Is Mental Illness Covered under Health Insurance?

Mental illness is something that is considered to be taboo. It is a topic that society does not want to talk about and has pushed behind closed doors. But now, the thinking of people is changing. Young people prefer to disclose than hide. They prefer to be cured than be left in a trap.

Here, the Insurance Regulatory and Development Authority of India (IRDAI) has come up to help bring the change.

Recently, IRDAI issued a circular directing all insurance companies (except ECGC and AIC) to comply with the provision of the Mental Healthcare Act, 2017 before 31 October 2022.

According to the Mental Health Care Act, 2017, all insurance companies need to provide coverage for mental illness under health insurance policies on the same basis as given for physical illness. This Act came into force in May 2018.

IRDAI said, “All insurance products shall cover mental illness and comply with the provisions of the MHC Act, 2017 without any deviation. Insurers are requested to confirm compliance before October 31, 2022.” An important point to be noted is that this may not cover existing mental illness or illness by birth. One needs to declare all facts with honesty and let the insurance company decide about acceptance or rejection.

What is Mental Illness?

Mental illness (mental health disorder) is a vast range of mental health conditions that affect a person’s mood, behaviour, and thinking making decisions. Basically, it affects a person’s psychological, social and emotional well-being. It leads to cognitive disorders.

Does Health Insurance Cover Mental Illness?

Earlier, health insurance did not cover mental illness. But people are more open to talk about their mental health or well-being.

In 2018, IRDAI made it mandatory for all insurers to cover mental illness under health insurance. And now IRDAI has again asked them to confirm compliance by this October 31.

What are the Inclusions of Mental Health Insurance?

A mental health insurance plan is similar to a normal health insurance plan that covers physical illness. It covers-

1. In-patient hospitalization expenses including
   • Cost of Treatment
   • Room Rent
   • Medicine Expenses
   • Ambulance Charges etc.
2. Some insurers offer OPD benefits too. These insurers will cover the cost of consultation, counseling as well as rehabilitation for mental diseases.
3. Mental diseases covered:
   • Schizophrenia
   • Obsessive-compulsive disorder (OCD)
   • Anxiety disorder
   • Bipolar disorder
   • Acute depression
   • Dementia
   • Psychotic disorder
   • Attention deficit
   • Mood disorder, etc.

There can be more inclusions in your health insurance policy. Read the policy document carefully.

Is There a Waiting Period in Mental Health Insurance?

Yes, there is a waiting period in mental health insurance. Generally, the waiting period for mental illness is 2 years. A claim cannot be raised before the waiting period comes to an end. In addition to this, the insured is expected to timely renew (pay the premium) during the waiting period.

Note: Waiting may vary from insurer to insurer. Read the terms and conditions of the policy document to know the waiting period of your insurance policy.

What are the Exclusions of Mental Health Insurance?

Mental health insurance does not cover the following:

• Outpatient consultations
• Mental disorders caused by the consumption of alcohol or drugs
• History of recurring mental conditions

Read the policy document carefully as there can be more exclusions to your policy.

Frequently Asked Questions:

Q1. What is known as mental health insurance?

Mental health insurance is a health insurance plan that covers expenses in case the insured was hospitalized under in-patient care due to mental illness.

Q2. Is depression covered under health insurance?

Yes. IRDAI mandates to cover mental illness. Therefore health insurance will cover the treatment cost to cure acute depression (a type of mental illness).

Q3. Is anxiety a mental disorder? Is it covered by health insurance?

Anxiety is one of the common mental disorders and is covered by mental health insurance.

Q4. Does Ayushman Bharat cover mental illness?

Ayushman Bharat Yojana (PM-JAY) covers mental disorders.

If you have a stressful life or had a painful experience of losing a loved one or you have any other reason to minimize the financial burden related to mental illness, then go ahead and buy a health insurance policy that covers mental illness.

If you have any genuine insurance complaint, you can connect with Insurance Samadhan.*

We have resolved 14,500+ insurance-related complaints. These insurance complaints include claim rejection, delay in claim settlement, mis-selling and fraud in insurance.

Contact us to get samadhan for your insurance-related issues, we’ll be happy to help you.

*Insurance Samadhan is a private organization and has no association with IRDA or any Government body.

Click on the below links to read some cases resolved by Insurance Samadhan:

Child health insurance claim rejection

Endowment policy sold in the name of FD