Beware of gaps in insurance policies for mental illness

mental health care actBhaskar Nerurkar, Head of Health Administration Team, Bajaj Allianz General Insurance said, “The Mental Health Care Act 2017 seeks to address the issue of mental illness and treat it at par with physical ailments. Accordingly, as per section 21(4) of the Act, every insurer shall make provision for medical insurance for the treatment of mental illness.”

Until a few years ago, there were no clear guidelines regarding coverage of mental health-related illnesses. Very few policies covered it, while most excluded it completely. “Not all insurers cover diseases like acute depression, anxiety and mental disorders, dementia, schizophrenia etc in their health policies,” said Rakesh Goel, director, Probus Insurance Broker.

mental illness: The Act states that mental illness is a significant disorder of thinking, mood, perception, orientation or memory that badly affects judgment. It also impairs a person’s ability to recognize reality or meet the normal demands of life and mental conditions associated with alcohol and drug abuse.

gap in coverageEverything you need to know about gaps in health insurance, especially those related to mental health coverage.

1. OPD: “If you buy a health insurance policy with mental illness coverage, it will only provide coverage for room rent, medications and diagnosis, ambulance fees, and treatment costs. However, outpatient departments adequate for people with mental illness (OPD) coverage is important as it requires prolonged consultation,” said Siddharth Singhal, Business Head- Health Insurance, Policybazaar.com.

Also, even if the policy offers outpatient consultation or medical coverage, one can avail it only after a waiting period of 2-3 years.

2. Sub-limits: Policies may have a sub-limit clause on the sum insured for mental illness coverage. Ankit Agarwal, CEO and Co-Founder, InsuranceDekho, said, “Policy coverage for mental illness can vary, depending on the underwriting procedures, type of policy and the insurer you choose while buying a health policy. Is. For example, all Niva Bupa health policies cover mental illnesses. In such policies, mental and physical illness are treated equally. While some older policies like Health Premia and Heart Beat have a sub-limit on certain mental illnesses, policies like Re-Assure offer full coverage till the sum assured is exhausted.

3. Paid Mental Health Issues: Like many other pre-existing diseases (PEDs), the insurer decides on medical underwriting and waiting periods for pre-existing mental disorders. This can usually happen for 3-4 years. In addition, the policy may not cover recurring mental conditions that indicate indiscipline in following prescribed treatment and medications.

4. Critical Illness Policies: These policies provide cover for specified diseases. “Mostly, critical illness policies do not cover all types of mental illnesses. Often such policies cover a certain number of critical illnesses. For example, HDFC ERGO’s Critical Illness Plan – Platinum 15 covers Alzheimer’s among other critical illnesses,” Agarwal said.

5. Challenges of HospitalizationHospitalization has some challenges such as the availability of good inpatient care facilities for mental illnesses – plus, the length of the treatment warrants long, frequent and supervised treatment costs.

Apar Kasliwal, Executive Director, Policyboss.com said that the availability and accessibility of specialized treatment units will determine the quality of care provided and subsequent use of the insurance cover. The indemnity policy generally covers the treatment of the patient, whereas counseling or therapy comes under the OPD rider. You can opt for a rider with health insurance policies and get reimbursed for the consultation.

“Insurers will have to set up supportive infrastructure for treatment of mental illness with specific network hospitals and clinics. The directive will also help in standardizing the cost of treatment for various mental illnesses. Insurers will also have to devise a transparent claim process for treatment of mental illness,” Kasliwal said.