Does health insurance cover psychological disorders?

Psychological Disorders 

A psychological disorder is a condition that causes significant disruption in an individual’s cognition, emotional regulation, or behaviour. This disruption often leads to distress or impairment in critical areas of functioning. 

Psychological disorders come in many different forms and may also be referred to as mental health conditions. The term mental health conditions encompasses a broader range of conditions, including psychosocial disabilities and other mental states that cause significant distress, impairment in functioning, or risk of self-harm. 

Some of the most common psychological disorders include: 

1. Depressive disorders 
2. Bipolar disorders 
3. Anxiety disorders 
4. Sleep disorders 
5. Eating disorders 
6. Stress disorders 
7. Schizophrenia and other psychosis 
8. Dissociative disorders 
9. Dementia 
10. Neurodevelopmental disorders 

Mental Health Issues in India 

World Health Organisation (WHO) in October 2020 stated that close to 7.5% of the Indian population was suffering from mental disorders. About 1 out of 20 people in India has mental health issues, says another survey. 

Mental Healthcare Act of 2017 

Introducing the Mental Healthcare Act of 2017 in India was a meaningful change. The Act explains mental illness as disruptions in mood, thinking, orientation, perception, or memory that significantly affect behaviour, decision-making, judgement, or everyday activities. 

In India, mental health problems are not as openly discussed as physical health issues, even though health insurance now covers treatment for both equally. This lack of awareness among the general public often results in delayed treatment for those suffering from mental health-related issues. 

Health Insurance and Mental Health 

Health insurance was focused on physical ailments, neglecting mental health. 

Recognising the importance of mental health, the IRDAI has instructed all health insurance providers in India to add coverage for mental illness in their policies compulsively starting 31 October 2022. 

In February 2023, the IRDAI released a circular that mandates all insurance companies to provide an exclusive product serving individuals with disabilities. 

This product guarantees coverage for expenses associated with inpatient hospitalisation because of mental illness, along with physical health conditions. 

Mental Health Coverage 

Understanding the terms and conditions linked with mental health coverage is essential. 

Disclosing During Purchasing 

Generally, insurers won’t allot a specific waiting period for mental illness. However, any mental illness is disclosed during the policy purchase. In that case, it will be classified as a pre-existing condition and subject to the waiting period mentioned in the product’s terms and conditions. 

Pre-Existing Condition 

Insurers may also consider any pre-existing mental health conditions, another crucial aspect. When it comes to individuals with a recent record of acute mental illness, insurers may choose to exercise their discretion in providing insurance plans. Some insurers may reject proposals based on risk elements; others may approve proposals with specific premium adjustments. 

Sub-Limits 

Health insurance plans may impose sub-limits on the coverage of specific mental health conditions. Inpatient hospitalisation coverage amounts for conditions like schizophrenia, psychosis, bipolar disorder, and depression may vary depending on the insurance provider. 

Why do I need to purchase mental illness coverage? 

In today’s increasingly complex world, individuals are becoming more vulnerable to mental health disorders. Therefore, it is recommended to protect yourself by obtaining a health insurance policy that covers such treatment. 

Acquiring coverage for mental illness provides financial security during health insurance emergencies and grants enhanced access to care and various treatment options per the policy’s terms and conditions. By doing so, you can ensure that you receive the necessary support while alleviating the financial strain associated with mental health treatment. 

When you need hospitalisation for inpatient treatment of mental illness, the health insurance policy will cover the cost of the treatment, including diagnostics, medicines, ambulance fees and so on. 

Points to note before buying health insurance with mental illness coverage 

Coverage: When picking a health insurance policy, it is crucial to carefully analyse the coverage offered, particularly regarding mental health conditions and treatments. Ensuring the policy covers the specific mental health conditions and treatments you may need is essential. 

Waiting Period: Considering the waiting period regarding mental health insurance policies in India is essential. This waiting period is in place to ensure that you will be covered when you need it the most. 

Exclusions 

Like any health insurance plan, mental health insurance also entails specific exclusions. Here are the critical exclusions to be aware of: 

1. Mental illness resulting from drug or alcohol abuse: Cases where mental illness arises due to substance abuse are excluded from coverage. 
2. Limited coverage for medical expenses: Most plans only cover medical expenses when the patient requires hospitalisation. 

Understanding these exclusions allows you to make informed decisions regarding your mental health insurance coverage and ensure that your claims are not rejected. 

Medi Classic Insurance Policy (Individual) 

Star Heath’s Medi Classic Insurance Policy (Individual) covers Psychiatric and Psychosomatic Disorders. It covers the hospitalisation expenses resulting from any psychiatric or psychosomatic disorder. 

Psychiatric and Psychosomatic Disorder 

Suppose the policyholder is diagnosed with psychiatric or psychosomatic disorder for the first time and hospitalised for a minimum period of five consecutive days under this policy. In that case, the Company will pay hospitalisation expenses up to the Basic sum insured, provided the insured person has been covered under this policy for 24 months without any break. 

Note: The treatment should be taken at an Authorized Psychiatric hospital licensed by the Mental Health Authority or any similar Authority of the Central or State Government or Union Territory. 

Conclusion 

Mental health issues in India have long been disregarded. Only in recent years the awareness has increased, and people have started realising the need for addressing mental illness and getting necessary treatment like any other ailments.