Mental well-being crucial amid coronavirus, so why is insurance not easy?

The coronavirus lockdown has taken a huge toll on people's mental well-being. People who have been forced to isolate themselves in their homes have complained about anxiety, depression and many other mental health issues that have been aggravated due to this confinement. Moreover, the sudden demise of Bollywood actor Sushant Singh Rajput, who was reportedly suffering from depression, has once again put the spotlight on mental illness and the need for proper and systematic treatment for mental health.

Recently, a PIL was filed in the Supreme Court on insurance coverage for mental illness treatment. The apex court asked insurance regulator IRDA to explain why insurers do not cover mental health under their regular schemes.

Interestingly, last year IRDA had come out with guidelines to standardise health insurance policies, which among others, mandated that all insurers have to include treatment of mental illness or psychological disorders in their health insurance policies by September 30. While most insurers are in the process of doing it, there are multiple challenges facing insurers and patients.

Outpatient and inpatient treatment

In the initial stage, if a person approaches a psychiatrist for diagnosis, it is a case of outpatient treatment. However, if the policy does not have outpatient benefits, it won't cover the treatment. "In case a patient has bought insurance only for institutional care, then he or she will only get coverage for that. Mental illness is a rare case. The majority of the patients seeking medical care for mental illness go to OPD check-ups and have to take medicines for it. If the insurance does not cover OPD charges, then patients visiting doctors for clinical treatment won't get coverage," says Sanjay Datta, Chief - Underwriting, Reinsurance & Claims at ICICI Lombard.

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So, if the illness does not require hospitalisation and you only have a basic indemnity plan without the OPD benefit, the insurance plan might not be very useful. Also, the in-patient treatment should be in the insurer's network of hospitals or in an authorised psychiatric hospital that is included in the list of hospitals that the plan has coverage for.

A Bajaj Allianz spokesperson told BusinessToday.In that they have been covering mental illness on OPD basis under Health Care Supreme Plan since 2014, and OPD basis in Infinity, Extra Care Plus & Arogya Sanjeevani plans.

No standalone policy

Datta says treatment for mental illness is expensive, and there's an ambiguity on the costs involved. Dr. S. Prakash, Managing Director, Star Health and Allied Insurance Co.Ltd also said that, "There is no strong data what percentage of population may need admission,  and what will be an average expense...there is no clarity on anything". This could be the reason why insurers have no standalone policy for mental illness. Besides, sometimes mental illnesses can demonstrate physical symptoms, which is why there are no standalone policies. Very few health plans cover mental illness. For instance, Star Health & Allied Insurance's Star Special Care plan covers autism for the age group of 3-25 years. This covers daycare treatments including therapy with some sub-limits of the Star Mediclassic Insurance policy. It also covers hospitalisation for psychiatric and psychosomatic disorders.

"If the insured person is diagnosed with a psychiatric or psychosomatic disorder for the first time and hospitalised for a minimum period of 5 consecutive days under this policy, then the company will pay hospitalisation expenses up to the basic sum insured, provided the insured person has been covered under this policy for a continuous period of 24 months without any break," said Star Health.

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What to keep in mind

If you are specifically looking for a health policy that covers mental illness, make sure to buy a plan that covers therapy, counselling along with hospitalisation. While a comprehensive indemnity plan can take care of hospitalisation, for therapy, the policy buyer should choose a plan that covers the high cost of private hospitals, and therapists. In metros like Mumbai and Delhi, private practitioners charge anywhere from Rs 1,500 to Rs 3,000 per session, excluding medicine. Often patients need to see psychiatrists every week, and over a period of time. Hence, seeking treatment becomes an expensive affair.

So far as existing policyholders are concerned, if you get afflicted by a mental disease or develop physical ailments as a result of mental disorder then insurers cannot refuse to cover it, but, of course, it will be subject to the underwriting limits.

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Why mental illness coverage is important

According to the National Crime Records Bureau (NCRB) data, every year around 1 lakh people die due to suicide in India. 'Family problems' and 'illness' were reportedly the major causes of suicides which accounted for 30.4 per cent and 17.7 per cent of a total of 1.34 lakh suicides in 2018.  Other reasons were marriage-related, concerning love life, career problems, and so on, as per the data provided by NCRB.

The Indian government, in 2017, passed the Mental Health Care Act on April 7 which in actual came into force on July 7, 2018. The Act aimed to safeguard the rights of the people with mental illness, along with access to healthcare and treatment without discrimination from the government. The Act also mandated for medical insurance for the treatment of mental illness on the same basis as is available for the treatment of physical illnesses.

Mental Health Act 2017 Section 21 (4) states that "Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for the treatment of physical illness".

Hence, in August 2018, the Insurance Regulatory and Development Authority of India (IRDAI) directed all insurers to comply with the Mental Health Act, followed by guidelines in 2019.

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