Does Your Health Insurance Policy Cover Mental Illness?

The Insurance Regulatory and Development Authority of India (IRDAI) mandates the insurance providers in India to provide coverage for mental illness. A medical insurance for mental health covers conditions like Schizophrenia, Obsessive-Compulsive Disorder (OCD), and Attention-Deficit/Hyperactivity Disorder (ADHD). However, it excludes conditions resulting from the misuse of any intoxicating drugs or alcohol.

Let us understand the coverage benefits and claim process of medical insurance for mental health in more detail.

What Does Mental Health Coverage Include?

Mental health coverage in health insurance policies typically encompasses various disorders that affect memory, cognition, behaviour, and decision-making. Conditions covered may include:

1. Schizophrenia

2. Obsessive-Compulsive Disorder (OCD)

3. Attention-Deficit/Hyperactivity Disorder (ADHD)

4. Bipolar Disorder and Depression

5. Post-Traumatic Stress Disorder (PTSD)

6. Anxiety Disorders

7. Psychotic Disorders

8. Somatoform Disorders (e.g., somatisation disorder)

Also Read: How to Choose the Best Health Insurance for Hypertension?

Understanding Exclusions in Mental Illness Coverage

Exclusion is not the end of accessing mental health coverage. By carefully understanding the policy and comparing plans, you can allocate the available resources to support the condition.

Here are the key exclusions of medical insurance for mental health:

1. Behavioural health insurance may not cover mental health or behavioural conditions caused by drug or substance abuse.

2. Some policies may offer coverage for substance abuse under a separate category.

3. In cases of extreme mental illness, insurers may decline mental health insurance altogether.

4. When reviewing the policy, take note of conditions flagged as exclusions to understand what is not covered, like intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol).

Benefits of Mental Health Coverage Under Health Insurance in India

A recent survey held by Sukoon Health revealed a surprising pattern. About 82% of Indians are not aware whether their insurance covers mental care. This shows social stigma, or continued indifference towards the subject. Hopefully, with more communication, campaigns, and community participation, this too will be rectified.

Moving on, including mental health coverage within a health insurance plan can also open doors to customers who ignore the importance of their mental wellness. Insurance companies are addressing these gaps to make mental health coverage more accessible.

Here are the key benefits of medical insurance for mental health:

Affordable Options

Insurance companies are offering plans with affordable premiums for mental care. Plans also come with co-pays, with lower costs for mental health services compared to other treatments. A lower cost option is much needed for sections from weaker socio-economic backgrounds, who also happen to be the ones most affected by poor mental health.

Addressing Stigma

More people are learning to discuss mental health through awareness campaigns. By openly discussing healthcare, insurance companies are amplifying the need for mental wellness. This destigmatises and encourages individuals to seek support without fearing prejudices.

Confidentiality

The Mental Healthcare Act 2017 protects mental health information, ensuring privacy and confidentiality for policyholders.

Expanded Coverage

More coverage options are being added, apart from allopathic consultations like therapy and psychiatric sessions. Some include yoga, mindfulness programs, and enhancing the scope of medical insurance for mental health.

Integration with Employee Benefits

Insurance companies are joining hands with employers and institutions to scale the benefits of mental well-being. They are offering integrated health insurance for mental health bundled into employee benefit packages. This is a necessary step in fostering a positive work culture.

How to Find the Right Policy for Mental Well-Being?

Medical insurance for mental health covers inpatient hospitalisation for mental illnesses, post-hospitalisation, outpatient department (OPD) consultations, along with the cost for a therapist, and even counselling sessions.

However, it is important to review your insurance policy carefully to avoid claim denial. Read through the fine print to check exclusions and inclusions. The plan will differ based on the severity of illness and the insurer's clauses:

Covered Services

Insurance companies offer different types of health insurance depending on mental health conditions and treatment covered. The type of Policy will determine what is included - visits to specialists, hospitalisation, medication, etc.

Some policies do not cover OPD charges, while others may do so. An extreme history of mental illness will probably not be included. So, be informed and choose the best policy for maximum benefits.

Coverage Limits

Individuals covered under critical illness insurance attend multiple therapy sessions annually. However, other insurance plans may have limitations on therapy sessions. This applies to inpatient hospitalisation as well.

Financial Limits

Co-pays are upfront costs that individuals are required to pay for a policy. As you settle on a plan, ask your insurance agent to explain about co-pays for mental health services like consultation, medication, and therapy.

Also Read: Are Hair Loss Treatments Covered By Health Insurance In India

How to File a Mental Health Insurance Claim?

Understanding the claim process of medical insurance for mental health in advance can reduce the chances of rejection. Here is a step-by-step procedure to claim health insurance for depression and anxiety or other mental illnesses:

Review Your Policy

Before proceeding with treatment and filing the claim, check your health insurance plan to verify whether mental illnesses are covered under the plan.

Understand Hospitalisation and OPD Coverage

Coverage for hospitalisation involves a situation where the patient is admitted to a hospital, rehabilitation centre, or any other mental health institution. On the contrary, many cases of mental illnesses are attended to with regular counselling therapies and consultations with psychiatrists.

Inform Your Insurer

In case of planned hospitalisation, it is important to alert the insurer 48 to 72 hours before hospitalisation. However, in emergencies, you must inform them within 24 to 48 hours after hospitalisation.

Collect a Psychiatrist's Letter

It is important to get a letter from the psychiatrist who will recommend treatment to the patients concerning mental illnesses.

Collect the Other Documents

You must also submit some crucial documents like the claim form, records from the hospital, therapy bills, among others.

Pre-Authorisation Request

The next step involves submission of a pre-authorisation request in case of cashless claims, where the insurer assesses whether your policy is valid and whether the mental illness is covered in the insurance plan.

Submit Reimbursement Claim

In the case of reimbursement of your costs, you should apply for it once you are discharged from the hospital.

Also Read: How to Claim Medical Insurance: Reimbursement vs. Cashless Claims

Things to Know Before Purchasing Health Insurance for Mental Health

Before you purchase medical insurance for mental health, you must have a look at the following pointers:

1. The scope of mental health coverage varies among insurers.

2. Coverage details, such as hospitalisation requirements or outpatient care, are specified in your policy documents.

3. Some policies may include therapy, counselling, and medication costs.

Mental health issues require long-term treatment, hospitalisation, and ongoing medical care. Explore the Bajaj General Criti Care policy to ensure financial preparation in these situations.

Tips to Maintain Good Mental Health

Here are practical ways to nurture your mental well-being:

Follow the tips below to know how to maintain good mental health:

1. Engage in activities you love: Spend time on hobbies or passions that bring joy.

2. Prioritise sleep: Aim for 7 to 9 hours of uninterrupted rest each night.

3. Connect with nature: Spend time outdoors to relax and recharge.

4. Stay active: Exercise, dance, or walk to release "feel-good" hormones.

5. Keep a balanced diet: Incorporate fruits, vegetables, and whole grains into your meals.

6. Practice yoga and meditation: These are excellent tools for stress management.

7. Be kind: Helping others can uplift your mood and foster positive emotions.

8. Plan Enjoyable activities: Having things to look forward to can improve overall happiness.

9. Express your feelings: Journaling or talking to someone you trust can provide relief.

10. Seek help when needed: Do not hesitate to consult a professional for persistent mental health concerns.

Also Read: What is the Importance of Yoga in Our Life?

Mental Health Matters

Getting medical insurance for mental health coverage and easy access to mental healthcare services provides an invaluable safety net for you and your loved ones, without worrying or stressing over out-of-pocket expenses. Reviewing policy features that align with a mental condition can also help policyholders make the most of their plan.

A comprehensive health plan can certainly go a long way in this regard. Bajaj General Insurance is a proud partner, supporter, and enabler of mental wellness. Check out some of our best health insurance plans for mental health services across a vast network of healthcare partners.

FAQs

What is the 2-year waiting period for health insurance?

Most health insurance comes with a pre-existing disease waiting period of 2 years. It implies the insured can avail of health insurance benefits after the completion of 2 years.

What is a mental health barrier?

A mental health barrier is a situation in which people hesitate to access mental care, citing lack of awareness, social stigma, and expenditure. These factors act as barriers to getting proper health treatment.

How do you break mental health barriers?

The stigma around mental health may lead to self-doubt and shame. This, in turn, will intensify the condition. It is safe to seek an online health consultation to get a picture. More people are making mental health their priority, which comes from opening up.

Does insurance cover treatment for depression?

Most insurance plans may exclude some services, like consultation or medication costs. It is better to consult the insurance agents to compile a comprehensive plan that focuses on depression alone.

Is mental health treatment covered by insurance in India?

Yes, the Mental Healthcare Act 2017 mandates health insurance to cover mental health services. All insurance providers are required to comply with the provision.

*Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.