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The New IRDAI Norms for Mental Health Coverage

We keep hearing of more and more people having mental illnesses. Be it among our friends, colleagues, relatives, neighbours or even celebrities. Mental illness can strike anyone. 

Mental health is also seen as a real, acute and growing problem globally. But a lot of interesting things have been happening in the mental health space recently.

The UN Convention on the Rights of Persons with Disabilities (UNCRPD)

In 2007, India signed and ratified a significant agreement. It was the United Nations Convention on the Rights of Persons with Disabilities or UNCRPD. Article 25(e) of the UNCRPD is a very significant clause. It states that signatory nations must prohibit discrimination against persons with disabilities.

The Mental Healthcare Act, 2017

In compliance with the UNCRPD, India passed the Mental Healthcare Act. It was passed in 2017 and came into force on 29 May 2018. The following aspects of the act are relevant to mental health insurance coverage in India:

  • It recognises the “right to access mental healthcare and treatment” for all persons without discrimination. 
  • It decriminalises suicide attempts. 
  • It states that insurers must provide medical insurance for the treatment of mental illnesses.
  • Such treatment should be on the same basis as for the treatment of a physical condition.

The IRDAI Circular on Mental Health Insurance

The IRDAI (Insurance Regulatory and Development Authority of India) subsequently issued a Circular on the Mental Healthcare Act 2017 on 16 August 2018. In the circular, the IRDAI stated that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for the treatment of physical illness”. 

To summarise, it asks all insurers to treat physical and mental illnesses at par.

It stated that this was in force with immediate effect. It also directed all insurers to notify all their branches and comply with the circular.

Mental Illnesses to be Excluded from Exclusions!

One year after the circular, the IRDAI issued another circular on 27 September 2019. This circular was about the standardisation of exclusions in health insurance. 

In this circular, the IRDAI stated that mental illnesses should not be excluded from coverage. This was to apply to all general health insurance indemnity policies. Insurers were asked to comply with this circular within one year, that is, October 2020.

Implementation

Insurers in India are at various levels of compliance with these directives. Some are better than others on compliance. The ones who are not yet fully compliant are taking all practical steps possible to be.

Standalone Mental Health Plans are also Available

Some insurers in India have floated specialised insurance for mental health. Examples are the government’s “Niramaya” scheme for autism and Star Health Insurance’s autism cover. 

Wondering what specific benefits and covers they provide? Read along to know more.  

Treatment using Medication/Therapy vs Treatment requiring Hospitalisation

Hospitalisations are the only way to treat some mental illnesses. At the same time, some others can be treated by therapy and medication. OPD stands for Outpatient Department, and it refers to all procedures that require less than a day of hospitalisation. Therapy, counselling and similar courses of treatment fall under OPD.

Are you looking to cover a specific mental illness? Find out which course of treatment is best for the condition. 

If the illness requires hospitalisation, go for a comprehensive indemnity health insurance policy. If it requires more therapy and medicine, pick a policy that also covers OPD.

Specialist therapists and counsellors’ can be expensive. So, it’s reasonable to purchase medical insurance for only therapy and counselling. 

Visit OneAssure’s Health Insurance Page to find help on your multiple health insurance needs.

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 costs covered in indemnity health insurance policies. These may be for consultation, treatment, medicine, procedures or room rentals. Many insurance policies for mental health also cover critical aspects of mental health. These can be thinking ability, memory, cognitive abilities, decision-making ability and general mental capacity.

Some mental health insurance policies also cover Outpatient Department or OPD Procedures. OPD Procedures are also called daycare procedures. That’s because they need you to be hospitalised for less than a day. 

Many mental health insurance policies cover well-known diseases and ailments. Commonly covered diseases are mood disorder, attention deficit disorder, obsessive-compulsive disorder and dementia. Some more illnesses commonly covered are post-traumatic stress disorder, bipolar disorder, anxiety disorders. Many policies also cover acute depression, Schizophrenia, Psychotic Disorder and more.

What is Not Covered?

Mental illnesses can arise out of substance abuse. They can also relapse and recur if proper discipline is not followed during the treatment, and these are not covered.

Consider Mental Health Insurance

You can consider the points explained above to assess your mental health insurance needs before buying. Knowing the IRDAI norms should lead you to make an informed decision about mental health insurance. 

Remember to assess your health insurance coverage regularly. Once a year is a reasonable interval. During these assessments, ask yourself the question: Am I adequately covered by health insurance today?

Click here to know more about Choosing the Best Mental Health Insurance Policy.


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