If an individual is diagnosed with a mental illness subsequent to buying a health insurance policy, the insurer cannot reject the claim (Photo: iStock)
If an individual is diagnosed with a mental illness subsequent to buying a health insurance policy, the insurer cannot reject the claim (Photo: iStock)

Health insurance policies now cover mental illnesses

  • The Mental Healthcare Act 2017, directs every insurer offering health insurance products to cater to policyholders with mental illnesses the same way they cater to physical illnesses or injuries
  • The Irdai guidelines say an insurer cannot discriminate an illness in being mental or physical

For the longest time, mental illnesses never got the attention they deserved. It took celebrities such as Deepika Padukone and Ellen Degeneres to speak out about battling depression for the masses to understand how a mental illness can take a toll on a person’s everyday life. Even Todd Phillips’ much talked about film Joker delves deeper into this subject. The film’s protagonist is a man dealing with mental and neurological problems who eventually turns into a criminal.

With all the attention that mental health is finally garnering, it became imperative for the Insurance Regulatory and Development Authority of India (Irdai) to work towards bringing mental illnesses within the scope of health insurance. Irdai recently released the guidelines on standardization of exclusions in health insurance contracts which states that treatment of mental illness, stress or psychological disorders will no longer be allowed as exclusions in health insurance policies. The Mental Healthcare Act, 2017, which was implemented last year directs every insurer offering health insurance products to cater to policyholders with mental illnesses the same way they cater to physical illnesses or injuries.

What is covered?

The Mental Healthcare Act, 2017, defines mental illness as a “substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence". Any policyholder who has a mental condition that falls under the above mentioned categories can file for a health insurance claim.

The Mental Healthcare Act, 2017, states that every person with mental illness will be treated as equal to persons with physical illness when it comes to healthcare, including health insurance. The regulator has also prescribed standard wordings for health insurance exclusions in order to remove ambiguity which could result in a policyholder’s claim getting rejected.

What it means

Health insurance will now cover treatment for mental illness, stress or psychological and neurodegenerative disorders, apart from other physical ailments. But whether a policyholder would be covered only for hospitalization or also for OPD (out-patient department) services would depend on the kind of the policy purchased. The guidelines say an insurer cannot discriminate an illness in being mental or physical. So if a policy covers physical illness for hospitalization, then it will also have to cover mental illness for hospitalization. Similarly, if the policy covers OPD expenses for physical illness, then the same would apply for mental illness too. Note that, typically, health insurance policies do not cover out-patient care but some insurers are now offering certain products that include OPD as well.

It’s advisable to read the fine print and understand the inclusions and exclusions of your policy before filing a claim.

It’s also important to understand that inclusion of mental illness doesn’t mean an insurer is liable to insure persons with pre-existing mental conditions. It simply means that if the insurer does decide to cover a policyholder in the future after the waiting period window, it cannot deny a claim. Similarly, if an individual is diagnosed with a mental illness subsequent to buying a health insurance policy, the insurer cannot reject the claim.

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