Is Mental Illness Covered By Health Insurance?

Mental health is the overall wellness of how you think, regulate your feelings, and behave. It is something we need to be conscious of and deal with care.

There are a lot of factors that affect mental health, including stressful life situations, traumatic experiences, medical conditions etc. In India, nearly 15% of adults require treatment for one or more mental health disorders, according to the National Mental Health Survey 2015-16.

Mental illnesses are becoming more prevalent and with growing awareness, the stigma around them is lessening. Getting treated for a mental illness costs quite a bit and might end up being as rigorous as getting treated for a physical condition.

Are these expenses covered by health insurance? Which mental illnesses are covered?

Let’s find out the answers to these questions and more in this article.

First, What Exactly Is Mental Illness?

The Mental Healthcare Act of 2017 describes mental illness as a substantial disturbance of thinking, mood, perception, orientation, or memory that impairs judgement, behaviour, the capacity to recognize reality, or the ability to meet daily challenges.

In simpler words, a mental illness can make you incapable of thinking, working, remembering, or even taking decisions like other people. This condition might affect your ability to perform ordinary tasks on a daily basis.

However, the Act excludes mental retardation, i.e., a condition of arrested or incomplete development of the mind of a person.

Now Mental Illness Covered By Health Insurance.

Mental illness wasn't covered by health insurance policies in India for a very long period of time.

The IRDAI announced in 2018 that all insurers must cover mental illness as per the Mental Healthcare Act 2017. According to the circular released by IRDAI, every insurer must cover mental illness treatment similar to treatments for physical illnesses.

Mental illness coverage is specifically designed to pay for expenses associated with mental health disorders. It covers illnesses such as bipolar disorder, anxiety disorder, depression, etc.

Covers For Mental Illness Available Under Health Insurance

A mental illness cover offers a number of benefits. A few of them are listed below:

The scope of coverage and types of mental illness covered may vary across insurers. You will find a list of such illnesses and coverage in your policy documents.

What Is Not Covered By Mental Illness Cover?

Insurance companies will not cover the following -

Getting A Fresh Cover For Someone With A Mental Illness

Even though IRDAI guidelines state that health insurance covers mental illnesses, it does not make providing coverage to people with mental illnesses mandatory.

This means that if you own a health insurance policy already and are diagnosed with a mental illness, the costs of your treatment will be covered as per the policy’s T&Cs. However, this guideline does not ensure new coverage for anyone who has a mental illness. Insurers may choose to cover or not cover people with mental illnesses based on their own internal underwriting policies.

Let’s understand this better with the help of an example -

Can You Get Health Insurance Coverage For Your Family Member With Mental Illness?

It is tricky to cover members with mental illness, especially because with the new IRDAI guidelines, hospitalisation expenses for mental illness treatment are now covered under health insurance.

Getting coverage for people with mental illness can be challenging, but not impossible. It is important to talk to a good financial advisor or a broker and determinedly apply to various insurance companies until the member is covered.

And, while buying the policy, make sure you make detailed declarations and don’t hide anything. Most importantly, do not completely rely on your advisor to fill out and process the application - this might cause them to miss out on minute disclosures, which will in turn be a problem when you make a claim.

Summing Up!

With the growing awareness about mental health, the stigma around it has lessened by miles. We hope this article helped you understand about how mental illnesses are covered by health insurance plans and the associated conditions plus limitations. Make sure you read through your policy wordings to be aware of the ins and outs.