Mental Health Insurance

According to the Ministry of Health and Family Welfare, 6% to 7% of the population of this country suffer from mental disorders. The prevalence of severe mental health illnesses in individuals above the age of 18 years is approximately 10.6%. These shocking numbers should be all the more reason for one to focus on their mental health and wellbeing. 

For the longest time, mental illnesses were never considered to be a serious issue in India and people often considered their mental health problems as insignificant. However, over the past few years, the importance of mental health awareness has been recognised by a large number of people across the world.

Various health organisations and public figures have highlighted the importance of mental health. It has also become important for insurance companies to focus on mental illnesses in the context of health insurance to attract more customers. Let’s take a look at how health insurance for mental illness works in India.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

Here are a few important factors about health insurance for mental illness you need to keep in mind when looking for the right plan to buy: 

Hospitalisation Coverage

Health insurance for mental illness provides coverage for medical expenses during hospitalisation due to any mental health conditions. The coverage includes the cost of treatment, medicine, rent for the room, etc.

However, the insured or the policyholder must be admitted to the hospital for more than 24 hours, for the health insurance coverage to take effect.

How Does Mental Health Insurance Work?

Following the IRDAI’s guidelines on mental health, most health insurance policies now have to offer a cover for the treatment of mental illness, neurodegenerative disorders, and stress. However, whether the policyholder will be covered specifically for hospitalisation or for outpatient services as well will be based on the type of policy chosen. 

Individuals with mental illness can make the most out of health insurance benefits by availing health insurance coverage. When you look for a health insurance policy, you need to choose a plan carefully and consider your mental health coverage requirements. Read the documents thoroughly and go through the terms and conditions of the policy before you file a health insurance claim. Make sure that the plan you are buying includes coverage for mental health

Here are the plans on Bajaj Markets that offer mental illness coverage.

Health Insurance Plan	Health Insurance Partner	Premium Amount	Check Plans
Health Guard Silver	Bajaj Allianz General Insurance Company	₹333/month
Health Guard Gold	Bajaj Allianz General Insurance Company	₹492/month
Health Guard Platinum	Bajaj Allianz General Insurance Company	₹546/month

Mental illness is defined as a significant disorder of mood, thinking, perception, memory, and/or orientation. It impairs a person’s judgement, behaviour and ability to conduct the regular activities of daily life, which can be terribly hampering. Finally, the world has started giving great importance to mental health after realising the sheer impact it can have on an individual.

As per the guidelines issued by the Insurance Regulatory and Development Authority of India (IRDAI), the treatment of stress, mental illness, and psychological disorders are no longer considered exclusions under health insurance coverage. This means that every health insurance policy will be inclusive of mental health. 

People who have a family history of mental illness should specifically look for health insurance plans that cover mental conditions. Moreover, anyone who is vulnerable to or suffering from any mental illnesses must also seek out health insurance with cover for mental conditions.

In case a policyholder has a mental illness as a pre-existing condition, a waiting period on the coverage for mental health treatment may apply. Usually, the waiting period for mental health conditions is 2 years, but it may differ based on the insurance provider chosen.

While buying health insurance, make sure that the plan you are purchasing specifically has coverage for mental illness cover. Many health insurance plans still do not have mental illness cover, so you need to be careful while buying the plan.

The following are some examples of the diseases which are covered under health insurance for mental illness:

• Depression

• Anxiety Disorders

• OCD

• ADHD

• PTSD

• Schizophrenia

• Mood Disorder

24 hours of hospitalisation can be covered under the mental illness benefit offered by Health Insurance plans across many platforms. You can claim these benefits at network hospitals for cashless treatments or claim for reimbursement at external facilities.

Health insurance for mental illness will not provide coverage for the following conditions:

• Coverage for mental conditions will not be provided if the policyholder or the insured has not been admitted to the hospital for more than 24 hours.

• Coverage for mental conditions will not be provided if they have been caused as a result of alcohol, drugs or substance abuse.

• Coverage for consultations will not be provided in case of mental conditions.

• If a person has a severe history of mental illness, the insurer may choose to not sell the insurance plan to that person.