Mental Illness Causes, Symptoms and Coverage in Health Insurance Policy, India

Over the last couple of years, there has been a rise in the number of mental health cases in India. While the cases of mental health conditions are increasing, nothing much has been offered by health insurance companies to deal with these conditions and their expenses. Especially after the pandemic, the cases of anxiety, depression, mental stress and other major issues were faced by many who sought treatment for such conditions. 

Hence, looking at the latest scenario IRDAI or Insurance Regulatory and Development Authority of India has recently mandated the insurance companies in India to compulsorily cover mental illness under health policies. The mandate was made effective from October 1, 2022 to address the rising number of mental illnesses in the country. 

The IRDAI formed a committee of medical and insurance experts who came to the conclusion about the need for comprehensive insurance for mental health conditions. As per the committee report, IRDAI instructed insurers to include mental health illness under their health insurance policies. 

The issue of mental health conditions is serious and the cases have aggravated after the Covid19 pandemic. The treatment of mental health involves therapy, counselling and supervision of experts etc., which are mostly done under OPD treatments. 

Hence, health insurance companies are now likely to come up with OPD treatment centric plans to allow comprehensive coverage to mental health conditions.

It is evident that there is a serious need for a good care system for psychiatric treatment along with the backup of mental health insurance India offered by prominent insurers.  Let’s discuss it in detail.

 

What is Mental Illness?

Before coming to mental illness coverage, let us check the mental illness definition as well as its causes to understand the disease better. So, mental illness is a health situation that involves fluctuations in behavior, emotions, or thinking of individuals. It can also be a blend of all such conditions together.

There are various causes of mental illnesses such as stressful life, emotional breakdown, financial loss, or because of genes and family history etc.  Further, there are different types of mental illnesses, which are characterized by varied mental conditions.  Change in feelings or conduct, loss of interest, change in the sleeping habits, low energy, loss of appetite or weight changes, uncontrollable emotions etc., are some of the mental health symptoms that might trigger the effects of the illness.

What is Mental Illness Coverage?

As per the Mental Healthcare Act, 2017, every insurer has to make a facility for offering medical insurance for the treatment of mental illness like they provide for physical illness. The Act was implemented in 2018 and it directs insurers to allow coverage against mental illness and cater to policyholders suffering from such conditions.

The Act further reiterates that mental illness is a substantial disorder that requires support of insurance. Policyholders with mental conditions can file for a health insurance claim if they fall within the category of agreed mental conditions as per the 2017 Act.

 

Plans Offering Mental Illness Coverage in India

As per the strict orders of IRDAI, all health insurance providers are required to provide mental health illness coverage under their health insurance plans.  However, there are some insurers who have come up with special plans catering to the specific needs of different kinds of mental illness under their policies.

4 Popular Health Insurance Plans by Insurers Covering Mental Illnesses

1. Activ Health Enhanced by Aditya Birla Health Insurance

The Active Health Enhanced plan by Aditya Birla Health Insurance is regarded as the first ever plan in the country to offer mental health illness counselling coverage. Generally, mental illness counselling is not included under medical insurance policies. However, this special plan is rewarding policyholders for up to 100% of insurance premium in the form of HealthReturnsTM. The policy offers coverage from day 1 for chronic diseases.

Below are the features of the plan:

Features	Details
Sum Insured	INR 2 lakh – 2 Crore
In-Patient Hospitalization	On the basis of sum insured
Pre-Hospitalization Expenses	Up to 60 days
Post-Hospitalization Expenses	Up to 180 days
Day Care Facility	Available
Ambulance facility	Available
Domiciliary facility	Available
Expenses of organ donor	Available
Sum insured reload facility	Offered up to 100% Sum Insured
Ayush treatment hospitalization expenses	As per sum insured
Mental illness hospitalization expenses	Up to sum insured

2. Max Bupa GoActive Plan

This holistic plan offers customers complete coverage for all their health requirements from day 1 of the policy. The cover also allows a total body check-up of up to INR 2,500. It also offers up to 20% renewal discount and a 10% discount as per the AdvantAGE feature of the plan as mentioned in the table below.

Mental disorder	Treatment details
Consultancy for Behavioural Assistance	3 consultations available per person per policy year
Second medical opinion coverage	Available, (one opinion per insured per mental illness (specific)
AdvantAGE	Can avail a 10% discount in base premium for first policy and subsequent renewals, if the policyholder enters the plan before the age of 35

3. HDFC Ergo’s Critical Illness Plan – Platinum

This platinum plan from HDFC Ergo offers cover against 15 critical illnesses including Alzheimer’s. The plan offers a lump sum amount if diagnosed with a critical illness included under its list. However, the policy is available with a waiting period of 90-days before the insured could raise a claim. The entry age of the plan is from 5 – 65 years of age.

4. Manipal Cigna ProHealth Insurance

This is another holistic policy designed to cover the insured with complete protection against medical emergencies. The plan is available in 5 different variants, namely:

• ProHealth Protect
• ProHealth Plus
• ProHealth Accumulate Large Cover
• ProHealth Preferred, and
• ProHealth Premier

With INR 2.5 lakh as the sum assured, the plan allows coverage against the expenses like hospitalization, day care procedure, and domiciliary treatment among others.

Mental Health Coverage, Waiting period and Exclusions

Coverage

It is always important to carefully study the coverage of your policy when buying a health insurance plan. You must examine if the mental health conditions are included under the plan and treatment expenses are covered for the same. Further, you should ensure that the particular mental health condition treatment that you are looking for is covered under the plan.

Waiting Period

Waiting period for specific diseases and their treatments is a part of most health insurance policies in India and this is likely even in the case of health policies covering mental health conditions. Hence, you should consider the duration of waiting period while choosing a health insurance plan to make sure that you get the coverage as and when you need it.

Exclusions

Going through the exclusions of a policy is very crucial, which many people tend to forget. To know what all covers are excluded from your health policy, you have to carefully go through the terms and conditions of the plan. This way, you can understand the limitations of the policy you are planning to buy. By reading and understanding the policy well, you can make sure that no such exclusions are there which might affect the coverage of your mental health conditions.