Mental Health Coverage in Health Insurance

For a very long time, mental illnesses were not considered to be a serious medical issue in India by the general public. Most people who suffered from mental health conditions did not take them seriously and were hesitant to seek treatment. In more recent years, however, mental illness has become a mainstream topic of discussion due to the extensive awareness campaigns organised by NGOs, hospitals, and internet influencers. More and more insurance companies have started offering coverage for mental conditions under their health insurance plans over the past few years. Let’s take a closer look at how mental coverage in health insurance works.

Health Coverage - Health Insurance
Health Coverage – Health Insurance

 

IRDAI Guidelines On Mental Health Coverage

In medical terms, mental illness refers to a disorder that affects a person’s ability to think, perceive, store memories, or make judgements. Mental illness is often disruptive for the affected and can hamper their ability to conduct day-to-day activities. The Insurance Regulatory and Development Authority of India (IRDAI) has issued certain guidelines which suggest that health insurance providers must offer coverage for the treatment of mental health conditions or psychological issues that policyholders or the insured suffer from. As a result, almost all reputed health insurance providers have started offering coverage for mental conditions under their plans. 

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Important Factors About Mental Health Under Health Insurance 

Here are some important points about coverage of mental health in health insurance that you should be aware of:

Mental Health
Mental Health

 

 

  • When you buy your preferred health plan, read the inclusions and exclusions of the policy to ensure that coverage of mental health is provided under the plan. 
  • Health plans that cover mental health issues only provide coverage when the policyholder or the insured has been hospitalised due to their mental condition for a period of more than 24 hours. 
  • The health policy will provide coverage for the cost of treatments, medication, etc. 
  • In case the policyholder suffers from a mental illness or condition as pre-existing disease, there will be a waiting period applicable. The coverage for these pre-existing conditions will resume once the waiting period is over, which is generally between 2-4 years.
  • People who have a family history of mental health issues or conditions should definitely get the health insurance plans that offer mental health coverage. 
  • Make sure you fill in all the correct information when applying for the policy. Even minor errors in your application can lead to your health insurance claims getting rejected in the future. 
  • Some of the common diseases that are covered under mental health coverage in health insurance are; depression, schizophrenia, anxiety, ADHD, PTSD, etc. 
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Exclusions Under Mental Health Coverage 

There are also some common exclusions under mental health insurance that you should know before buying a plan:

Mental Health Insurance
Mental Health Insurance
  • No coverage for mental health conditions will be provided if the insured has not been admitted to a hospital for at least 24 hours. 
  • If mental conditions or illnesses are caused due to the consumption of drugs or alcohol, no coverage will be provided. 
  • If an individual has a history of serious mental illness, the insurer may refuse to sell them a health plan with coverage of mental health. 

Note: These are just a few common exclusions in mental health coverage. To know the full list of inclusions and exclusions, refer to your insurance policy document. 

To Conclude 

Mental health conditions can negatively affect an individual’s daily life routine, work, peace of mind, and relationships with others. Even if you are not currently suffering from any mental health issues, it is better to be prepared with a health plan that covers mental conditions. If you are looking to buy individual health insurance with mental health cover, you should check out the plans offered by insurers online and then decide which is the right choice for you. 

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Dr. Amanda
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