Health-related discussions have always been at the forefront and promoted by everyone. Through means of convincing people to examine lifestyle and consequently triggered ailments, or weight loss programs or techniques to embrace healthy living, the list goes on. But not nearly enough regarding our mental well-being is given such extensive reach.
First and foremost, it is important to understand what mental illness means. Mental illness according to Mental Healthcare Act, 2017 is defined as, “Mental illness means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation, which is a condition of arrested or incomplete development of mind of a person, especially characterized by sub-normality of intelligence.”
Insurance companies have to make a plan for the treatment of mental illness in the same way as they would cater to treat physical sicknesses. They have to comprehend the definition of mental illness and incorporate necessary action plans.
The extent of coverage
Technically, anyone who suffers from a mental condition as specified above is eligible to apply for a health insurance claim. The Mental Healthcare Act, 2017, also explicitly expresses the fact that every policyholder suffering from a mental illness will be treated in the same manner as those applying for a claim out of any physical sicknesses. This is to support and encourage as many as those who are suffering from any mental disturbances like anxiety, clinical depression, and other psychological disorders, to reach out for help. IRDA (Insurance Regulatory and Development Authority) has also issued guidelines for all insurers on the standardization of policy. Hence, any treatment for a mental illness can be availed in your health insurance policy.
A health insurer has to cover treatment for a mental illness, but whether you are eligible to get a cover for OPD (out-patient department) apart from the hospitalization would depend on the health insurance policy you have acquired. According to the guidelines, the insurer is not allowed to differentiate between physical and mental illness, which means if your policy covers physical illnesses for hospitalization, subsequently it will cover mental illnesses as defined above. Moreover, if your health plan provides you a cover towards OPD charges for a physical illness, then the OPD charges for any mental illness will be covered too.
Pre-existing mental illness covered
An insurance company is free to provide a cover for pre-existing sicknesses, subject to some waiting period, or a reduced insurance cover. The same practice pertains to mental illness as well, wherein an insurance company can cover the same subject to a waiting period of 2-3 years. So, a policyholder may not get a claim for medical treatment expenses during this period. But once the waiting period is over, the insurance company is subject to offer cover for all claims related to any mental illness treatment.
