Do Health Insurers Cover Mental Illnesses in India?

Geetika talks openly about her mental health situation. She suffers from depression and anxiety. She attends regular therapy sessions and takes her medication daily, even when around people. A few years ago, it would have been not easy to imagine this situation. The term “mental” had a very negative connotation to a majority of us.

The IRDAI Mandate

The IRDAI has now made it mandatory for insurers to cover mental health. Insurance companies are in various stages of being compliant with IRDAI’s mandate. Some insurers are ahead of others in this aspect. However, the ones who are not yet fully compliant are actively taking steps to be.

All Indemnity Plans Cover Mental Health

As per IRDAI’s mandate, all indemnity plans cover mental illnesses up to the specified underwriting limit. Only the ones that cover specific physical diseases are exempt from this rule. Also, if mental illnesses lead to physical ailments, they need to be covered too. So, if a person develops hypertension as a result of his anxiety, it should be covered. 

If your plan covers hospitalisation, it includes hospitalisation due to mental illness. If your plan includes OPD, it covers OPD treatments for mental illnesses too.

Standalone Mental Health Plans are also Available

Some insurers in India have specialised insurance for mental health. Examples are the government’s “Niramaya” scheme for autism and Star Health Insurance’s autism cover. Wondering what the specific benefits and covers they provide are? Read along to know more.  

Benefits of Insurance for Mental Health

The coverage for in-patient hospitalisation is similar to that of a regular health insurance plan. Your insurance plan for mental health may cover the following, among others:

  • Consultation
  • Treatment
  • Medicine
  • Procedures
  • Room Rent

Most insurance policies for mental health also cover the following aspects

  • Thinking Ability
  • Memory
  • Cognitive Abilities
  • Decision-Making Ability
  • Mental Capacity

In addition, some mental health insurance policies also cover Out Patient Department or OPD Procedures. Any procedure requiring less than a day’s hospitalisation is generally called an OPD procedure.

Diseases Covered in Mental Health Insurance

  • Mood Disorder
  • Attention Deficit Disorder
  • Dementia
  • Post Traumatic Stress Disorder
  • Bipolar Disorder
  • Obsessive-Compulsive Disorder (OCD)
  • Anxiety Disorders
  • Acute Depression
  • Schizophrenia
  • Psychotic Disorder

Waiting Periods for Diseases

Mental health insurance treats mental illnesses similar to pre-existing conditions. Insurers assign waiting periods for diseases up to a few years. If the waiting period for a specific condition is four years, here’s what it means. You must purchase the policy and renew it for four consecutive years to cover the condition.

What is Not Covered?

Mental illnesses can arise out of substance abuse. Recurring Mental illness due to indiscipline in following the course of the treatment and medication is not covered.

Consider Mental Health Insurance

Mental health has a profound impact on how you think, act and feel. It affects the way you deal with stressful situations. It also determines how you make choices and interact with people.

You can consider the points mentioned above to assess your mental health insurance needs before buying.

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