Mental Health Insurance: What You Need to Know

IRDAI mandates mental health insurance, covering various disorders while highlighting coverage challenges and treatment gaps in India.

Highlights:

Mental health coverage in insurance includes conditions like depression and schizophrenia but varies by insurer
Policies often exclude outpatient care and substance use disorders
Overcoming stigma is essential to ensure people seek timely mental health care with trust and support

Mental health is the state of a person’s cognitive, behavioral, and emotional well-being. However, many people lack access to treatment. In October 2022, the Insurance Regulatory and Development Authority of India (IRDAI) mandated mental health coverage for all health insurance companies ().

Depression Calculator
A quick, simple and anonymous self-assessment health tool to assess the level of depression using the famous Zung Self-Rating Depression Scale.

‘Did You Know?
About 1 in 8 people suffer from mental illness in India. #mentalhealthinsurance #healthcare #medindia’

Mental Health of People in India

About 1 in 8 people suffer from mental illness and there are more than 14% of mental health cases that require immediate treatment in India. According to the World Health Organization, around 80% of Indians do not receive treatment for mental illness.

Many people are unaware that their insurance covers mental health. Due to social judgment or self-doubt, people often tend to ignore the signs of mental health problems. It is important to break the stereotype and promote overall well-being.

Mental Health Expenses Surge Over 50% Since COVID-19
Post-pandemic, monthly mental health spending per 10,000 beneficiaries rose to over $3.5 million, compared to about $2.3 million pre-pandemic.

Mental Health Conditions Covered by Insurance

Any mental health illness that requires a minimum of 24-hour hospitalization is covered by the health insurance company. Most mental health insurance plans provide coverage for both inpatient and outpatient treatments like pre and post-hospitalization, consultation, and treatment costs. However, the coverage limitations may vary from insurer to insurer.

Many insurance providers in India offer mental health insurance along with physical health insurance. Mental disorders that are covered under mental health insurance are:

Acute depression
Anxiety disorders
Attention deficit disorder
Bipolar disorder
Dementia
Hyperactivity disorder
Mood disorder
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Psychotic disorder
Schizophrenia

Affordable Care Act Improves Insurance Coverage for More People With Mental Illness
The Affordable Care Act have resulted in an estimated 20 million people gaining health insurance between the passage of the law in 2010 and early 2016.

How Insurance Covers Mental Illness Treatment

Health insurance primarily covers mental illness expenses when you require hospitalization as an in-patient which includes room rent, medical treatments, and other expenses during the hospital stay.

Outpatient department (OPD) treatments are not covered by the policy because it is a day-to-day consultations and do not require hospitalization. This means costs for therapy sessions with counselors or medical professionals outside of a hospital setting may not be covered.

Some insurers require the first hospitalization and diagnosis for a mental illness to occur during the policy period for coverage to apply. Insurance coverage for mental illness typically applies when treatment is provided by a qualified psychiatrist or a practitioner with specific postgraduate qualifications in related fields. Some policies may cover the full amount while others may cover a part of the amount, either as a percentage or a fixed amount.

Insufficient Mental Health Insurance Risking People
More than 8.3 million of the Americans aged 18 and 64 suffer from serious psychological distress -feelings of sadness, worthlessness.

Challenges in Mental Health Insurance Coverage

Most insurance companies use the definition of mental illness from the Mental Health Care Act (MHCA) 2017. However, this definition is subjective and can vary in interpretation, which may exclude people with less severe mental health conditions from the coverage.

Many insurance companies do not provide coverage for drugs or substance use mental illness. This is an issue because substance use disorders often occur alongside other mental health conditions, which can prevent people from getting their health insurance.

In India, suicide is a leading cause of death, and it is often associated with mental health disorders like depression or anxiety. Mental health insurance policies exclude which restricts people from seeking help.

Some insurance policies delay the sanction of mental health coverage up to 48 hours which can delay treatment and create financial barriers for people in urgent need of care.

Addressing these issues can break the stereotype and make people with medical illnesses seek help and support with trust.

Reference:

Impact of Mental Health Insurance Legislation on Mental Health Treatment in a Longitudinal Sample of Adolescents - (https://pmc.ncbi.nlm.nih.gov/articles/PMC8425633)

Source-Medindia