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Things to Know About Mental Health Coverage

Mental issues have been ignored and avoided for long in our country. But we are fortunate enough to be witnessing a significant shift in the same. Today, more people are open about mental issues than they were in the past, including celebrities. And this gradual shift has impacted the way health insurance policies are framed too.

Till date, health insurance plans catered only to physical ailments or issues. But going forward, they must look into mental issues/ailments as well. All thanks to the introduction of the Mental Healthcare Act of 2017. In brief, the Act makes it possible to give equal importance to physical as well as mental issues.

­­The Insurance Regulatory and Development Authority of India (IRDAI)has sent out circulars to all the insurers to start complying with the Act at the earliest.

Definition of Mental Illness

The Mental Healthcare Act of 2017 provides the definition of mental illness, which all the insurers must abide by. As per the Act, if there is considerable disorder in the mood, thinking, perception, orientation or memory of an individual that hampers the behavior, decision making, judgement or the capability to meet ordinary day to day activities, it will qualify as mental illness. The Act keeps mental retardation out of the definition since it is mostly due to incomplete or arrested brain development.

Exclusions for Health Insurance Plans

As is the case with any other insurance plan, mental health insurance also has exclusions. Exclusions are essentially situations or scenarios that the plan doesn’t offer coverage for. And it is important that you are aware of these scenarios. This will help you avoid claim rejections by your insurer.

If you go by the definition of mental illness, there are two clear exclusions present in them. Firstly, the plans would not cover any sort of mental retardation. Secondly, outcomes due to abuse of drugs or alcohol would also be excluded from the plan.

It must be noted that insurers are still in the nascent stages when it comes to implementing these changes. It is very likely that they will come out with revamped health insurance plans. And in those, there could be some additional exclusions.

Since insurers will relook into their policies, one would have to wait for some interesting aspects. For instance, would insurers add waiting periods for certain mental issues like they have for physical ailments? Also, how insurer handle pre-existing mental illnesses would be another tricky clause to keep an eye out for.

Changes in Premiums

Since the Act was introduced only the previous year, most of the insurers are yet to incorporate them into their policies. On the surface, it might not come across as a lot of change, but internally it is. Only after all these changes are made, one can be sure of the next steps. It would most probably increase insurance premiums as well.

With HDFC ERGO my:health Suraksha you can get hospitalisation expenses covered due to mental illnesses.

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


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