Knowledge Centre

Mental illness coverage by Health Insurance – All you should know

Published on 15th Aug 2020 EST Read time 4 Mins

The coronavirus outbreak has brought India’s health care infrastructure under close scrutiny. And, apart from physical wellbeing, the pandemic has also highlighted the importance of mental health. In 2015-16, the National Mental Health Survey found that 1 in 20 Indians suffers from some form of depression. So, it is not hard to imagine why the numbers have gone up in 2020, when people are facing pay cuts and layoffs, cases of domestic violence are rising, and lockdowns are getting extended. But amidstall this gloom, the good news is that you can opt for mental illness plans that can cover your treatment costs.

How and When IRDAI Mandates Offering Mental Illness Cover?

There was a time when mental health issues were ignored and brushed off as quirky personality traits. However, today, there is a significant shift in this manner of thinking. The Mental Healthcare Act 2017, which came into effect in July 2018, states that that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness”.

Following this, the Insurance Regulatory and Development Authority of India (IRDAI)directed general and health insurance companies to comply with the Act’s provisions and treat all mental illnesses at par with physical ailments. The insurance regulator also issued guidelines that barred the exclusion of “mental illnesses, stress or psychological disorders, behavioural and neurodevelopment disorders” in September 2019.

What are the Benefits Offered under Mental Illness coverage?

Mental Illness is covered under my:health Suraksha . The Mental Healthcare Act of 2017 defines what must be considered as mental illness and all the insurers must abide by it. According to the Act, any considerable disorder in an individual’s mood, thinking, perception, orientation or memory that may hamper his/her behaviour, decision making, judgement or the capability to meet ordinary day to day activities, will qualify as mental illness.

The benefits include cashless treatment, reimbursement of pre and post hospitalization charges, easy renewability of the existing  health insurance plan , etc. However, it’s important to note the exclusions. The Act has excluded mental retardation, and therefore, the claim will get rejected if the policyholder suffers from any form of mental retardation. Secondly, any harm caused due to the abuse of drugs or alcohol would also be part of the plan’s coverage.

Types of Mental Illness which may require Hospitalisation

There are few mental illnesses that require more than just consultation, and need intensive treatment, hospitalisation included. 

  • Schizophrenia: It is a serious brain disorder that impairs its emotional and cognitive abilities. It affects basic functions like communication, perception and other activities. Some of the symptoms of schizophrenia are hallucinations, incoherent speech, delusions, hearing voices, and social withdrawal. 

  • Anxiety Disorders: These disorders can be of various kinds and indicate mental stress and fear. Patients get these attacks in bouts and many experience it while undergoing stressful situations. These stressful situations are subjective to the person. Symptoms of anxiety disorders can include panic attacks, nightmares, physical symptoms such as pain, nausea and headaches, fear of leaving the house, and obsessive thoughts.

  • Dementia: This disease is classified as a disruption in consciousness, which also affects the cognitive functions of the brain. It also includes loss of motor skills and memory.  Some of the most common forms of dementia are substance induced dementia, Parkinson’s, and Alzheimer’s disease.

You can trust us

The law mandates that there cannot be any discrimination between a patient with mental illness and someone who is afflicted by physical ailments. We, at HDFC ERGO, abide by the law and provide coverage for mental illness treatment. Our network includes over 10,000 hospitals, many of which provide psychiatric treatment. We process claims in a hassle-free and transparent manner.

This  blog is written by Kavita Ganesh Asst. Vice President, Health & Accident Product Underwriting

About The Expert :  Dr. Kavita Ganesh holds over 15 years of work experience in health insurance industry. She highly recommends buying health insurance for securing finances in case of a medical emergency. Looking at the current pandemic situation, she enforces the idea of having a higher sum insured for covering the entire family. Disclaimer:

The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

my:health Suraksha HDFHLIP20049V041920.  UID No D2HI808. If an Insured Person is hospitalized for any Mental Illness contracted during the Policy period We will pay Medical Expenses under Section A in accordance with The Mental Health Care Act, 2017, subsequent amendments and other applicable laws and Rules provided that; i. The Hospitalization is prescribed by a Medical Practitioner for Mental Illness ii. The Hospitalization is done in Mental Health Establishment". 


Awards & Recognition