Mental illness has to be a big part of insurance policies3 min read . Updated: 25 Oct 2020, 07:39 PM IST
- The first issue is that the mentally ill find it difficult to buy health insurance, even in minor conditions
- This leaves them uncovered even for physical illnesses
Throughout my school and college years, Bai lived with us, moving across cities, helping us grow, for all practical purposes a dear family member. As she grew older, Bai began imagining that people were attacking her. We could not understand what had happened, but she went back to her village and died a few years later, untreated for schizophrenia. Mental illnesses are prevalent, some consider it an epidemic, and this has only worsened during this pandemic. The challenges in addressing mental illness are considerable: building patient, doctor awareness and treatment capacity. Insurance currently has a minor role in mental illness and we could do more.
The first issue is that the mentally ill find it difficult to buy health insurance, even in minor conditions. This leaves them uncovered even for physical illnesses. I have seen many proposals rejected for conditions such as stress and anxiety, and proposals for more serious mental conditions get turned down. So, most persons with mental health issues will not disclose their condition, exposing themselves to claim rejection later. Some families with mentally challenged children have health insurance because this was bought many years ago when the child’s health condition was not asked for. Today that would be difficult.
The second issue is that guidelines to insure persons with mental health issues are not explicit. In June, the regulator asked all insurers to upload underwriting approaches for mentally ill on their websites by 1 October. The thought being that such persons or their guardians should know how insurers will treat their application. When I checked some days ago, only a handful had complied and the policies put up were not meaningful. For example, insurers said, “we treat physical and mental illnesses at par. Like physical illnesses, mental illnesses will be subjected to evaluation and basis the outcomes would either be accepted as standard or with additional premium and/or waiting periods or rejected basis the chronicity, severity and complications due to the disease or treatment, and “acceptance of proposals with declaration of any conditions falling under the mentioned categories would be as per underwriting guidelines of the product and pre-policy medical tests." This is difficult to decipher, unhelpful and appears to be a declaration to tick the regulatory box.
The third, more complex issue is to design products that cover the largely out-patient (OPD) and caregiver cost. Most insurances cover hospitalization costs, but these are relatively infrequent in mental illness. Treatment is mostly provided on OPD basis. Sessions are expensive as there are few specialised counsellors, psychologists or psychiatrists and sessions take a long time. A full treatment cycle can cost ₹10,000-20,000. Caregiver cost is high for more advanced conditions. Often such care is needed lifelong. I recall a panel discussion some years ago where a dignified gentleman in his 80s told me about his severely autistic daughter. He worried about who would look after her when he died and I had no answer. I do not expect insurance to solve all these problems but there have to be ways that we can chip in more.
Insurers could be more open in selling health insurance to persons with minor, manageable illnesses. They could develop products or add-ons specific to mental illness. Most importantly, insurers could consider building capacity for mental health issues and price this as a value-added service. Recently, we started a complimentary OPD service for employees working at our clients and a large number of people reach out every week. This can be done for mental health on a much larger scale. Insurers could partner with mental health institutions to create capacity. There are some institutions that offer free and high-quality counselling, and understand the issues and solutions deeply.
Had Bai been diagnosed for schizophrenia, the cost of treatment to allow her a full, normal life would have been no more than a few hundred rupees a month. This incident took place 35 years ago, but on mental health, time has stood still.
Kapil Mehta is co-founder, SecureNow