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Does your health insurance policy cover mental illness

Team AckoFeb 27, 2024

Mental illness has been stigmatised and avoided for a long time by society, family and friends. While there have been enough conversations on physical health complications, there are hardly any on the increasing case of mental illness due to the stigma attached to it. But, thanks to the Mental Healthcare Act, 2017, implemented in 2018, that focuses on the inclusion of mental illnesses for health insurance coverage. Read on to learn about health insurance for mental health in India and its coverage details.

Contents

Does health insurance cover mental health?
What is mental illness insurance cover?
Benefits of health insurance coverage for mental health
List of diseases covered under mental illness cover
Exclusions under mental illness cover
Things you should know about mental health insurance
- Takeaway
Frequently asked questions

Does health insurance cover mental health?

A study by the National Institute of Mental Health and Neurosciences (NMHS), mental illnesses such as anxiety, depression, severe mental disorders, and substance use disorders affect nearly 11% of India’s population. Mental issues have always been looked upon as a stigma and something that people don’t want to talk about. That has changed for good in recent years. People have started to take mental illnesses or disorders more seriously. This change in perspective has influenced the insurance industry too by customising health insurance plans to cover the treatment of mental illness.

One of the important provisions of the Mental Healthcare Act, 2017 states that mental illnesses need to be included in the health insurance coverage. The Insurance Regulatory and Development Authority of India (IRDAI), the regulator of the insurance industry, has asked insurance companies to include coverage for mental health in their health insurance plans.

What is mental illness insurance cover?

The Mental Healthcare Act, 2017 defines mental illness as a considerable disorder in moods, perception, thinking, memory, or orientation that impacts their decision making, judgment, behavior capabilities to meet ordinary day-to-day activities. The Act does not include mental retardation outside mental illnesses since it is primarily due to arrested or incomplete brain development.

Mental illness insurance cover is designed to provide coverage for treatment of the above-mentioned mental disorders. Health insurance coverage for mental disorders undoubtedly would help those with mental illness and reduce their financial burden.

Benefits of health insurance coverage for mental health

Health insurance policies should provide comprehensive coverage, including treatment for mental disorders. Here are the benefits of health insurance for health illnesses.

Mandatory as per the law
One of the primary benefits of health insurance for mental disorders is that it is compulsory to be included in the health insurance coverage as per the Mental Health Act, 2017. Insurers must offer coverage to persons diagnosed with mental illness. There are provisions in the policy to offer coverage for patients suffering from mental health disorders.
Covers a broad range of mental illnesses
Health insurance policies for mental disorders provide financial coverage for a broad range of mental illnesses, including Schizophrenia, Bipolar Disorder, Anxiety Disorder, Dementia, and Alzheimer’s disease. These disorders can interfere with a person’s day-to-day activities and with the normal functioning of the human brain. The financial protection and the scope of mental health insurance coverage is a vital benefit for those requiring medical attention for the betterment of health.
Wider coverage
Most of the plans are designed to offer inpatient and outpatient coverage along with a good sum insured amount. The cost of pre- and post-hospitalisation, treatment and recovery, tests, and diagnosis are covered under the plan. Some of the plans offer coverage for the treatment of poor decision-making capabilities, disorderly mood, memory, and perception.

List of diseases covered under mental illness cover

Following are some of the conditions that are covered under the mental illness cover.

Bipolar disorder
Acute depression
Schizophrenia
Obsessive-compulsive disorder
Anxiety disorders
Hyperactivity/attention deficit disorder
Mood disorders
Post-traumatic stress disorder
Psychological disorders

Exclusions under mental illness cover

Like any other health insurance plan, mental health insurance also has its exclusions. Exclusions are primarily scenarios or situations that the policy doesn’t offer coverage for. It is essential to know the exclusions of mental illness cover to help you avoid rejections of claims. Following are the exclusions under the mental disease cover.

Any type of mental retardation
Mental illness arising from drug or alcohol abuse
Most plans cover medical expenses only when the patient is hospitalised
History of recurring mental illness

Things you should know about mental health insurance

Mental health is vital for a person to perform day-to-day activities without much help. There has been a considerable increase in mental issues due to a sedentary lifestyle, stress, etc. in recent times. Pandemics such as the Covid-19 have had a lasting impact on several people.

It is essential to know the importance of mental health insurance to receive the proper medical care. Apart from being mandatory coverage in health insurance, it covers wide-ranging mental illnesses.

Takeaway

Good mental health will enable you to do your best and perform your daily activities without much help. The severity of mental illnesses is immense, and the treatment can be expensive, and not everybody can afford the medical costs.

Suppose you are looking to minimise your financial burden arising due to the treatment of mental disorders. In that case, it is advisable to buy a suitable health insurance plan that provides substantial coverage for common physical ailments and mental health issues.

Frequently asked questions

Following are some of the commonly asked questions about mental health insurance.

What does a mental health insurance policy cover?

The policy provides coverage for medical costs towards the hospitalisation of the policy’s beneficiary to treat mental illness. The coverage includes treatment costs, medications, diagnostics procedures, road ambulance charges, room rent, etc.

Is depression covered under health insurance?

Health insurance plans that cover mental illnesses cover the treatment of depression and other mental health-related issues such as Schizophrenia, anxiety disorders, bipolar disorders, etc.

Who should opt for mental health insurance?

It is suggested that anyone with any traumatic experience or with a family history of mental illness opt for mental health insurance. It is also helpful for those suffering from trauma due to the demise of their loved ones or from a post-accident trauma. With the stressful lifestyle, anyone could be vulnerable to mental-related health insurance; hence, it is advisable to purchase a health insurance plan covering mental disorders.

Are counseling and consultations covered under mental health insurance?

The coverage differs from insurer to insurer. Not all insurers provide health insurance that covers mental illnesses under the Out-patient Department (OPD) benefit. Check with the insurer about the plan’s coverage and if it includes OPD benefits for mental illnesses.

Is there a waiting period for a mental health insurance policy?

Yes. Like all other pre-existing illnesses, mental illnesses also have a waiting period. You need to check with the respective insurer about the waiting period.

What is the minimum time a mental illness patient must be hospitalised to be covered under mental health insurance?

To avail of the health insurance coverage for mental illness treatment, you must be hospitalised at least for a minimum of 24 hours. Some insurers provide OPD coverage for the treatment of mental illness. Check with the insurer while purchasing the plan to understand the extent of the coverage.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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