Is Mental Health Covered in My Health Insurance Plan?

With regulatory changes in India and increasing awareness around mental health conditions, medical insurance policies cover them. Remember, your mental health is just as important as your physical health. Therefore, you must monitor the inclusions, coverage and claim process. 

Does a Health Insurance Policy Cover Mental Health?

Yes, mental health conditions are also covered by the health insurance plan. The Mental Healthcare Act of 2017 (effective from May 29, 2018) mandates all insurers to offer coverage for mental health illnesses under the health insurance policy under the same conditions as physical illnesses. 

The Insurance Regulatory and Development Authority of India (IRDAI) has also directed the insurance companies to follow the rules stated in The Mental Healthcare Act, 2017, and offer mental illness treatment coverage in their policy products.

What is the Mental Health Insurance Cover?

The rising cases of stress, depression and anxiety led the government to introduce the Mental Healthcare Act. The Mental Healthcare Act, 2017, identifies mental illness as significant changes in memory, thinking and mood which prevent them from making sane decisions, affecting their behavioural capabilities and judgment. This affects their daily functioning. 

With such a grave concern, the medical health insurance cover has been introduced to offer coverage for mental health problems. Mental health treatment, such as therapy, can be expensive. Not having coverage means you have to pay for your treatment from your pocket. This can put extra financial strain, triggering the mental health to worsen. That's why getting coverage is essential, not only for treatment but also for preventing unwanted financial drain.

What Mental Conditions Does a Health Insurance Policy Cover?

The health insurance policy covers a wide range of mental health conditions. These conditions are the ones that affect cognition, behaviour, memory and decision-making skills of the individuals. Therefore, some of the mental health conditions covered by the insurance policies include:

• Anxiety disorders
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Psychotic Disorders
• Somatoform Disorders
• Schizophrenia
• Bipolar Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Depression
• Obsessive-Compulsive Disorder (OCD)

Note: The coverage for all these conditions will depend on the insurer. Thus, make sure to compare the coverage among all.

What are the Inclusions of Health Insurance Plans for Mental Conditions?

The inclusions for mental conditions are the same as those of physical conditions. Most of the plans are designed to offer proper inpatient treatment benefits. However, outpatient treatment like day-to-day consultations and therapy might not be covered by your health insurance plan. 

The insured received a significant amount as the sum insured. Therefore, these would include pre- and post-hospitalisation expenses, examinations, diagnostic tests and treatments. There are specific policies which may also offer coverage regarding memory problems, mood issues and other perceptual problems. 

Are There Any Exclusions for the Health Insurance Policy?

Yes, there are specific exclusions for health insurance regarding mental conditions. Familiarity with the exclusions will help you prevent the risk of claim rejection. Some of the standard exclusions within the mental disease cover include:

• Mental retardation.
• Mental illness that happened because of drug or alcohol abuse.
• History of recurring mental health conditions.

Benefits of a Health Insurance Policy for Mental Health Conditions

A lot of people are not aware that they're suffering from a mental health illness. This is a strong reflection of the stigma around this subject. Moreover, many people did not seek treatment due to its high cost. However, with mental illness coverage in health insurance policies, a lot of people are going for treatment. 

Some of the key benefits of mental illness coverage in a health insurance policy include:

• Affordable premium options are available for better mental care of patients. The premiums are affordable, as mental health is included in your standard health insurance policy and not sold separately for a higher cost. 
• Mental illness coverage in health insurance policies also helps to address stigmas and promote the need for mental wellness care. 
• The insurers are required to maintain the confidentiality and privacy of the policyholder under the Mental Healthcare Act, 2017. 
• Mental health insurance comes with a wide range of coverage, especially for psychiatric sessions and therapy. 

Essential Points to Know About

Some of the key things to know about mental health illness coverage as per your insurance policy include the following:

• Insurance claims will only be provided if a qualified professional does the treatment. 
• The waiting period usually ranges from 24 to 48 months, depending on the insurer. 
• OPD treatments that require daily consultations aren't covered by insurance.