Mental Health To Be Covered Under Insurance From 31 Oct: How Will It Work?

What mental illnesses are covered under the insurance? Will it cover therapy? Here's what we understand so far.

In a welcome move, all health insurance policies will mandatorily cover mental illnesses from 31 October.

“All insurance products shall cover mental illness and comply with the provisions of the MHC Act, 2017 without any deviation. Insurers are requested to confirm compliance before 31 October 2022,” the Insurance Regulatory and Development Authority IRDAI said in a circular issued on 18 October.

What kind of illnesses are covered under the mental health insurance? Will it cover costs of therapy? Here's what we understand so far.

What kind of illnesses are covered under the mental health insurance?

The Mental Health Act, 2017, which lays the foundation for insurance for psychological disorders, defines “mental illness” as "means 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."

Medical insurance will therefore cover treatment of mental diseases that fall under the ambit of this definition.

Which disorders will be covered under insurance?

While the extent of the coverage varies with the insurer, some of the disorders whose treatment will be insured are bipolar disorder, acute depression, schizophrenia, panic disorders, hyperactivity/attention deficit disorder, post-traumatic stress disorder, personality disorders, eating disorders, and dissociative disorders.

Which illnesses will not be covered?

The Mental Health Act, 2017, does not include mental retardation in its definition, which it considers as "a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence."

Issues related to mental retardation will therefore not be covered under insurance.

Treatment related to intentional self-inflicted Injury or attempted suicide is also not insured.

Complications relating to disorders of intoxication, dependence, abuse, and withdrawal caused by alcohol and other substances will also not be considered under the mental health insurance.

What benefits will be provided?

Many plans cover medical expenses only when the patient is hospitalised. The benefits are the same as insurance for physical health ailments, such as cashless treatment and pre and post hospitalisation cover depending on the policy.

Depending on the insurer, the coverage may include treatment costs, medications, diagnostics procedures, road ambulance charges, room rent, etc.

Are counseling and consultations covered under mental health insurance?

The coverage differs from insurer to insurer. Not all insurers provide health insurance that covers mental illnesses under the out-patient department (OPD) benefit.

While many insurers had already extended cover for mental illnesses as per the guidelines of the Mental Health Act, more clarity on the changes is expected to emerge after insurers release their revised policy documents.