is mental health care covered by insurance
Health Insurance

Is Mental Healthcare Covered in Health Insurance?

For the longest time, mental illnesses were considered taboo in India. Most patients either remained in denial or hesitated to seek treatment, often assuming that the disease would pass. However, in the last few years, the attitude towards seeking treatment for mental health has changed in India. But it often takes time to recover from mental health problems, and the costs can pile up. So, the question remains – is mental healthcare covered by insurance? Let’s find out.

Is mental health care covered by insurance?

Insurance companies in India traditionally only covered their customers against physical ailments requiring surgery or other forms of physical treatment. However, in August 2017, the Insurance Regulatory and Development Authority of India (IRDAI) made a revolutionary change when it instructed insurance companies to include mental illnesses under the ambit of health insurance.

The IRDAI directed insurance companies to offer mental health insurance plans. Per the IRDAI guidelines, insurance companies must treat mental illnesses the same way as they would physical illnesses and cover the costs of treatment under these insurance policies.

Illnesses covered under mental health plans

Insured parties can utilise their health insurance policies to seek treatment for various kinds of mental ailments such as:

  • Acute depression
  • Anxiety disorder
  • Attention deficit hyperactivity disorder
  • Bipolar disorder
  • Dementia
  • Mood disorder
  • Obsessive–compulsive disorder (OCD)
  • Post–traumatic stress disorder
  • Psychotic disorder
  • Schizophrenia

Mental health plans in India – What’s not included

While policyholders can seek treatment for various mental ailments, they may not file a claim for the following:

  • Outpatient counselling and consultations (unless expressly specified under the health insurance plan)
  • Mental illness caused due to drug or alcohol abuse
  • Recurring mental conditions arising from not following the suggested treatment course or prescribed medications.

Mental health insurance - The prerequisites

Below are some factors you need to know if you intend to get insurance for mental health conditions.

  • Mental health insurance providers typically cover the same or almost similar benefits as those covered under a standard health insurance policy.

  • You can get coverage for in–patient treatment and hospitalisation expenses, diagnostic tests, room rent, ambulance charges, medical costs, surgeon fees, etc.

  • The mental health plan covers individuals affected by a variety of conditions affecting their cognitive abilities such as memory, decision–making skills, mental capacity, thinking and behaviour.

  • Insurance companies may offer various types of health insurance plans, and the premiums, inclusions, and exclusions may differ from one insurance provider to another.

  • If a policyholder is diagnosed with mental illness before getting a new health plan, i.e., pre–existing conditions, they may file claims only after the waiting period ends.

  • The waiting period for pre–existing mental health conditions is typically two years.

  • Insured parties can file a claim only if they have been hospitalised for a minimum of 24 hours.

Invest in health insurance today

In these fast–paced times, life has become incredibly stressful. Today, it is crucial to invest in health insurance plans for both, your body and mind. Remember to choose a health insurance policy with a high sum assured to get optimum coverage. A good health insurance policy reduces the stress associated with a worrisome diagnosis.

Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.

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