Mental illness has not received as much attention as physical illnesses in the past. However, with Covid, many things changed, including the perspective around mental illness. In the National Mental Health Survey of India conducted in FY16, nearly 15% of adults in India require treatment for mental illnesses. This iterates the importance of mental health coverage under health insurance plans for comprehensive and holistic coverage and well-being.
Prior to Nov 01, 2022, most health insurance policies did not cover mental illness treatments, irrespective of whether they were pre-existing or diagnosed post-policy issuance. This has undergone a change post-01 November 2022. This is a landmark date within the insurance space, it was integral for health insurance to acknowledge mental illness as a serious disorder which could lead to many complications, including suicidal or homicidal tendencies in individuals.
The regulatory changes by IRDAI:
The IRDAI (Insurance regulatory and development authority of India) has made it necessary for all health insurance policies to cover all types of mental illness diagnosed post-issuance of policy. The pre-existing mental illness will also be covered post-waiting period as mandated by the insurer. However, the pre-existing mental illness waiting period is similar to that of physical pre-existing diseases, which is usually 2 years.
This coverage is extended across both new and old policies. Mental illness will be treated in the same manner in which physical and critical illnesses are treated. Given that both old and new policies are required to cover mental illness, the clauses of the old policies will undergo necessary changes to ensure that they mention the inclusions and exclusions of mental illness coverage. The insured will be able to avail coverage for hospitalisation expenses that are incurred towards mental illness treatments.
Inclusions and exclusions of the norm:
The inclusions that most insurance companies are likely to cover are dementia, bipolar, depression, OCD, anxiety disorder, ADHD, PTSD, mood disorder, psychotic disorder, schizophrenia and Alzheimer’s, which were not available for coverage in basic health policies earlier. This is an incredibly important step towards holistic and comprehensive coverage, which promotes the well-being of the individual. It’s important to note that the exclusions will be explicitly mentioned in the policy, and one has to correctly evaluate and read through the entire document before signing up with any insurance provider.
Health insurance offers coverage only upon a minimum of 24 hours of hospitalisation. This is likely to be extended for all types of mental illnesses where hospitalisation would be necessary. There are many insurance policies which offer OPD coverage. This could be at an additional premium cost. Such OPD coverage, when purchased, would be extended to mental illness consultations, diagnostics and tests.
New Born Baby Coverage
All mental illnesses that are mandatorily covered by the rules will be applicable for a new born baby also. “The new born baby, once added to the policy, will be covered for any mental illness-related condition. Few policies cover the new born from day 1, while others provide cover after 90 days of birth,”
This is a major step towards uniformity of health insurance plans. Some of the major insurance companies were already providing coverage for mental illness. However, with the new mandate issued by the IRDAI, most of the other health insurance companies have joined the bandwagon and are now providing coverage for mental health as well. This move by IRDAI’s move is a great step towards an inclusive populace where everyone is duly taken care of. If you have any questions, you can contact the experts at Tata Capital Wealth for clarification.