Insurance regulatory authority of India (IRDAI), the insurance regulator, came out with a circular on the 18th of October 2022, directing health insurers to comply and provide cover for mental illness under their health insurance policies. The circular can be downloaded through this link.
According to this IRDAI circular:
- Health insurers must comply with the provisions of the Mental Health care Act, 2017
- All insurance products that are in force on or after the Mental Health care Act, 2017 act coming into force shall be deemed to provide cover for mental illness diseases.
- Insurers must confirm compliance to the above by 31st October 2022.
What is mental illness according to the Mental Healthcare Act, 2017?
Mental illness means a “substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour, capacity to recognise 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, specially characterized by sub normality of intelligence”.
The Mental healthcare act 2017 states that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness”.
Let us look at five policies from five insurers and the extent of their coverage of mental illness as per their policy wordings:
- National Parivar Mediclaim
Parivar mediclaim Policy wordings – Page 7
The National Insurance policy lays down the conditions under which hospitalisation cover is provided for mental illness. Any form of psychological counselling/therapy expenses are expressly excluded from coverage if the insured is not hospitalised.
In this policy, there is no sub-limit mentioned for mental illness cover.
- Manipal Cigna pro health prime
Pro health prime Policy wordings – page 5
This policy covers mental illnesses without any sub-limits provided there is a waiting period of 24 months before availing this benefit, and then only on hospitalisation of the insured.
Pro health prime policy wordings – page 20
This policy specifies WHO’s International statistical Classification of Diseases and health problems 10th version (ICD) codes for the mental illnesses which have a waiting period.
- Niva health recharge
Health recharge Policy wordings – page 9
Niva Bupa’s health recharge specifically covers mental illnesses up to sum insured without any sub limits provided hospitalisation is necessary. However, some of the specified mental illnesses have a sub-limit of only ₹50,000 per policy period.
Health recharge Policy wordings – page 10
- Navi Health super top-up
Navi super top-up Policy wordings – page 10
Navi super top-up policy wordings – page 17
Certain mental illnesses are covered up to a maximum of ₹3,00,000 only as given in the above extract. These disorders also have a 24-month waiting period in the Niva super top-up policy.
- New India Premier Mediclaim
Psychiatric and psychosomatic disorders ,under this policy, have a lower sub-limit of only 5% of sum insured of the New India policy. As with all the other policies listed above, only in-patient expenses are covered here.
Premier mediclaim Policy wordings – page 17
Adult personality disorders, on the other hand, are covered after a waiting period of 24 months and have a sub-limit of 25% of sum insured.
Premier mediclaim Policy wordings – page 16
Psychiatric and psychosomatic disorders on the other hand, have a lower sub-limit of only 5% of sum insured of the New India policy. As with all the other policies listed above, only in-patient expenses are covered here.
Though the IRDAI circular requires insurers to comply with the provisions of the Mental healthcare Act, 2017, as can be seen from the five policy examples:
- Different policies have different coverage of mental illnesses.
- Sub-limits on coverage of mental illnesses ranges from 10% to 25% to absolute rupee limits to no limit on coverage i.e., coverage till the sum insured amount.
- Certain policies have mentioned mental illnesses covered specifically, also mentioning their ICD codes used for diagnosis of illnesses by psychiatrists, whereas some insurers provide a general “mental illness cover”.
- None of these policies provide coverage for outpatient expenses like psychiatric consultation or for any form of individual or family therapy sessions. Only inpatient hospitalisation expenses are included in the coverage.
- Despite the regulator’s circular, many policies (not included in the list) are yet to be updated with details of the included mental illness coverage.
It is a crucial step taken by the Insurance regulatory authority of India to force health insurers to comply with the Mental healthcare Act, 2017 covering various mental illnesses and disorders as are available for physical illnesses.
However, the steps taken by health insurers as per their policy offerings, are currently woefully inadequate in the range of mental illnesses covered, low sub-limits available for treatment and lack of any coverage of outpatient therapy expenses
The above mentioned five policies are examples and not recommendations. Please read the complete policy wordings before buying any insurance policy.
If you would like to know the factors to consider before buying a health policy read this article.
