transparency, forced waiting periods and limited scope of coverage (such as the exclusion of suicide and related health complications, exclusion of certain types of mental disorders, etc.) among others, that complicate individual access to such insurances still persist. Furthermore, many insurers focus on hospitalisation and leave out outpatient, aftercare and rehabilitation services which are crucial to mental health recovery. We hope that mental health advocacy in the coming years will influence mental health insurance policies to expand to include diverse mental health services to serve the diverse needs of persons with mental illnesses.
Bibliography: Gowda, M., Basavaraju, V., & Math, S. B. (2019). Health insurance and mental illness. Indian Journal of Psychiatry, 61.
Ministry of Law and Justice. The Mental Healthcare Act; 2017. Available from: http://www.egazette.nic.in/ WriteReadData/2017/175248.pdf.