Mental health is an important aspect of an individual's well-being. Health insurance can be a valuable resource for individuals seeking mental health services. However, the barriers to accessing mental health services, including the stigma and cost, can be overwhelming. Additionally, navigating the varying levels of coverage for mental health services across different insurance plans in India can be difficult. Hence, this article will delve into the world of mental health coverage in health insurance in India, so you can better understand the options available in the market.
Understanding Mental Health Coverage In Health Insurance
In recent years, awareness about mental health in India has increased, leading to a rise in the demand for mental health services. Thus, the passage of the Mental Healthcare Act of 2017 was a landmark judgment by the Indian Government. Based on this judgement, the Insurance Regulatory and Development Authority of India (IRDAI) instructed health insurance providers in the country to cover mental illnesses such as bipolar disorder, acute depression, post-traumatic stress disorder (PTSD), eating disorders, dementia, schizophrenia, and more. As a result, many health insurance companies in India now provide their policyholders coverage for mental health services.
However, the coverage of mental health services under health insurance plans can vary depending on the policy's terms and conditions. For example, some policies may cover only a limited range of mental health services, while others may cover a broader range of services.
Coverage Of Mental Health Services Under Different Health Insurance Plans
While most health insurance companies in India offer plans that cover mental health services, the level of coverage for mental health services can vary depending on the specific plan. For instance, some plans may provide coverage only for hospitalisation, while others may provide coverage for both inpatient and outpatient services. Additionally, some plans may provide coverage for medication and therapy, while others may only cover one of these options.
When choosing a Lifetime health insurance, it is essential to carefully review the policy's terms and conditions to determine the extent of mental health coverage. Policyholders can also reach out to the insurance company to seek clarification on the policy's coverage of mental health services.
Out-Patient and In-Patient Coverage
Mental health care is broadly divided into two: the Outpatient (OPD) treatment and Inpatient (IPD) hospitalisation. They both are necessities, although not all health insurance policies cover them equally.
In-Patient Coverage (Hospitalisation)
Under the MHCA guidelines, insurers must cover hospitalisation expenses for mental health conditions, just as they would for any physical health issue. This includes:
- Psychiatric evaluation
- Hospital stay charges
- Medicines and medical consumables
- Diagnostic tests
- In-hospital therapies
- Treatment for conditions like severe depression, schizophrenia, bipolar disorder, OCD, acute anxiety, and other psychiatric disorders
Most health plans readily include this coverage, though some may impose a waiting period before mental health benefits can be claimed. Common waiting periods are:
- 24 months to 36 months for pre-existing mental health conditions
- No waiting period for newly diagnosed mental illnesses (in some comprehensive plans)
Out-Patient (OPD) Coverage
OPD coverage is where differences become prominent. Mental health treatments that are based on OPD tend to involve:
- Therapy and counselling sessions
- Psychiatric consultations
- Follow-up visits
- Medication management
- Outpatient diagnostic assessments.
Most insurance schemes do not provide OPD mental health coverage automatically or provide it as an optional benefit with restricted financial cover.
Even when OPD is covered, policies may cap:
- The frequency of OPD visits annually.
- The maximum claim amount
- Qualification of particular mental health practitioners (psychologists vs. psychiatrists)
Because most mental health treatments are therapy-driven and non-hospitalised, OPD coverage plays a major role in reducing true out-of-pocket costs. Choosing a policy that includes OPD support is particularly important for long-term or chronic mental health conditions.
Policy Limits and Sub-Limits for Mental Health
Even though mental health cover is becoming part of health insurance, policy limits and sub-limits may severely affect the amount you are able to claim.
Sum Insured Restrictions
Some health insurance plans offer mental health benefits only up to a certain amount rather than allowing claims up to the full sum insured. For example:
- A 5 lakh health plan will only cover 50,000-1 lakh of mental health treatments.
- OPD mental health benefits may be capped at ₹1,000 to ₹5,000 annually.
These caps vary widely across insurers.
Therapy Session Limits
Despite the fact that therapy is covered, there might be:
- A set number of sessions per year that is fixed.
- A cap on per-session reimbursement.
- The need to meet network-approved therapists.
In the case of conditions that need long-term psychotherapy, these limits might not cover the entire amount.
Room Rent and Hospitalisation Caps
Other plans have sub-limits on:
- Room rent
- Daily hospital charges
- Specific cost limits on psychiatric hospitalisation treatment.
This could affect the selection of the hospital and the total cost burden.
Co-payment Clauses
Other insurers have a co-payment on mental health claims, particularly in the case of senior citizens or high-risk claims. This implies that the policyholder has to pay a certain percentage of the amount of the claim using his or her own money, usually 10-20%.
Knowledge of these limits will aid in the choice of a policy that more closely reflects the real-world requirements of mental healthcare.
Out-of-Pocket Costs for Mental Health Services
Even with the insurance coverage, a significant number of people continue to pay out-of-pocket costs for mental health treatments. This may be due to the nature of treatment, policy formulations, or even accessibility.
Here are the most common out-of-pocket expenses:
1. Therapy and Counselling Sessions
Therapy is often a long-term, recurring requirement. Even if your policy includes OPD coverage, limits may not be sufficient. For example:
- A single therapy session can cost ₹800 to ₹3,000
- Long-term treatment may require 8 to 30+ sessions per year
Given typical OPD caps, policy coverage may only pay for a few sessions.
2. Medication Costs
Some psychiatric medications are expensive and may not be fully covered if:
- They fall under non-payable lists
- You purchase them outside of network pharmacies
- The insurer has restrictions on long-term medication claims
3. Diagnostic Tests
Psychological assessments, cognitive tests, or specialised evaluations are considered OPD expenses, and many plans don’t pay for them.
4. Non-Network Providers
If your preferred therapist or psychiatrist is not part of the insurer’s network, reimbursement may be:
- Lower than the actual expense
- Rejected
- Subject to extra documentation
5. Indirect Costs
These are travel, lifestyle changes, or alternative treatment (music therapy, mindfulness training, etc.), and this is not typically covered.
Although insurance would narrow down the significant costs, such as hospitalisation, routine mental healthcare in most instances would still demand individual financial investment.
Challenges with Mental Health Coverage in Health Insurance
Although the inclusion of mental health in health insurance is a big step in the right direction, there are still numerous obstacles that influence the ability of policyholders to take advantage of these benefits.
Awareness and Stigma Around Mental Health
Even though there is increased awareness, stigma is a significant barrier to accessing timely treatment. Many individuals:
- Do not reveal mental health problems to insurers.
- Delay treatment because of the fear of being judged.
- Do not realise that mental illness is a legally safeguarded right that should be covered.
- Lack of knowledge about OPD vs. IPD benefits in mental care.
- Wary of utilising mental health services that are cashless because of privacy concerns.
This ignorance leads to poor use of mental health benefits, despite the existence of policies that cover them.
Limited Network of Mental Health Professionals
Inadequacy of mental health professionals in insurer networks is another major challenge.
Many insurers still have fewer:
- Psychiatrists
- Licensed clinical psychologists
- Counsellors and therapists
- Specialised psychiatric hospitals
As a result:
- The network providers may not be available in the vicinity of the policyholders.
- Delays in reimbursement are frequent.
- Quality therapy might not be insured.
- Continuity of treatment is a challenge.
As the need for mental healthcare increases, insurance companies should seek to increase their network relationships to enhance accessibility.
Conclusion
While some of the major players in the health insurance industry are starting to offer insurance policies for mental health, there is still much progress to be made in terms of providing comprehensive services for the same. However, as more health insurance companies begin to prioritise the importance of mental health, now may be an ideal time to explore mental health coverage options for yourself.
FAQs:
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Will insurance cover mental health?
Many health insurance plans in India provide coverage for mental health services, but the extent of coverage can vary depending on the specific plan's terms and conditions.
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How much is the mental illness allowance in India?
The mental illness allowance in India is a government-provided benefit that offers a monthly stipend between INR 500 and INR 1200 to individuals with mental illnesses, depending on the severity of the psychiatric disability. Health insurance companies do not provide this benefit.
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Which insurance company covers mental health?
Many health insurance companies in India offer plans that cover mental health services. The level of coverage can vary depending on the specific plan's terms and conditions.
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Is depression covered by health insurance?
Many health insurance plans in India cover depression, but the level of coverage can vary depending on the specific plan's terms and conditions.
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Is mental health covered under all health insurance plans?
Mental health services are not covered under all health insurance plans in India. The level of coverage can vary depending on the specific plan's terms and conditions.
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What mental health services are typically covered under health insurance?
Mental health services typically covered under health insurance plans include inpatient and outpatient services, medication, and therapy. However, these services can differ depending on different policy providers.
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Are there any out-of-pocket costs for mental health services under health insurance?
Some health insurance plans may require a deductible for mental health services, and some plans may limit the number of mental health sessions covered under the policy.
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Can I see any mental health professional I choose under my health insurance plan?
Policyholders may be required to choose a mental health professional who is covered under their insurance plan. It is essential to review the policy's terms and conditions to determine the network of mental health professionals who accept the insurance plan.
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How can I find a mental health professional who is covered under my health insurance plan?
Policyholders can reach out to their insurance company to obtain a list of mental health professionals who accept their insurance plan. Additionally, some insurance companies may have an online directory of mental health professionals who accept their insurance plans.
