Decoding Mental Illness In Health Insurance

Mental health is an integral part of our overall well-being. It has become all the more important in the current times of the pandemic when people are observing social distancing and avoiding stepping out of their homes. Depression, stress, and anxiety have increased among people due to a lot of factors like living alone, facing burnout due to work from home, etc.  

According to research by the Suicide Prevention Foundation of India, in May, nearly 65% of 159 mental health professionals surveyed reported an increase in self-harm among their patients. More than 85% of therapists surveyed said they were experiencing caregiver fatigue, and over 75% said fatigue had impacted their work.

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Even before Covid-19, the National Mental Health Survey 2015-16 in India revealed that nearly 15% of Indian adults need active intervention for one or more mental health issues and one in 20 Indians suffers from depression. A report by the World Health Organization(WHO) said that India is the sixth most depressed country in the world leaving the USA and China behind. With 6.5% of the population suffering from some form of mental illness, this goes on to prove that there is a huge gap between patients and mental health care professionals to be filled. The ratio is quite staggering, with 1 doctor for every 1,00,000 patients. Almost 80% of people diagnosed with mental sickness do not seek any kind of treatment and there are 150 million more who need access to therapy.

Law regarding mental healthcare
According to the Mental Healthcare Act 2017, “Mental illness” means a substantial disorder of thinking, mood, perception, orientation, or memory that grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person.
Sec 21(4) of the Act says that every insurer shall make provision for medical insurance for the treatment of mental illness on the same basis as is available for the treatment of physical illness.

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IRDAI directs insurers to cover mental illness

The Act came into force in May 2018 and subsequently, IRDAI directed all insurers to comply with it. Still, a lot of insurers didn’t cover mental illness for customers. So, keeping in mind the growing need for health-care towards mental illnesses, the Insurance and Regulatory Authority of India had issued guidelines last year which stated that exclusion of treatment of mental illness, stress or psychological disorders, and neurodegenerative disorders shall not be allowed in health insurance.

Buy a comprehensive cover

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According to Chhabra, inpatient hospitalization, as well as OPD expenses, will be covered for mental illness by every insurer.

Check if you want OPD or IPD cover
“The coverage of OPD and IPD will be on the basis of terms of conditions of your policy. So, customers need to check whether they want OPD or IPD coverage for mental illness. One needs to check whether the disorder requires hospitalization or can be treated through medical consultation or therapy and select a cover accordingly,” he added.
According to Medical Trends Around the World Survey Report 2018 by Mercer Marsh Benefits, mental treatments requiring hospitalization are far less compared to expert consultations, counseling, and medication. In fact, it is seen that in Asia, insurers have seen only 2% of mental illness claims registered under OPD and none for IPD cases.
If you want to buy a health insurance plan which covers OPD, you can check Digit’s OPD cover. It is available in sum assured options of Rs 5 lacs and Rs 10 lacs. It covers drugs and medication prescribed by any medical practitioner, fees for medically necessary consultation, psychiatric consultation, etc. For a 30-years-old person living in Delhi, the plan for a sum assured Rs 10 lacs will cost Rs 984 per month.

Care NCB health insurance plan covers OPD expenses. Star Comprehensive health insurance plan also has an OPD benefit with a limit of Rs 300/- per consultation. Similarly, Max Bupa Go Active plan gives an OPD benefit as well as pre and post hospitalization cover. If someone has a pre-existing mental illness before buying a health insurance policy, the insurer will issue the policy depending on the severity of the mental illness. If the severity is less, the insurer may issue the policy and decide the waiting period accordingly.

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