Does Your Health Insurance Policy Cover Mental Illness? Here’s What Insurers Say

Battling COVID-19: Does Your Health Insurance Policy Cover Mental Illness?

Few insurers supply merchandise that present holistic well being cowl for psychological diseases.

COVID-19 has not solely affected the bodily well being of individuals, but in addition led to greater stress ranges, nervousness and even despair throughout the globe. In keeping with the findings of a World Well being Group (WHO) survey, revealed in October, the coronavirus pandemic has disrupted or halted essential psychological well being providers in 93 per cent of nations worldwide whereas the demand for psychological well being is growing. The survey, protecting 130 nations, highlighted the influence of COVID-19 on entry to psychological well being providers, underscoring the pressing want for elevated funding.

Surveys performed late final 12 months reveal a big improve in psychological sickness circumstances in India following the imposition of the world’s greatest lockdown on March 25.

With the passage of the Psychological Healthcare Act in 2017, the Insurance coverage Regulatory and Improvement Authority of India (IRDAI) — the nation’s insurance coverage regulator — mandated the protection of psychological well being situations underneath insurance coverage in the identical method as bodily well being situations. (Additionally LearnWhat Changes In Your Health Insurance Policy From October 1: 5 Points )

Via a round issued in June final 12 months, the regulator directed insurers to incorporate psychological sickness in common medical health insurance protection. In keeping with IRDAI, all insurers should supply insurance coverage protection to individuals identified with psychological diseases. IRDAI instructed all insurance coverage corporations within the nation — be it life, well being or normal insurers — to adjust to the directions by October 1, 2020.

Complying with the regulatory tips, some insurers have already customised their merchandise to cater to particular wants of people affected by psychological diseases.

Personal insurer ICICI Lombard Basic Insurance coverage, for instance, provides plans to cowl psychological well being issues. The corporate’s flagship product — ICICI Lombard’s Full Well being Insurance coverage Product — gives hospitalisation protection for all declared and accepted psychological well being issues. In case the shopper has opted for out-patient protection by paying extra premium, OPD advantages may even be obtainable as much as the OPD sum-insured.

“Psychological diseases now stand to be coated alongside the identical traces as bodily sickness supplied the identical have been declared and accepted on the time of issuance,” says Sanjay Datta, chief-underwriting, claims and reinsurance, ICICI Lombard Basic Insurance coverage.  The corporate has standardised its coverage wordings “with respect to definitions, exclusions, and normal phrases and situations.. and the language used is easy and lucid,” he provides.

Whereas most insurers acknowledge that the remedy for many psychological health-related points occur exterior a hospital, there are few merchandise that present holistic well being cowl.

Personal sector insurance coverage firm Star Well being and Allied Insurance coverage provides plans that cowl in-patient hospitalisation for all psychological problems that require hospitalisation.

“We cowl all psychological problems that require hospitalisation in all our medical health insurance insurance policies. For instance, Schizophrenia, manic-depressive psychosis, bipolar problems, extreme despair, extreme nervousness neurosis, electroconvulsive remedy and many others,” stated Dr S Prakash, managing director, Star Well being and Allied Insurance coverage. A number of the firm’s plans cowl each in-patient in addition to out-patient remedy.

In keeping with healthcare platform Practo, on-line queries for psychiatry on grew 50 per cent within the first two weeks of the lockdown, with most queries coming from the age group of 21-30 years. On-line consultations for psychological well being queries grew 180 per cent into the six months of the COVID-19 pandemic, based on Practo.

Nevertheless, some insurers say psychological well being remains to be thought-about a stigmatised idea in numerous elements of the nation.


“You will need to perceive that the difficulty of psychological sickness is stigmatised in India and for any well being cowl to work successfully, we now have to first normalise the idea,” says Max Bupa, a non-public sector well being insurer. “Someday again, our companion Bupa launched a marketing campaign known as ‘Is it regular?’, which extensively centered on endeavours to normalise the difficulty of psychological well being and inspired extra individuals to hunt medical assist,” it provides.

Pre-Present Circumstances

In keeping with non-public insurance coverage dealer Marsh India, pre-existing psychological well being situations are coated underneath tailored well being plans, during which the subscriber will get the identical remedy as in case of pre-existing bodily diseases.

“Whereas hospitalisation is the commonest profit, insurers are keen to underwrite outpatient care coverages in addition to remedy periods when prescribed by a psychiatrist. Not solely have we been in a position to get this underwritten for company-paid group covers, but in addition by means of a modular/versatile method which requires worker contribution on a voluntary foundation,” stated Sanjay Kedia, nation head and CEO, Marsh India Insurance coverage Brokers.

“The power to customize the psychological well being profit as per particular person shopper necessities primarily based on demography wants and budgets has considerably elevated the prevalence of this protection,” he provides.

Max Bupa began protecting psychological health-related situations with the launch of its product, GoActive, in early 2018.  “We launched protection for psychological well being associated diseases underneath a few of our merchandise similar to GoActive, ReAssure and Well being Premia, a lot earlier than regulator’s standardisation round got here out,” says the insurance coverage firm, which claims to have a non-discriminatory method to bodily and psychological well being.

“Many of the generally occurring psychological well being associated situations discover acceptance and protection in our merchandise… Many psychological well being associated consultations will be addressed by means of OPDs, that are additionally coated underneath GoActive, which provides  behavioural counselling which allows prospects to avail telephonic counselling from main psychiatrists, psychologists and psychological well being professionals from the consolation of their dwelling,” Max Bupa provides.

How To Choose A Well being Plan With Psychological Sickness Protection

Your commonplace medical health insurance plan might not cowl psychological diseases. Due to this fact, it’s prudent to learn about the important thing options to remember whereas choosing probably the most applicable insurance coverage coverage, say specialists.

“If an individual desires to put money into a psychological sickness cowl, he/she ought to examine if the dysfunction requires hospitalisation or will be handled by means of remedy and drugs. Within the former case, the individual can go for a complete indemnity plan that covers hospitalisation, and within the latter, the individual would require a plan that additionally provides OPD,” says Naval Goel, CEO, and founding father of, an IRDAI-approved insurance coverage comparability portal.

“If a person is identified with a psychological sickness subsequent to purchasing a medical health insurance coverage, the insurer can’t reject the declare,” he explains.

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