According to Medical Trends Around the World Survey Report 2018 by Mercer Marsh Benefits, mental treatments requiring hospitalisation are far less compared to expert consultations, counselling and medication. Photo: iStock
According to Medical Trends Around the World Survey Report 2018 by Mercer Marsh Benefits, mental treatments requiring hospitalisation are far less compared to expert consultations, counselling and medication. Photo: iStock

Will health insurance plans cover mental illness comprehensively?

Irdai has asked insurers to not discriminate between mental and physical health when giving a cover. How will this change health insurance plans and how comprehensively will they cover mental illness?

Mayank Bathwal, Chief executive officer, Aditya Birla Health Insurance

As per National Mental Health Survey of India for FY16 conducted by the National Institute of Mental Health and Neuro Sciences, nearly 15% of adult Indian population suffers from mental health issues which require active intervention.

The latest regulatory guidance enables “provisions for medical insurance for treating of mental illness on the same basis as is available for treatment of physical illness". While this comes as a general guidance, the insurers have to find answers to how the offering may be structured and what shall stand excluded prudently.

The challenges which insurers may encounter are around the current industry experience and how the pricing may get impacted by offering mental health coverage. The underwriting mechanism would need to be structured to gauge mental condition and charge cautiously to the customer, to ensure fair pricing.

This move is in line with offerings in developed nations, ensuring long-term growth for the industry and certainly is a positive step.

Varun Gera Founder and chief executive officer, HealthAssure

Introduction of Mental Health Act will have an overarching impact as it provides the right for mental health to every citizen. It also requires insurance policies to place mental health treatment at par with physical health.

It will provide easier access to mental treatment, and will help evolve a better mental health delivery infrastructure and include this in the mainstream medical delivery which needs attention. This would be available to most customers having health insurance policies who need hospitalisation for mental health. Health insurance policies which cover OPD will cover hospitalisation and mental counselling and associated medication. It will also create more supply of mental health delivery and reduction in pricing over time. Since this will be a new coverage, insurance companies will be defining policy guidelines for inclusion of mental health in their existing policies.

Neerja Birla Founder and chairperson, Mpower

The stigma around mental health is deep-rooted and mental health conditions are ignored. Mental illness requires prolonged medical attention, continuous care and support from professionals, which often is a financial burden on families. The increasing costs of treatment, make patients drop out of the treatment cycle. However, covering mental health concerns under existing insurances may cause a slight rise in the premium since most individuals with these conditions are treated as out-patients. The decision will now encourage people to reach out for professional help. This will also give us a reality-check on mental health awareness in India. Although, it might be seen as a welcome change by the public, who will have to contribute a little more than usual towards their premiums, the insurance companies might end up facing a crunch given the huge number of individuals.

Mohit Agarwal, MD Employee Health & Benefits, Marsh India Insurance Brokers

With the insurance regulator’s circular, we will have more insurance companies participate in developing this segment.

Unlike other aspects of medical insurance where hospitalisation and day care procedures are major requirements, mental illness needs coverage on OPD basis that is access to resources like specialists, counselling, medication and rehabilitation services. Given that insurance plans currently don’t cover these, it will not make a major impact on the outcome.

According to Medical Trends Around the World Survey Report 2018 by Mercer Marsh Benefits, mental treatments requiring hospitalisation are far less compared to expert consultations, counselling and medication. In fact, it is seen that in Asia, insurers have seen only 2% of mental illness claims registered under OPD and none for IPD cases.

Our understanding on employers’ approach indicates they are not hesitant to implement this move even as it may come at a cost, but the insurance industry needs to innovate.

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