How does your health insurance’s mental health coverage give you absolute protection?

Mental health is an area riddled with stereotypes and stigma. It is therefore not surprising that even though people were faced with this problem, they were afraid to talk about it openly. However, the silver lining of the pandemic era was that this conversation came to light after collectively leading a life of isolation and dealing with personal loss.

According to the recent Deloitte report, the scale of mental health disorders in India is enormous, accounting for around 15% of the global mental health burden. The main reason given is the treatment gap and the lack of conversation around this crucial subject. Moreover, the taboo associated with the disease further aggravates the problem.

While awareness is slowly but steadily setting in, there is still a long way to go. Just as it is important to seek treatment for mental health issues, it is equally important to ensure mental health coverage through a comprehensive health insurance plan. While awareness of health insurance has increased following the Covid-19 outbreak, most people are still unaware that mental health coverage is part of an overall health policy.

So, on this World Mental Health Day, here’s everything you need to know about mental health coverage in your health insurance:

Know about mental health

Recognizing the seriousness of mental health issues post-pandemic, the Insurance Regulatory and Development Authority of India (IRDAI) has issued new guidelines for insurance companies to add mental health coverage to all health insurance plans in 2020. Insurers are therefore required to comply with the definition of mental illness under the Mental Health Act 2017 for underwriting the risk.

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What falls under mental health coverage?

Most comprehensive health insurance policies available today cover the insured against hospitalization costs that might result from a probable mental disorder. These policies cover the patient’s room rent, medications and diagnostics, ambulance costs and treatment costs.

A person with mental illness is also likely to spend a significant amount on OPD (outpatient) expenses, such as day care, medication, or doctor visits. Increasingly, insurance companies are offering plans that cover these OPD costs. It is of utmost importance to opt for policies that include OPD expenses.

Some illnesses that fall under mental illness and are covered by insurance are:

  • Anxiety disorders
  • Acute depression
  • post-traumatic stress disorder
  • Attention Deficit/Hyperactivity State
  • Bipolar disorder
  • Mood disorders
  • Schizophrenia
  • Obsessive Compulsive Disorder
  • Psychotic disorder

Who should buy it?

With an increase in overall stress levels, mental health disorders are not limited to any particular age or group of people. They range from the youngest to the oldest populations, even students and young adults are prone to them. However, people with a family history or suffering from such a traumatic experience should seriously consider purchasing this insurance, as such scenarios increase the likelihood of being affected. Others who should get mental health insurance are those who have ever used antidepressants or opioids. For this, the insured must declare it as a PED, the basis on which the underwriter assesses the risk. Likewise, individuals with an established record of clinical depression, personality or neurodegenerative disorders, sociopathy or psychopathy are also eligible for this policy. The positive part is that more insurers are now willing to provide cover for most mental disorders.

Is there a waiting period for mental illness insurance?

Like all insurance, a person with a pre-existing condition does not immediately benefit from the policy and will have to wait for a set period, as indicated by the policy, from the date the policy is issued. Usually, this duration varies between 2 and 3 years. Therefore, if a person is looking to purchase this coverage in the coming times, it is recommended to start as soon as possible.

What is the premium charged?

Mental health being part of an insurance plan is a relatively new practice; thus, insurers find the best way to assess the risk. Currently, there is no additional premium for this coverage; it is naturally covered by your health plan.

What are the exclusions?

Like all health insurance coverage, this one also has certain exclusions. The first is mental retardation or intellectual disability, which characterizes and impairs intellectual and adaptive functioning due to neurodevelopmental disorders.

In conclusion, with high intensity stress coming from all directions, neglecting your mental health could be a ticking time bomb. So, remember to compare the different policies available online and read the inclusions, exclusions, and disclaimers before selecting the best one for you.

(By Amit Chhabra, Manager – Health Insurance,

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