Health Insurance with Mental Illness Cover: A Step in the Right Direction

Health insurance is a complex type of insurance that keeps developing its terms and conditions on offering every now and then. However, a basic health insurance policy covers you for the medical expenses incurred during an accident or illness, which can be extended to covering lifestyle diseases as well. But the recent amendment made by IRDAI said mental illness will be a part of its coverage soon.

Until now, health insurance policies did not include mental illnesses, but that is set to change, with this announcement made on 16th August 2018 as per the rules laid by Mental Healthcare Act, 2017.

Health Insurance towards Offering Coverage to Mental Illness

As per the survey conducted by the National Institute of Mental Health and Neuro Sciences on ‘National Mental Health Survey of India’ in 2016, nearly 15% of Indian population is in need of involvement in tackling mental health issues.

Define Mental Illness

Mental Healthcare Act says that Mental illness considers a substantial disorder of thinking process, mood, orientation, perception or memory that hideously impairs capacity to recognize, judge, behave or ability to meet the ordinary demands of life. The act further says that every person with mental illness will be treated equally when it comes to healthcare.

What will Your Policy Pay For?

Buying health insurance is not enough, you also need to know what you are getting covered for. A right health insurance policy pays for in-patient hospitalisation expenses, including pre and post hospitalisation. That means your consultation with doctors will not be covered, but if you’re hospitalized due to mental illness, the expenses incurred towards the treatment will be covered. A very small portion of total population need hospitalisation in case of mental illness, where the majority opt for out-patient care like a consultation or may be medication, which health insurance currently doesn’t cover.

Exclusions: Important Clause

No doubt it is a step towards the right direction but it may come with a set of exclusions and even have a bearing on the premiums. As health insurance for physical illnesses doesn’t cover everything, the insurer could carve out exclusions with regard to mental illnesses just the way they have done in case of other illnesses. For instance, typically treatment expenses incurred for cosmetic surgery are not covered under health insurance. Similarly, the insurer may impose exclusions with regard to mental illness. When it comes to its exclusions, health insurance strictly excludes mental retardation and secondly mental condition linked with abuse, alcohol or drugs. There could be a specific waiting period for some of the illnesses.

Final Word!

The exclusions will limit the scope of your health insurance. As the insurance market in India is under-developed in case of covering out-patient treatment, the initiative such as mental illness will help in the long run. However, a very few insurance companies have come up with OPD covers with not-so-high coverage. However, this can be a good initiative to push the industry to focus on developing insurance products with OPD benefit.