Difficult to Cover Mental Health with Health Insurance?

Most patients having mental ailments do not exhibit extreme or severe symptoms. However, their daily lives are affected by their diseases. The definition of mental illness is that it interferes with the daily functioning of the individual. Let’s also examine the mental health insurance situation. 

Read along to know more.

Insurance Business and Risk

Private insurance, like any for-profit business, is a business that would rely on profit. They take on the health risk associated with an insured person. For that, they charge an annual premium and have a pre-decided sum insured for every policy. The sum insured is the maximum that they are ready to pay for indemnity health insurance.

To go about their business and make a profit, health insurance companies need to quantify risk. They need to assign numbers and metrics to the health risk associated with every insured person. They use statistical models to determine probabilities of incidences of diseases based on medical data. 

Based on these numbers, they offer policies at varying premiums to each insured person. They offer coverage to a large group of insured persons at a profit based on probability.

Medical Expenses for Mental Illness Treatment can be Hard to Quantify

The world is opening up to mental illnesses. They are now seen to affect a larger proportion of the population. Mental illnesses, by their nature, can be unpredictable and indeterminate. We are still unsure about the exact courses of treatment and medications that a patient needs. Therein lies the crux of the issue.

Because insurers cannot yet quantify and statistically model mental illnesses very accurately, they are wary. They choose to stay away from the risks that they cannot quantify and understand. At least to the degree of accuracy with which they can do it for physical ailments.

Here are a few interesting facts about why it is difficult to cover mental health with health insurance:

The IRDAI Mandate

The IRDAI is the insurance regulator in India. It has mandated insurers to cover mental health in all general health insurance indemnity plans. Insurance companies are in various stages of being compliant with the IRDAI’s mandate. Some insurers are ahead of others in complying with this mandate. The ones who are not yet fully compliant are actively taking steps to be.

Standalone Mental Health Insurance Plans

Some Indian insurers have specialised insurance for mental health. Examples are the government’s “Niramaya” scheme for autism and Star Health Insurance’s autism cover. Another such standalone policy is the Epilepsy Care Plan by Bajaj Finserv.

Read about Choosing the Best Mental Health Insurance Policy

Insurance for Mental Health Coverage

Hospitalisation coverage is similar to that of a regular health insurance indemnity plan. Your insurance plan for mental health may cover expenses commonly covered under health insurance. These may be consultation fees, treatment costs, costs of medicines, procedures and room rentals.

Many insurance policies for mental health also cover various facets of your mental health. These may be thinking ability, memory, cognitive abilities, decision-making ability and overall mental capacity.

In addition, a few mental health insurance plans also cover Outpatient Department or OPD Procedures. An OPD procedure is any procedure requiring less than a day’s hospitalisation.

Most mental health insurance policies also cover certain diseases or conditions. These may be among mood disorders, attention deficit disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder. Other covered conditions are dementia, bipolar disorder, anxiety disorders, acute depression, schizophrenia and psychotic disorder.

Read more about Do Health Insurers Cover Mental Illnesses in India?

About Waiting Periods for Diseases

Mental health insurance policies look at mental illnesses like pre-existing conditions. Insurers assign waiting periods for psychological disorders, and these can be up to a few years. Suppose the waiting period for a specific condition is four years. In that case, you can purchase a policy and renew it for four consecutive years to cover the condition.

Consider Mental Health Insurance

Do you wish to protect your kitty from the potential medical expenses of mental illnesses? Despite the perceived difficulty in covering mental health, you should consider purchasing insurance for mental health.

Click here to know more about Five Things to Know While Buying Mental Health Insurance

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