4 Things to Know about Mental Health Coverage in Health Insurance

A whole range of Health Insurance benefits are available out there. In this article, we will tell you about 4 things to know about Mental Health Coverage in Health Insurance

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4 Things to Know about Mental Health Coverage in Health Insurance

For too long, mental health has been a taboo topic in India. It is only recently that conversations around this topic have started becoming common. One area which has seen a positive change in this regard is health insurance. The Mental Healthcare Act of 2017 stated that mental health patients should be treated on equal par with patients suffering from physical ailments. This includes getting coverage under health insurance plans as well. Insurers have since incorporated mental health conditions as a part of their health insurance offerings. Awareness about this inclusion is highly needed.

In this article, we look at 4 things to know about mental health coverage in health insurance.

1. Coverage of inpatient and outpatient hospitalization

The treatment of mental health ailments can differ from the treatment of physical conditions. A mental health patient is more likely to require outpatient treatment and OPD care. While not all health insurers are presently offering OPD coverage, there are some reliable ones who do. It would be preferable to opt for health insurance plans that offer OPD cover as most cases of mental illnesses require therapy and counselling more than they require inpatient hospitalization.

2. Mental illness definition and inclusions

According to the Mental Healthcare Act, 2017, mental illness can be defined as having a “substantial disorder of thinking, mood, perception, orientation, or memory that grossly impairs judgement, behaviour, capacity to recognize reality or ability to meet the ordinary demands of life.” Mental conditions related to the abuse of alcohol and drugs are covered under this definition as well; however, the condition of mental retardation has been excluded.

Thus, any person who suffers from health problems related to the above-mentioned definition should be able to get coverage under their medical insurance.

3. Coverage subject to limits

The coverage each mental illness would receive may differ as per the insurer. Illnesses such as schizophrenia, bipolar disorder, psychosis, depression, and so on may have limits on the inpatient hospitalization coverage amount, depending on the health insurance provider. It is recommended to look for health insurance plans that have high sub limits so that the patient has access to the best treatment. Besides these, the sub-limits of OPD coverage may also be applicable.

4. Separate waiting period for mental illnesses

Some health insurance plans may have a separate waiting period for mental illnesses as compared to the waiting period for other physical ailments. A short waiting period is preferable as the sooner the coverage begins, the better it is for patients. A waiting period of 24 months would be ideal.

The inclusion of mental illnesses in health insurance has been welcomed by the insurance industry as well as the medical field at large. The inclusion of mental illnesses in coverage is expected to increase awareness regarding mental health problems in India. The hush-hush attitude that most people associate with mental illnesses has led to its sufferers being excluded from the general society. Those who suffer from mental illnesses have often felt hesitant about opting for treatment due to all the misconceptions surrounding them and their illnesses. A health insurance policy that covers their conditions would bring a positive change, motivating them to be more optimistic about treatment. Hopefully, it would also normalize getting treatment for mental health issues.

Do remember that different insurers may have different terms and conditions for mental health coverage within their medical insurance plans.


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