Mental Illness - How Much Is Covered In Health Insurance?
  • Why There Is A Need For Mental Illness Coverage?
  • What Are The Best Plans Offering Mental Illness Coverage?
  • How To Check About Mental Illness Coverage In Your Plan?

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Mental Illness Coverage: Emerging Need in Health Care Plan

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.

On the contrary, there is hardly any conversation about the increasing cases of mental illness amongst the masses. If numbers are to be believed then, according to WHO studies, over 90 million Indians, or 7.5 percent of the country's population of 1.3 billion, suffers from some form of mental disorder. Even a 2019 study by a British charity, Mental Health Research UK, found that 42.5 percent of the employees in India's corporate sector suffer from depression or an anxiety disorder i.e. almost every second employee. According to the National Mental Health Survey 2016, about 130 million people require mental health services.

More shockingly, an online doctor consultation website revealed a record growth in the demand for mental illness treatment post the hit of the pandemic. The online queries for psychiatry grew 50 per cent in the first two weeks of the lockdown in 2020, with most queries coming from the age group of 21-30 years. Online consultations for mental health queries grew 180 per cent into the six months of the COVID-19 pandemic.

The above given numbers as well as the excessive number of people being vocal about their psychiatric illnesses have demonstrated an urgent need of a mental care system in India to offer a proper infrastructure as well as facilities to the patients battling with such challenges including 'Insurance'.

Mental Illness Coverage in Health Insurance

The Mental Healthcare Act, 2017, implemented in 2018, directs every insurer offering health insurance products to cater to policyholders with mental illnesses the same way they cater to physical illnesses or injuries.

The act defines mental illness as a "substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence".

Any policyholder who has a mental condition that falls under the above mentioned categories can file for a health insurance claim.

Plans Ensuring Mental Illness Treatment

With a stringent mandate issued by IRDAI, all health insurance plans automatically include the coverage of mental illness coverages. But there are a number of plans available in the market which are being one step ahead by clearly mentioning about the kind of mental disorders tackled by their policies to support their customers. Here are those plans.

Here Is The List Of Top Plans Covering Mental Illnesses-

  1. Activ Health Enhanced

    Aditya Birla Health Insurance launched an initiative of up to 100 percent health insurance premium returns and allied product offering upgrades under a newer version of its Activ Health policy. Known as Asia's first ever health insurance plan offering mental illness counselling coverage, this plan covers counselling for mental health illness which is traditionally excluded in medical policies.

    India's first health insurance plan rewarding consumers up to 100% of their health insurance premium as HealthReturnsTM - maximise earnings by leading a healthy life. Day 1 cover for Chronic illnesses like Asthma, High Blood Pressure, High cholesterol and Diabetes. Double Sum Insured in 2 claim-free years- earn 50% No Claim Bonus for every claim-free year - max up to 100% of Sum insured.

    Key Features of Activ Health Enhanced

  2. Max Bupa's GoActive Plan

    GoActive is a holistic health insurance plan that has been designed to give customers 360 degree coverage for their daily health needs including inpatient hospitalization and on-the-go access to OPD, diagnostics, personalized health coaching, 2nd medical opinion, behavioral counseling and much more.

    This Plan offers savings to customers from day 1 including a complimentary complete body check-up up to INR 2500 per adult, diagnostics and cashless/reimbursement OPD coverage. The plan also offers benefits such as a renewal discount of up to 20% on achieving their health goals. Additionally, it introduces AdvantAGE - a 10% discount on base premium at the time of buying and on all future renewals if the age of the eldest enrolled person is below 35 years.

    Key Features of Max Bupa GoActive plan

  3. Manipal Cigna's ProHealth Insurance

    It is a complete medical and health policy, designed to provide full protection against any ailment or medical emergencies. The plan comes with different variants viz., ProHealth Protect, ProHealth Plus, ProHealth Accumulate Large Cover, ProHealth Preferred, Prohealth Premier. This plan comes with coverage from Rs. 2.5 Lakh onwards which takes care of your hospitalisation, day-care procedures and domiciliary treatments.

    It features Health Maintenance Benefits, Cumulative Bonus, Restoration of Sum Insured, Worldwide Emergency Cover, Health check-up on every renewal, Expert Opinion on Critical Illnesses and Comprehensive cover - up to Rs.1 crore. The plan caters to all unforeseen health complications, maternity benefits and cover expenses related to the medical treatment of the newborn.

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  5. HDFC Ergo's Critical Illness Plan - Platinum

    This plan offers coverage for 15 critical ailments includingAlzheimer and provides a lump sum payout on diagnosis of the illnesses covered under the policy. This health care provides policyholders with a lump sum amount after the initial diagnosis, provided the policyholder survives a 30-day survival period. The lump sum amount provided covers the cost of the treatment, recuperation aids, provides reimbursement for income loss suffered due to the diagnosis and is also useful for paying off any debts but comes with a 90-day waiting period before raising a claim.The plan permits enrollment of people starting from the age of 5 to 65 years.

    Key Features of HDFC Ergo Critical Illness Plan - Platinum

  6. Niramaya Health Insurance Scheme for Disabled Persons

    This Scheme is being offered by The National Trust in collaboration with ICICI Lombard, a private insurance company. The National Trust is a statutory body constituted by enactment of an Act of Parliament by the Government of India, for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities.

    This scheme offers same premium of Rs. 1 Lakh per beneficiary, irrespective of the age of the person and same coverage for all irrespective of the type of disabilities covered under by The National Trust. Insurance is guaranteed. No "selection" will be made. Every persons with developmental disabilities and enrolled with The National Trust will be eligible for insurance. There is no exclusion will be made because of pre-exisiting condition and requires no medical tests before providing the insurance cover.

    This covers regular medical check up, hospitalization, therapy, corrective surgery, transportation, repetitive medical intervention as an in-patient, pre and post hospitalization expenses. OPD treatment can be taken from any qualified Medical Practitioner. In-patient (i.e. admitted in hospital) treatment can be taken from any hospital. The cost will be reimbursed (subject to the insurance limit)

    Company NamePlan Name Premium -1 YearSum Insured
    HDFC Ergo Health InsuranceHDFC Ergo Critical Illness Platinum planRs 41305 Lakh
    Reliance General Insurance Health Gain Insurance PolicyRs 69316 Lakh
    ManipalCigna Health Insurance ProductsManipal Cigna's ProHealth InsuranceRs 74225.5 Lakh
    Aditya Birla Health InsuranceActiv Health EnhancedRs 73375 Lakh

    *Premium is for 30 years old non smoker male

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 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 Max 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".

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 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.

Written By : Naval Goel

Last Updated : May, 2021

Naval Goel is the CEO & founder of policyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, pune. He has been authorized by IRDAI to act as a principal Officer of policyX.com Insurance Web Aggregator.

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