Is there a specific type of insurance plan that covers mental illness?

Mental health coverage is often included in comprehensive health insurance plans, including both family floater and individual plans.

Are there any limitations or restrictions on mental health coverage?

Some insurance plans may have limitations on the number of therapy sessions covered, require pre-authorization for certain treatments, or have restrictions on specific medications.

Can I use my insurance for both inpatient and outpatient mental health treatment?

Yes, insurance coverage can apply to both inpatient and outpatient mental health treatment, although specific coverage details may vary.

Does insurance cover alternative or complementary treatments for mental illness health insurance?

Insurance coverage for alternative or complementary treatments, such as acupuncture or herbal remedies, may vary and typically has more restrictions.

What is the minimum and maximum age for Mental illness coverage?

There is a minimum age requirement of 18 and a maximum age limit of 65 or no upper age limit; this will entirely depend on the company.

Who needs cover for mental health?

An individual with these symptoms of Acute Depression, Bipolar disorder, Schizophrenia, Anxiety disorders, Obsessive-compulsive disorders, Attention-deficit/hyperactivity disorder, Post-traumatic stress disorder, Mood disorder, or Psychotic disorder needs cover for mental health.

What is the waiting period for mental health insurance coverage?

Generally, the waiting period for mental health coverage ranges from 90 days to 2 years, it depends on the insurer and the policy you have opted for.

Written by Simran saxena

Published: 16 Aug 2024

Updated: 17 Jul 2026

4 min read

Expert Verified

IRDAI Licensed

Mental Illness Coverage

You might have noticed a friend who is usually calm behaving rudely. Perhaps she fought with someone, or maybe life has been harsh to her. Whatever the reason, her mental health may be affected. Mental health is as critical as physical health and may require a doctor's help. Treatment costs for mental health can be as high as those for physical health, potentially draining your finances. However, health insurance for mental illness can protect you from such financial burdens.

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

What is Mental Illness?

Mental health is a broad term that encompasses your emotional, psychological, and social well-being. It influences your thoughts, feelings, and how you cope with daily life. Mental illness is a specific health condition that can significantly disrupt your thoughts, emotions, and behaviors. It can cause distress and affect day-to-day life and relationships, both personally and professionally.

Key Takeaway Points for Mental Illness

It is more than just sadness or occasional stress; it is more persistent and severe, significantly impacting daily life.
It has different types and symptoms.
It is treatable. Conditions can be managed effectively with therapy and proper medications.
It is common. Approximately 1 in every 5 individuals experiences mental illness, so you are not alone.
Remember, mental illness is not a weakness or a character flaw. It is a health condition that deserves understanding, compassion, and proper treatment.

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.

Learn more about: Mental Illness vs. Mental Health

The Need for Mental Illness Health Insurance

While significant attention has been given to the rapidly increasing physical health complications in the country due to factors like environmental pollution and sedentary lifestyles, and the need for robust insurance to provide financial protection against various illnesses, mental health also requires urgent focus.

What the Data Says

According to World Health Organization (WHO) studies, over 90 million Indians, or 7.5% of the country's population, suffer from a mental disorder.
A 2019 study by the British charity, Mental Health Research UK, found that 42.5% of employees in India's corporate sector suffer from depression or anxiety, indicating that nearly every second employee is affected.
According to the National Mental Health Survey 2016, about 130 million people require mental health services.
Online queries for psychiatry grew by 50% during the COVID-19 pandemic.
Most queries regarding mental illness were raised by individuals in the 21-30 age group.

These statistics, coupled with the increasing number of people openly discussing their psychiatric illnesses, highlight an urgent need for a robust mental healthcare system in India, including proper infrastructure, patient facilities, and comprehensive health insurance coverage.

Regulatory Changes and Mental Illness Coverage in Health Insurance

The Mental Healthcare Act 2017, implemented in 2018, mandates every health insurance provider to offer coverage for mental illness. IRDAI has also mandated all insurance providers to offer specific mental illness-dedicated plans.

A notable change introduced by 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.

Details of Plans that Cover Mental Illness

HDFC ERGO My:Health Suraksha

HDFC ERGO's My:Health Suraksha plan is a comprehensive plan offering coverage for various medical issues, including mental healthcare. HDFC ERGO believes mental healthcare is as crucial as physical health, covering hospitalization expenses due to mental illness. Premiums start from just ₹19 a day, and the plan offers a Sum Insured up to ₹1 Crore.
Niva Bupa Aspire Plan

The Niva Bupa Aspire Plan offers a WellConsult OPD Wallet benefit, providing 10 cashless emotional wellness sessions via its app. This comprehensive plan provides extensive coverage to policyholders, including mental health counseling and information on activities to maintain mental well-being. The Aspire plan offers a Sum Insured of up to ₹1 Crore.
Digit Health Care Plus

Digit Health Care Plus covers hospitalization and other medical expenses for psychiatric illnesses and disorders such as schizophrenia, schizotypal, neurotic, stress-related, unspecified mental, affective, and somatoform disorders. Additionally, the plan offers a Sum Insured backup equal to 100% of your Sum Insured amount.
Niva Bupa Go Active Plan

The Niva Bupa Go Active Plan provides complimentary mental care in cases of trauma. This comprehensive plan offers coverage for families and individuals, with hassle-free claims. The mental care benefit provides extensive support for trauma, such as accidents or other related situations.

Eligibility Criteria for Mental Health Insurance

Mental health insurance aims to provide coverage for future treatment and support. Here are some key eligibility criteria:

Age: Most insurance policies have a minimum and maximum age limit for enrollment. Typically, individuals above 18 years of age can apply for mental health insurance coverage.
Pre-existing Mental Health Conditions: Many insurance companies may assess the presence of pre-existing mental health conditions before providing coverage. Pre-existing condition exclusions or waiting periods may apply.
Medical History: Insurers may consider an individual's medical history, including any past or current mental health issues, treatments, or hospitalizations.
Premium Payment: Eligibility for mental health insurance is also contingent on paying the required premiums. Premiums are typically based on factors such as age, medical history, coverage limits, and selected policy features.
Insurer's Policy Guidelines: Each insurance provider may have its own specific guidelines and requirements for mental health insurance eligibility.

Important Considerations

As people become more vocal about psychiatric issues, the insurance sector is moving towards preparing comprehensive plans to address various mental illnesses. While developing these plans, health insurance companies have also introduced caps on facilities offered, in the form of sub-limits or exclusions related to mental illness.

It is important to note that mental retardation is generally excluded. While the Act includes mental conditions associated with alcohol and drug abuse, most insurers often exclude these.

For pre-existing mental conditions, coverage may be excluded or the plan modified based on the individual's health.

A waiting period is often applied, delaying coverage for mental illness expenses. Some plans also have clear restrictions on the percentage of the sum insured that can be spent on mental illness.

There may be additional exclusions specific to mental illness and certain waiting periods for some conditions, which vary by policy. Currently, many policy documents contain exclusion clauses for mental illness, such as: "Treatment of any mental or psychiatric condition including but not limited to insanity, mental or nervous breakdown/disorder, depression, dementia, Alzheimer's disease."

Therefore, it is always advised to thoroughly read, analyze, and compare different plans to select the one most suitable for your mental health condition.

Case Study

Recently, a Niva Bupa Health Insurance policyholder, with a sum insured of ₹35 Lakh, was denied a claim settlement for mental health treatment. The insurer cited a policy condition restricting the sum assured for mental illness to ₹50,000.

When the insured approached the Delhi High Court to seek justice, the court referred to the Mental Healthcare Act of 2017, which clarifies that there can be no discrimination between mental and physical illnesses in insurance coverage.

While the matter is currently pending, the Delhi High Court has noted that "this matter requires consideration, inasmuch 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".

What's Covered: Inclusions

As mental health insurance coverage is now mandatory for all providers, here are the details of what a mental health insurance policy typically covers:

All Major Mental Health Issues

Mental health insurance covers most conditions within this category, from anxiety and depression to complex and difficult-to-diagnose conditions.
Inpatient and Outpatient Procedures

Previously, health insurance companies only covered hospitalization expenses for mental health issues. However, many mental health issues are managed through behavioral therapies and outpatient department (OPD) consultations. With updated government guidelines, both inpatient and outpatient procedures are now covered by these policies.
All Other Medical Expenses

Mental illness treatment is not always confined to hospitalization. Modern mental illness policies include pre and post-hospitalization charges, treatment recovery, medical tests, and other benefits as specified in the plan.
List of Covered Diseases

Insurers cover a range of mental illnesses, including acute depression, bipolar disorder, schizophrenia, anxiety disorders, obsessive-compulsive disorders, attention-deficit/hyperactivity disorder, post-traumatic stress disorder, mood disorder, and psychotic disorder.
Coverage for Therapy Sessions

Hospitalization and therapy expenses for mental illness treatments are also covered.
Coverage for Critical Mental Illnesses

Critical mental illnesses like depression, dementia, bipolar disorder, and Alzheimer's are covered, subject to certain exclusions decided by the insurer.

What's Not Covered: Exclusions

Pre-existing Mental Illnesses

If you have a pre-existing mental illness, your insurance policy may not cover it for a certain period. The duration of this exclusion period may vary from insurer to insurer.
Self-inflicted Injuries

If you intentionally harm yourself, such as in the case of attempted suicide, your insurance policy may not cover the costs associated with the treatment of any injuries sustained.
Substance Abuse

Mental illness coverage policies may not cover the treatment of mental health issues caused by substance abuse or addiction.
Experimental Treatments

Treatments not widely acknowledged by the medical community are considered experimental and may not be covered by mental health insurance.
Alternative Therapies

Some alternative treatments, such as yoga, acupuncture, and hypnosis, may not be covered by mental illness insurance.
Mental Retardation Arising from Substance Abuse

Mental illness health insurance generally does not cover mental retardation or mental illnesses resulting from drug or alcohol abuse. It is crucial to differentiate between inherent mental health conditions and those resulting from external factors.
Outpatient Treatment Limitations

While mental health insurance may cover hospitalization expenses, it's important to note that the extent of coverage for outpatient treatments such as consultations and therapy sessions can vary significantly between plans, with some plans having limitations or exclusions.
Waiting Periods

Many mental illness plans include waiting periods for specific mental disorders. It is essential to check policy details, as no compensation will be paid for treatment related to these specific disorders during the waiting period.

Things to Know About Mental Health Insurance

As per new guidelines, insurance companies in India cannot simply reject new policy applications from individuals with mental illness.
Insurance companies must include mental illness in their health insurance policies.
Some insurers and policies also cover consultations and counseling for mental illness under the OPD benefit of health insurance.
Critical illnesses like depression, dementia, bipolar disorder, and Alzheimer's are also covered by some insurance companies.
Mental health insurance coverage also includes hospitalization and therapy expenses, such as 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, depending on the chosen policy. Always check policy details before buying.
To raise a claim for hospitalization, a mental illness patient must be hospitalized for a minimum of 24 hours.

How to Verify Mental Illness Coverage with Your Insurer

Your health insurance plan website should contain information about your coverage and expected costs. Since insurers offer a variety of plans, ensure you are logged in and viewing your specific policy details.

If your plan requires you to choose treatment and hospitals within its 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 health or behavioral assistance program services you can expect coverage for, as well as any out-of-pocket costs you may incur.

Ask Your Therapist

Therapists, counselors, and other mental health treatment facilities often change the insurance plans they accept and may have opted out of your network.

Claim Process for Mental Health Insurance

Understanding the claims procedure of your plan is crucial to avoid future discrepancies. The claims process for mental health insurance is as follows:

Step 1: Seek diagnosis and treatment from a qualified mental health professional, who will provide the necessary documentation and medical records to support your claim.

Step 2: After treatment, contact your insurance provider to initiate the claims process.

Step 3: Prepare necessary documents, including medical reports, prescriptions, invoices, and treatment receipts.

Step 4: Accurately fill out the claim form provided by the insurance company and provide all requested information.

Step 5: Submit the completed claim form and supporting documents to the insurance provider within the specified time frame mentioned in your policy.

Step 6: The insurance provider will review your claim and assess its validity based on the submitted documentation. If necessary, they may request clarification or further details.

Step 7: If your claim is approved, the insurance provider will process it and provide reimbursement or payment for covered expenses as per your policy terms.

Conclusion

Mental illness is a common problem in today's fast-paced world, yet it has long been stigmatized and avoided by society. While physical health complications have received considerable attention, mental illness has often been overlooked due to associated stigma. However, the Mental Healthcare Act 2017 brought much-needed attention to this issue. We also appreciate the efforts of health insurance companies in developing new plans for mental illness coverage.

If you or your loved ones are struggling with mental health, seek expert help. For any doubts regarding mental illness health insurance, feel free to contact PolicyX.