Mental Health Insurance: Just like other health insurance plans, there are some guidelines that need to be followed for the mental health insurance plan.
In India, mental health coverage in health insurance plans has been a long-awaited reform. According to data, over 60 million people struggle with mental illness in India, and the situation was quite confusing and claims settlements were being made as per the insurer’s convenience.
However, giving in to the long-pending demand, IRDA allowed the claim settlement of mental illness to be covered under all health insurance from November 1, 2022, by bringing transparency to the topic.
What Is Covered?
According to Shilpa Arora, Co-Founder & COO, Insurance Samadhan, after the mandate, most mental illnesses like depression, obsessive-compulsive disorder (OCD), bipolar disorder, anxiety, post-traumatic stress disorder (PTSD), schizophrenia, sleep disorders, and dementia are covered under health insurance, with a waiting period of six months.
“Additionally, therapies and counseling sessions are allowed under the daycare treatment, adding further relief to the insurer, as it was considered a major hurdle for the claim approval. However, some mental illnesses, such as autism, might be excluded from the plan,” she added.
Things To Keep In Mind
Just like other health insurance plans, there are some guidelines that need to be followed for the mental health insurance plan. For instance, a few policies might include the co-payment clauses in case recurring counseling and therapies are required. In this clause, the standard price of the co-pay is 20 per cent. However, a few plans might ask the policyholder to pay a 40 per cent co-pay.
“Policyholders reacted positively to the move, as they can claim insurance for mental health treatment just like any other illness. It is important for the policy buyer to declare any mental health illness as a pre-declared condition, which will allow underwriters to assess the risk. If the policyholder fails to do so, there’s a chance that the application may be declined. Notably, around 80 per cent of applications struggle to get coverage due to this problem,” Arora said.
Mental health insurance is still a new concept in India, and due to a lack of proper knowledge and limited experience in claim settlements, it is hard for insurers to know the difference between the plans.
