Do Health Insurance Companies Offer Mental Health Coverage? What is its Importance?

Do Health Insurance Companies Offer Mental Health Coverage? What is its Importance?

Bajaj Finserv Health
September 15, 20215 mins read

Key Takeaways

  • Mental Healthcare Act of 2017 promotes the importance of mental health
  • Depression, dementia, and anxiety are covered under mental health insurance
  • A mental healthcare plan doesn’t cover illnesses due to alcohol and drug abuse

Mental health has been neglected in India for a long time. However, with the rise in healthy conversations around mental disorders in recent years, more people are acknowledging their importance. Still, the burden of mental health problems in India is estimated at 2443 disability-adjusted life years (DALYs) per a population of 10,000, as per the WHO [1]. One smart way to address mental issues is to get a mental health coverage plan.

Fortunately, the Mental Healthcare Act of 2017 gives equal importance to both physical and mental health issues. Moreover, the IRDAI has advised all health insurance companies to offer medical health coverage for such problems. Health insurance that covers mental health is fairly new in India. So, read on to understand what is covered under a mental healthcare plan and why you need it.

Additional Read: Health Insurance Myths: 7 Common Myths About Health Policies and Important Facts

Benefits of mental health coverage I Bajaj Finserv Health

Benefits of mental health insurance

  • A mental health insurance plan essentially covers in-patient hospitalization expenses. These expenses may include treatment charges, diagnosis costs, medications, room rent, ambulance charges, and more. The benefits provided in this case are similar to that of a normal medical health coverage
  • Mental healthcare plans cover a number of mental disorders such as acute depression, mood disorder, anxiety, psychotic disorder, and schizophrenia [2]. Mental health coverage also includes disorders that affect thinking, memory, behavior, decision-making, and cognitive abilities.
  • Some insurers cover OPD expenses under their mental health insurance plan. This benefit may include consultation, counselling, and rehabilitation expenses.

Waiting period in a mental healthcare plan

Similar to pre-existing diseases in medical health coverage, mental health insurance also comes with a waiting period. Most health insurance companies require you to wait for two years. Moreover, they require hospitalization for at least 24 hours for your claim to be eligible. However, this period may differ from one provider to another. So, make sure you compare plans and go for a policy that has the least waiting period. Also, buy a mental healthcare plan early in life to benefit from it.

mental health insurance cover

Exclusions of mental health coverage

Like regular medical health coverage, mental health insurance also has certain exclusions. Make sure you know about what is included and what is not to be informed and avoid rejections of your claims. Mental health coverage does not cover the following in most cases.

  • Mental retardation

Mental retardation is excluded under mental health insurance. Mental retardation begins before the age of 18 and is classified by significantly below average functioning of intellect [3]. A mentally retarded person will have an IQ below 70 to 75 and have substantial limitations in two or more adaptive skills [4]. Some adaptive skill areas include self-care, communication, social skills, work, and leisure.

  • Outcomes due to alcohol or drug abuse

Mental health insurance plans would not cover any mental illnesses arising out of drug or alcohol abuse. Your settlement claim will be rejected in such a case.

  • Outpatient consultation

Generally, mental health coverage covers expenses only when you are hospitalized and doesn’t include OPD expenses. However, few health insurance companies may cover outpatient consultation or counselling charges.

  • Recurring mental conditions

Your mental health insurance claim is likely to get rejected in case of recurring mental problems. This is because recurring conditions often take place due to lack of discipline with medications and treatments.

Expenses for mental health issues I Bajaj Finserv Health

Should you buy health insurance for mental health?

The rise in mental health issues in India and around the world can be associated with genetic and environmental factors [5]. Stressful lifestyles have made more people vulnerable to mental illnesses. Rising diseases, unemployment, and poverty are all linked with mental health issues [6]. Thus, buying mental health coverage in the present times has become a necessity.

With a family history of mental illnesses, the risk of such conditions increases. If you fall in this category, you should definitely buy mental health insurance. People suffering from traumatic experiences, such as surviving an accident or losing a loved one, should also think about getting health insurance for mental health. Most importantly, buy a suitable medical health coverage to lower the financial burden of mental illnesses. However, do not forget to compare the plans, waiting period, and benefits and read policy documents carefully for inclusions and exclusions.

Additional Read: 6 Important Tips to Choose the Right Senior Citizen Health Insurance Policy

With the rise of mental health problems [7] including stress, depression, and anxiety among people nowadays, it is necessary to buy mental health insurance. To start the journey of taking care of your mental health, check the Aarogya Care health plans on Bajaj Finserv Health. Make sure you also address symptoms of such problems at once by booking an online or in-personal consultation with a therapist or psychologist. This way, you are focusing on overall well-being instead of just your physical health.

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Please note that this article is solely meant for informational purposes and Bajaj Finserv Health Limited (“BFHL”) does not shoulder any responsibility of the views/advice/information expressed/given by the writer/reviewer/originator. This article should not be considered as a substitute for any medical advice, diagnosis or treatment. Always consult with your trusted physician/qualified healthcare professional to evaluate your medical condition. The above article has been reviewed by a qualified doctor and BFHL is not responsible for any damages for any information or services provided by any third party.

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