Mental Illness Coverage

You might have noticed your friend who usually stays calm is behaving very rudely someday. Have you understood why, maybe she fought with someone? Or maybe her life is a little harsh to her? Whatever the reason is, her mental health is affected. Sometimes, it is as critical as physical health and might need a doctor's help. Certainly, the fees for mental health are also equal to the normal physical health doctor's and can drain your pocket brutally. But having health insurance for mental illness can save you from this situation.

Before delving deeper into this discussion, let's first understand,

What is Mental Illness?

Mental health is a broad term. It can impact your thoughts, feelings, and how you cope with life regularly. Mental illness is part of mental health. It is a health condition that can significantly disrupt your thoughts, emotions, and behaviours. It can cause distress and affect day-to-day life, and relationships, both on personal and professional levels.

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Mental Health Insurance

Key Takeaway Points for Mental Illness

• It is more than just sadness or occasional stress. It is more persistent and severe, impacting daily life in a significant way.
• It has different types and symptoms.
• Of course, it is treatable. You can manage the conditions effectively with therapy, and proper medications.
• No worry, it is common. 1 in every 5 individuals experiences mental illness, so you are not alone.
• And remember, mental illness is not a weakness or a character flaw. It is a health condition that deserves understanding, compassion, and proper treatment.

Here are,

Some Common Types of Mental Illness

• Anxiety disorder
• Bipolar affective disorder
• Depression
• Eating disorder
• Obsessive Compulsive Disorder
• Paranoia
• Schizophrenia
• Psychosis
• Post-traumatic stress disorder

And much more...

Know More About- Mental Illness Vs Mental Health

Need of the Hour for Mental Illness Health Insurance

Certainly, there has been enough concentration laid on the rapidly increasing physical health complications in the country due to several reasons such as environmental pollution, sedentary lifestyle, etc and the need to protect people with a strong insurance system that provides sufficient financial protection against various kinds of illnesses.

What Data Says?

If numbers are to be believed then:

The above given numbers as well as the excessive number of people being vocal about their psychiatric illness have demonstrated an urgent need for a mental healthcare system in India. This will include proper infrastructures and facilities for the patients battling with such challenges and this includes health insurance too.

New Scenarios of Mental Illness Coverage in Health Insurance!

The Mental Healthcare Act 2017, which was implemented in 2018, directs every health insurance provider to add mental illness health insurance too. Also, IRDAI has mandated all insurance providers to curate specific mental illness-dedicated plans for those who need help with mental illness.

One notable alteration of the act is that patients now have the freedom to choose from a range of mental healthcare facilities The law ensures several fundamental rights, including social inclusion, privacy, access to health information, protection from cruel or inhumane treatment, and the prohibition of discrimination. Even underprivileged and homeless individuals with mental illnesses are eligible for free mental health therapy, regardless of their economic status.

Health Insurance Plans that Cover Mental Illness

Details of Plans that Cover Mental Illness

1. HDFC ERGO My:Health Suraksha

   My:Health Suraksha plan by HDFC ERGO is a comprehensive plan that offers coverage for multiple medical issues including mental healthcare. HDFC ERGO as a company believes that mental healthcare is as important as physical health. Thus you will get coverage for even hospitalisation expenses due to mental illness. And the good news is that your premiums will be starting at just Rs 19 a day. Additionally, with HDFC ERGO health insurance you will get the Sum Insured up to Rs 1 Crore.

2. NIVA BUPA Aspire Plan

   With the WellConsult OPD Wallet benefit, you can avail the benefit of 10 cashless sessions on emotional wellness, through the app of NIVA BUPA Aspire Plan. NIVA BUPA Aspire plan is a new plan by the company that gives complete and extensive coverage to the policyholders. Along with mental health counselling, you will get to know about the activities that you can do to maintain your mental health. You will get upto Rs 1 crore of Sum Insured with Aspire plan.

3. Digit Health Care Plus

   Digit Health Care Plus offers coverage for hospitalisation and other medical expenses for psychiatric illnesses and disorders like Schizophrenia, Schizotypal, neurotic, stress-related disorders, unspecified mental disorders, affective disorders, and somatoform disorders. With the Digit Health Care Plus plan, you will get a sum insured back up which is 100% of your sum insured amount.

4. Niva Bupa Go Active Plan

   With the Niva Bupa Go Active Plan, you will get complimentary mental care in case of trauma. It is a comprehensive plan that offers coverage to families and individuals. Avail hassle-free claims with the plan. With the mental care benefit, you will be provided with extensive care if there is any trauma, like an accident or other such related situations.

Specifications Needed For Mental Health Insurance

It is important to note that mental health insurance aims to provide coverage for future treatment and support, regardless of past conditions. Here are a few eligibility criteria:

Important Things to Notice

With people are being vocal about psychiatric issues, the insurance sector is also inching towards preparing a comprehensive plan to provide aid against different nature of mental illnesses. Currently, working towards building constructive plans, the health insurance companies have also put caps on the facilities offered in their health care plans in the form of various sub limits or exclusive with regards to the mental illness.

From the above definition, it is clear that mental retardation is excluded. The Act includes mental conditions associated with the abuse of alcohol and drugs. However, this has been put under exclusions by almost all insurers.

In case, there is pre-existing mental condition with the customer, either it is not covered in the policy or the plan is modified according to their health conditions.

The waiting period is a big tool that has been used to keep the mental illness expense at the bay for some time. In fact, some of the plans have a clear restriction on the percentage of the sum insured to be spent on a mental illness.

There could be few more exclusions specific to mental illness and also certain waiting periods for some of the illnesses, these remain to be seen. As of now, most brochures and policy documents exclude mental illness in this way - "Treatment of any mental or psychiatric condition including but not limited to insanity, mental or nervous breakdown / disorder, depression, dementia, Alzheimer's disease."

Hence, it is always advised to thoroughly read, analyse and compare different plans in order to select the right one which is suitable for your mental health condition.

Case Study

Recently, a policyholder of Niva Bupa Health Insurance, who has been paying premium for a sum insured INR 35 Lakh, was denied claim settlement raised for the mental treatment. The condition given to him by the insurer stated that in case of a mental illness the sum assured is restricted to ₹ 50,000.

When the insured approached the Delhi High Court to seek justice, the apex body referred the Mental Healthcare Act of 2017, an act that clarifies that there can be no discrimination between mental and physical illnesses and the insurance provided in respect thereof.

While the matter is pending with the apex body as of now but concurrently, the Delhi High Court has notified that "this matter requires consideration, in as much as the Insurance Regulatory and Development Authority of India ought to place on record the basis on which approval has been granted for such insurance policies".

Know What's Covered- Inclusions

As insurance becomes mandatory for every insurance provider to offer to its customers, here are the details of what a mental health insurance policy will cover:

What is Not Covered?- Exclusions

Things to Know About Mental Health Insurance

• As per new guidelines Insurance companies in India cannot simply reject new policy applications for people with mental illness.
• Insurance companies must include mental illness in their health insurance policies.
• Few insurers and policies even cover consultations and counseling for mental illness, and this is covered under the OPD benefit of health insurance.
• More critical diseases like depression, dementia, bipolar disorder and Alzheimer's are also covered by a few insurance companies.
• Mental Health Insurance Coverage also includes hospitalization and therapy expenses, this includes diagnostics, medications, treatment costs, room rent and even road ambulance charges.
• Companies generally provide mental illness benefits with a waiting period ranging from 90 days to 2 years. This depends on the policy you opted for, check the details of the policy before buying.
• To raise the claim for hospitalization, the minimum time of hospitalization for a mental illness patient has to be 24 hours.

How To Verify If Your Insurance Provider Covers Mental Illness?

Register and log on to your insurance account online

Your health insurance plan website should contain information about your coverage and costs you can expect. Since insurers offer a variety of plans, make sure you're logged on and viewing your specific insurance plan.

If you're required to choose a treatment and hospitals that's in your plan's network, a list of network providers should be available online.

Call your insurance provider

If you need additional information, call the toll-free number on the back of your insurance card and ask questions about the types of mental or behaviour assistance program services you can expect coverage for, as well as any out-of-pocket costs you may incur.

Ask the therapist

Therapists, counsellers and other mental treatment related hospitals often change the insurance plans they're willing to accept and may have opted out of your plan.

Conclusion

Mental illness is a common problem in today's fast-paced world. But it has been stigmatised and avoided for a long time by our society. However, there have been enough conversations on the physical health complications and mental illness due to the stigma attached. But, we need to appreciate the Mental Healthcare Act 2017, which gave limelight to the scenario. And appreciate the efforts of health insurance companies who are working on adding new health insurance plans for mental illness.

Get in touch with the expert if your loved ones or you feel depressed in life. You can easily contact PolicyX in case of any doubt about mental illness health insurance.