Health Insurance 206 views June 15, 2021

Does Your Health Insurance Cover Mental Illness?

For a long time, mental illnesses didn’t find a mention in the list of coverages under health insurance plans. It was July 7, 2018, a year and 3 months after the passage of the Mental Healthcare Act (2017) in the Parliament, when mental illness got the official nod for an entry into health insurance plans. Section 21(4) of the Act mandates every insurer to cover mental illnesses the same way as physical ailments. In August 2018, the Insurance Regulatory Development Authority of India (IRDAI) told all insurers to adhere to the provisions of the said Act and a month later issued a guideline asking them to remove mental illnesses from their list of exclusions. Although it’s definite that insurers will need to cover mental illnesses, the lack of clarity still persists on the issue. Let’s check the ambiguities as well as other critical information on this subject.

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Ambiguities Regarding Health Insurance Cover for Mental Illness

Since mental illness has been the latest addition to health insurance plans, insurers are finding it hard to assess the cost and other important aspects concerning the treatment of the said ailment. Let’s focus on these concerns.

Problems Faced in Fixing the Premium of Plans with Mental Illness Cover

Insurance companies are struggling to ensure effective underwriting and actuarial procedures as mental illness has been added to health plans recently. Treatment of most mental illnesses is done out of pocket at private institutions. So, insurers find it hard to figure out the treatment cost of these illnesses.

Hospitalization and OPD Treatment

Most mental illnesses don’t require hospitalization. So, if you get caught with such illnesses and don’t have to go through hospitalization, you won’t have any benefit if the plan doesn’t have OPD treatment under its ambit. So while comparing plans for mental illness cover, do check whether they have OPD treatment as part of their coverage.

What are the Costs Involved in Mental Illness Treatment?

Although it’s not clear how much one has to pay to recover from mental illness, you should at least know the counselling sessions or therapies that you may have to avail of at private institutes. Besides the costs of such sessions and therapies, fees of psychologists and medication costs are also incurred for the treatment of mental illnesses.

Are There Any Dedicated Plans for Mental Illnesses?

There are not many dedicated plans for mental illnesses. We’ve found one dedicated plan from Star Health InsuranceStar Special Care. It covers children aged from 3 to 25 years with Autism Spectrum Disorder. This regular indemnity-based health insurance plan covers behavioural therapy, occupational therapy, speech therapy and physiotherapy. The premium of this plan ranges from INR 5,664-7,169 per annum. On the other hand, the policy comes with a sum insured of INR 3 lakh and a co-payment clause of 20% for every claim. Room, boarding and nursing expenses are covered up to INR 5,000 per day. In case of a shared accommodation, the insurance company will pay INR 500 per day, up to INR 2,000 and INR 10,000 per hospitalization and policy period, respectively. Besides, the plan covers the fees of surgeons, medical practitioners, consultants, and costs of several treatment equipment.

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