Mental Health Insurance Cover A Boon For Patients

Mental Illness Insurance Claim
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Mental health has always been a sensitive subject, considered as a very ‘hush hush’ topic even up to a decade ago. Although today people have come out in the open about their mental state, there is still some stigma and myths attached to it.

Therefore, vouching to tackle stigma of mental illness, the Insurance Regulatory and Development Authority of India (IRDAI) in its circular, asked insurers to make provisions to insure mental illness, according to the rules laid down by the Mental Healthcare Act, 2017, that came into force from May 29, 2018. Millions of people have health insurance as well as life insurance but now those policyholders can upgrade their policies after finding out more information on new clauses, such as a mental health clause.

According to Section 21(4) of the Act, every insurer needs to make provisions for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness. The circular stated that insurers will need to comply with these provisions with immediate effect. If insurers do not follow through with these provisions, it is highly likely that individuals and businesses alike will begin switching health insurance policies and providers en masse.

“The Irdai has taken cognisance of the law, and asked insurance companies to implement its provisions. So, the health insurance policy will no longer be able to have blanket exclusion on mental illness,” says Karan Agarwal, Former Business Associate, Tata AIG Life Insurance Company.

One of the rationales of the Act is to not discriminate between mental illness and physical illness. Now, if an alcohol-induced physical illness leading to hospitalization like in the case of cirrhosis is not covered, in a similar manner alcohol-induced mental illness too will also not be covered.

“Even now, the insurer can altogether deny health insurance to a person suffering from a physical illness, say cancer or heart disease, as per its underwriting norms. The same underwriting criteria should apply to individuals with a pre-existing mental illness. However, if the insurer agrees to insure them, then after the waiting period on the pre-existing ailment, these conditions would need to be covered.” If there can be insurance providers created purely to take care of those that suffer from chronic physical diseases, such as special risk managers for those that live with heart complications but still wish to take out life insurance, why would mental health insurance be treated differently in a day where mental health complications are becoming accepted as actual illnesses?

The Irdai’s directive says mental healthcare includes analysis and diagnosis of a person’s mental condition and treatment as well as care and rehabilitation of such person for his mental illness or suspected mental illness, according to the Mental Healthcare Act 2017.

In India, the Mental Health Care Act 2017 was passed on April 7, 2017 and came into force from July 7, 2018.

Speaking on the inclusions and technicalities of the Act, Agarwal says, “Being insured is not enough, you also need to know what your health cover will pay for. A typical health insurance policy pays for in-patient hospitalisation and not out-patient treatment. Understandably, people can worry about spending too much on their insurance to make sure that everything is covered, but that doesn’t always have to be the case. For example, you can find cheap health insurance jacksonville fl (or if you look close enough you might find cheap insurance closer to where you live). So it is possible to not spend a fortune on your insurance, and still get the cover you need.

“In other words, your consultation with your doctor or medicines that you buy will not be payable. But if you are hospitalised on account of a mental illness, then the policy will cover you. It’s a very small portion of people with mental illness that actually need hospitalisation. A majority of people with mental conditions need out-patient care like consultations or may be medication which health insurance policies in their current form don’t cover.

“However, the insurer and his family can be befitted in terms of monitory benefits and also they can show Section 10(10D) of Income Tax that exempts any income received from an insurance policy from income tax,” adds Agarwal.

Duration of insurance reimbursements

In most cases, it will take at least 30 days from the date the insurer receives a claim to when your mental health practice will receive reimbursement. Some insurers move faster, with turnaround times of two to three weeks, but, as a rule, 30 days is what most practices can expect.

Madhavi Purohit, a counsellor, feels that this step will at least help people come out of their closet and speak about mental illness. “I believe this will be a great jump for destigmatising mental health in the country. People even today tend to ignore the importance of being healthy mentally. Many expert counsellors and psychologists believe that just by sharing and speaking, a patient can be brought out of trauma and the pressure that builds upon leading to suicides or self-harm. Mental health literacy is a must from earlier stages in life as it does not come with age or for any particular reason,” adds Purohit.

Proving the testimony, Brijesh Dixit says a huge amount of money is spent on the treatment, counselling and rehabilitation of a person suffering with any mental condition. “It is not easy. I almost dropped down to selling my assets in that one year of stabilising my mental condition.

The cost of each counselling session followed by medications and further procedures is huge. Covering mental health under the health insurance policy will support many families, when someone undergoes the treatment.

“Moreover, they will also come out and agree to getting them treated knowing that some part of their expenses is covered by the insurance,” he adds.


#All views expressed are those of the respondent’s and Pune365 does not necessarily subscribe to them.

Loveleen Kaur

Loveleen Kaur

She loves travelling, dogs, sarcasm, humour and anything that spells F O O D, in that order. A writer on a journey to make positive stories a morning ritual and give society what it needs the most - optimism !!

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Loveleen Kaur