IRDAI Mandates Mental Illness Coverage In Health Insurance, But Challenges Persist

IRDAI has mandated all health insurance policies must cover mental illness from October 1, 2022, in response to the rising cases of mental health issues, mainly during the pandemic.
IRDAI Mandates Mental Illness Coverage In Health Insurance, But Challenges Persist

Despite the insurance companies' coverage of mental health, the last-mile delivery of this benefit to all those who need it may still be a challenge. Therefore, the Insurance Regulatory and Development Authority of India (Irdai) has recently formed a five-member committee of medical professionals and insurers to address the need for comprehensive mental health insurance.

Irdai had instructed insurance companies to include mental illness in their health insurance policies from October 1, 2022. While mental health has always been a serious issue, mental health problems among individuals have only aggravated since the pandemic.

However, there is still a long way to go. Says Bhabatosh Mishra, director, product, underwriting & claims, Niva Bupa Health Insurance: "Mental health issues in India have been on the rise. Most mental health treatments involve therapy and counselling sessions under expert supervision. Since these ailments mostly require treatment in OPDs (outpatient departments), health insurance products must have an OPD component to facilitate mental health treatment."

Mental health insurance policies usually cover the expenses for inpatient treatment in a hospital, including room rent, boarding, and nursing charges. "Today, nearly all health insurance products in India are inpatient centric, whereas most mental health conditions need out-patient treatment," says Mishra.

"Many policies also cover the expenses for outpatient treatment, such as consultation fees for psychiatrists, psychologists, or other mental health professionals, diagnostic tests, and prescribed medication," says Venkatesh Naidu, CEO of BajajCapital Insurance Broking. This is important because mental health treatment generally involves consultants with experts who may not require hospitalization but may be expensive.

Hence, before you buy a health insurance policy, it is vital to keep the following in mind. The mental health offerings may not be consistent across all insurance providers, which makes it important to see what is covered and what is not.

Coverage: When choosing a health insurance policy, it's important to carefully examine the coverage offered, especially regarding mental health conditions and treatments. It's important to ensure that the policy covers the specific mental health conditions and treatments you may require.

Waiting Period: "Many mental health insurance policies in India have a waiting period before they become effective. Consider the waiting period to ensure that you will be covered when you need it," says Naidu.

Exclusions: Carefully read the policy's terms and conditions to understand the exclusions and limitations. Ensure the policy has no significant exclusions affecting your mental health coverage.

"Even the health plans which cover mental health conditions limit the value with regards to these conditions. Currently, an unreasonably high 18 per cent GST is levied on health insurance premiums, which is a serious impediment in building out-patient products into health insurance," says Mishra.

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