Mental Illness Causes, Symptoms and Coverage in Health Insurance Policy, India

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6 min read

Updated on Jan 23, 2023

Mental illness is a serious health condition that is hardly being talked about in India. Even the health insurance providers are not giving much attention to this severe condition. Let us discuss mental illness, its symptoms and coverage, in this post. 

As compared to the physical illnesses, which receive all the attention under medical insurance coverage, the mental illnesses are not much spoken or cared about. However, this doesn’t mean that there are no cases of mental illness in India. In fact, as per a report by WHO, 7.5 per cent of India’s population is suffering from mental diseases. It has also been recorded in reports that a large mass of employees working in the corporate sector in India suffer from anxiety and depression.

Despite that, mental illness is a health condition that is not getting the required attention from health insurance providers. This is clear from the meagre number of policies which cover the disease extensively.

Over the last few years, especially during the post pandemic period, there has been a huge surge in the number of patients suffering from mental disorders. This indicates the likelihood of having a record growth in the demand for mental health condition coverage.

It is evident that there is a serious need for a good care system for psychiatric treatment along with the backup of mental health insurance India offered by prominent insurers.  Let’s discuss it in detail.

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What is Mental Illness?

Before coming to mental illness coverage, let us check the mental illness definition as well as its causes to understand the disease better. So, mental illness is a health situation that involves fluctuations in behavior, emotions, or thinking of individuals. It can also be a blend of all such conditions together.

There are various causes of mental illnesses such as stressful life, emotional breakdown, financial loss, or because of genes and family history etc.  Further, there are different types of mental illnesses, which are characterized by varied mental conditions.  Change in feelings or conduct, loss of interest, change in the sleeping habits, low energy, loss of appetite or weight changes, uncontrollable emotions etc., are some of the mental health symptoms that might trigger the effects of the illness.

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What is Mental Illness Coverage?

As per the Mental Healthcare Act, 2017, every insurer has to make a facility for offering medical insurance for the treatment of mental illness like they provide for physical illness. The Act was implemented in 2018 and it directs insurers to allow coverage against mental illness and cater to policyholders suffering from such conditions.

The Act further reiterates that mental illness is a substantial disorder that requires support of insurance. Policyholders with mental conditions can file for a health insurance claim if they fall within the category of agreed mental conditions as per the 2017 Act.

Know More: Do Health Insurance Policies Cover Depression?

Plans Offering Mental Illness Coverage in India

As per the strict orders of IRDAI, all health insurance providers are required to provide mental health illness coverage under their health insurance plans.  However, there are some insurers who have come up with special plans catering to the specific needs of different kinds of mental illness under their policies.

Popular Health Insurance Companies 2023

4 Popular Health Insurance Plans by Insurers Covering Mental Illnesses

1. Activ Health Enhanced by Aditya Birla Health Insurance

The Active Health Enhanced plan by Aditya Birla Health Insurance is regarded as the first ever plan in the country to offer mental health illness counselling coverage. Generally, mental illness counselling is not included under medical insurance policies. However, this special plan is rewarding policyholders for up to 100% of insurance premium in the form of HealthReturnsTM. The policy offers coverage from day 1 for chronic diseases.

Below are the features of the plan:

Features  Details
Sum Insured INR 2 lakh – 2 Crore
In-Patient Hospitalization On the basis of sum insured
Pre-Hospitalization Expenses Up to 60 days
Post-Hospitalization Expenses Up to 180 days
Day Care Facility Available
Ambulance facility Available
Domiciliary facility Available
Expenses of organ donor Available
Sum insured reload facility Offered up to 100% Sum Insured
Ayush treatment hospitalization expenses As per sum insured
Mental illness hospitalization expenses Up to sum insured

Also Read: Celebrate World Mental Health Day 2022-23

2. Max Bupa GoActive Plan

This holistic plan offers customers complete coverage for all their health requirements from day 1 of the policy. The cover also allows a total body check-up of up to INR 2,500. It also offers up to 20% renewal discount and a 10% discount as per the AdvantAGE feature of the plan as mentioned in the table below.

Mental disorder  Treatment details 
Consultancy for Behavioural Assistance 3 consultations available per person per policy year
Second medical opinion coverage Available, (one opinion per insured per mental illness (specific)
AdvantAGE Can avail a 10% discount in base premium for first policy and subsequent renewals, if the policyholder enters the plan before the age of 35

3. HDFC Ergo’s Critical Illness Plan – Platinum

This platinum plan from HDFC Ergo offers cover against 15 critical illnesses including Alzheimer’s. The plan offers a lump sum amount if diagnosed with a critical illness included under its list. However, the policy is available with a waiting period of 90-days before the insured could raise a claim. The entry age of the plan is from 5 – 65 years of age.

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4. Manipal Cigna ProHealth Insurance

This is another holistic policy designed to cover the insured with complete protection against medical emergencies. The plan is available in 5 different variants, namely:

  • ProHealth Protect
  • ProHealth Plus
  • ProHealth Accumulate Large Cover
  • ProHealth Preferred, and
  • ProHealth Premier

With INR 2.5 lakh as the sum assured, the plan allows coverage against the expenses like hospitalization, day care procedure, and domiciliary treatment among others.

To Conclude

With more and more people becoming vocal about mental health issues, the insurance sector is also coming up with new and upgraded policies to cater to the various mental illnesses under their comprehensive mental illness insurance coverage plans.

However, right now in most policies offering coverage for mental illness, the exclusion and waiting period serve as hindrance to keep the policyholder away from availing the benefits. Hence, it is important to read through the clauses well and compare plans before buying a health insurance covering mental illness to cater to your needs.

Read More: 

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FAQs: Mental Illness Coverage in Health Insurance

Is mental illness covered by insurance?

Yes, as per the Mental Healthcare Act, 2017, health insurance companies in India provide coverage for psychological disorders under the mental illness cover.

How does insurance work in mental health?

To avail the facility of health insurance coverage for mental illness treatment, the insured has to be hospitalized for a minimum 24 hours. There are some insurers who offer mental illness OPD coverage, however, it is necessary to check with the insurer before buying the policy.

Why is mental health insurance important?

A mental illness patient spends a significant amount of money on OPD expenses, such as medicines, daycare treatments, consultations etc. With the availability of insurance coverage under different plans that cover such OPD costs and other related expenses, it becomes easy for the patient to avail the treatment. 

What factors appear to be most linked to mental health and illness?

Some of the factors which might affect mental illness, include:
Family history of mental illness 
Stressful life situations
Financial problems
Loss of a loved one
Some chronic medical condition that is ongoing etc.

What benefits are available for mental illness?

Ayushman Bharat is the flagship health insurance scheme of Government of India that offers insurance coverage of up to INR 5 lakh. This scheme is one of the first government plans that allow coverage for mental illness with 17 mental health disorders being covered under the plan. 

Does Bupa cover autism?

Yes, Niva Bupa Health Insurance Policy offers coverage against autism.

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Jan 19, 2023
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PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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