Does Your Health Insurance Policy Cover Mental Illness?

Mental health has finally found its place under the sun. A couple of decades ago, it wasn’t really recognised as being a concern but today, more and more people appreciate the fact it matters in so many ways. As more study goes into this space, it has also been found that mental health can swing up and down, irrespective of whether a person has (or does not have) any history with it. A lot of research also suggests that the psyche does indeed influence physical well-being to some extent. Unfortunately, mental health does not fall into state sponsored health programmes and costs quite a bit. Financial constraints are one of the major reasons people don't proactively approach or keep prepared for mental health treatment. To address this, the  Insurance Regulatory and Development Authority (IRDAI) passed the Mental Healthcare Act, 2017, to ensure appropriate treatment and services for those affected. The act defines mental illness broadly, encompassing various conditions affecting cognition, mood, and behaviour, excluding only mental retardation. Today, health insurance providers like Bajaj Allianz strive to break down financial barriers by providing inclusive health coverage that covers mental healthcare costs for you and your family members along with other benefits.

What Does Mental Health Coverage Include?

Mental health coverage in health insurance policies typically encompasses various disorders that affect memory, cognition, behavior, and decision-making. Conditions covered may include:

1. Schizophrenia
2. Obsessive-Compulsive Disorder (OCD)
3. Attention-Deficit/Hyperactivity Disorder (ADHD)
4. Bipolar Disorder and Depression
5. Post-Traumatic Stress Disorder (PTSD)
6. Anxiety Disorders
7. Psychotic Disorders
8. Somatoform Disorders (e.g., somatization disorder)

Things to Know

1. The scope of mental health coverage varies among insurers.
2. Coverage details, such as hospitalization requirements or outpatient care, are specified in your policy documents.
3. Some policies may include therapy, counseling, and medication costs.

Breaking Barriers: How Insurance is Making Healthcare Accessible

A recent survey held by Sukoon Health revealed a surprising pattern: about 82% of Indians are not aware if their insurance covers mental care. This shows social stigma, or continued indifference towards the subject. Hopefully, with more communication, campaigns, and community participation, this too will be rectified. Moving on, including mental health coverage within a health insurance plan can alos open doors to customers who ignore the importance of their mental wellness. Insurance companies are addressing these gaps to make mental health coverage more accessible.

Affordable Options

Insurance companies are offering plans with affordable premiums for mental care. Plans also come with co-pays with lower costs for mental health services compared to other treatments. A lower cost option is much needed for sections from weaker socio-economic backgrounds, who also happen to be the ones most affected by poor mental health.

Addressing Stigma

More people are learning to discuss mental health through awareness campaigns. By openly discussing healthcare, insurance companies are amplifying the need for mental wellness. This destigmatized and encourages individuals to seek support without fearing prejudices.

Confidentiality

The Mental Healthcare Act 2017, protects mental health information, ensuring privacy and confidentiality to policyholders.

Expanded Coverage

More coverage options are being added apart from allopathic consultations like therapy and psychiatric sessions. Some include yoga, mindfulness programs, and enhancing the scope of psychology health insurance.

Integration with Employee Benefits

Insurance companies are joining hands with employers and institutions to scale the benefits of mental well-being. They are offering integrated health insurance for mental health bundled into employee benefit packages. This is a necessary step in fostering a positive work culture.

The Right Policy for Mental Well-Being

Mental health insurance covers in-patient hospitalisation for mental illnesses, post-hospitalisation, outpatient department (OPD) consultations along with the cost for a therapist, and even counselling sessions. However, it is important to carefully review your insurance policy to avoid claim denial. Read through the fine print to check exclusions and inclusions. The plan will differ based on the severity of illness and the insurer's clauses:

Covered services

Insurance companies offer different types of health insurance depending on mental health conditions and treatment covered. The type of Policy will determine what is included - visits to  specialists, hospitalisation, medication, etc. Some policies do not cover OPD charges while others may do so. An extreme history of mental illness will probably not be included. So, be informed and choose the best  policy for maximum benefits.

Coverage limits

Individuals covered under critical illness insurance attend multiple therapy sessions annually. However, other insurance plans may have limitations on therapy sessions. This applies to inpatient hospitalisation as well.

Financial Limits

Co-pays are upfront costs that individuals are required to pay in a policy. As you settle on a plan, ask your insurance agent to explain about co-pays for mental health services like consultation, medication, and therapy.

Understanding Exclusions in Mental Illness Coverage

Exclusion is not the end of accessing mental health coverage. By carefully understanding the policy and comparing different plans, you can channel the resources available to support the condition.

1. Behavioral health insurance may not cover mental health or behavioural conditions caused by drug or substance abuse.
2. Some policies may offer coverage for substance abuse under a separate category
3. In cases of extreme mental illness, insurers may decline mental health insurance altogether
4. When reviewing the policy, take note of conditions flagged as exclusions to understand what is not covered, like intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol).

Tips to Maintain Good Mental Health

Here are practical ways to nurture your mental well-being:

1. Engage in Activities You Love: Spend time on hobbies or passions that bring joy.
2. Prioritize Sleep: Aim for 7–9 hours of uninterrupted rest each night.
3. Connect with Nature: Spend time outdoors to relax and recharge.
4. Stay Active: Exercise, dance, or walk to release "feel-good" hormones.
5. Eat a Balanced Diet: Incorporate fruits, vegetables, and whole grains into your meals.
6. Practice Yoga and Meditation: These are excellent tools for stress management.
7. Be Kind: Helping others can uplift your mood and foster positive emotions.
8. Plan Enjoyable Activities: Having things to look forward to can improve overall happiness.
9. Express Your Feelings: Journaling or talking to someone you trust can provide relief.
10. Seek Help When Needed: Don’t hesitate to consult a professional for persistent mental health concerns.

Mental Health Matters

Getting health insurance with mental health coverage and easy access to mental healthcare services provides an invaluable safety net for you and your loved ones: without worrying or stressing over out-of-pocket expenses. Reviewing policy features that align with a mental condition can also help policy holders make the most of their plan. Mental wellness is arguably the most impactful factor on how we live: professionally and personally. While poor mental health can negatively impact people and their families, addressing it and keeping well can be a blessing.  A comprehensive health plan can certainly go a long way in this regard. Bajaj Allianz is a proud partner, supporter, and enabler of mental wellness. Check out some of our best health insurance plans for mental health services across a vast network of healthcare partners. Click here to learn more or apply for a health insurance plan that is mindful of your mental and physical well-being.

FAQs

1. What is the 2 year waiting period for health insurance?

Most health insurance comes with a pre-existing disease waiting period. It implies the insured can avail of health insurance benefits after the completion of the waiting period.

2. What is a mental health barrier?

People hesitate to access mental care citing lack of awareness, social stigma, and expenditure. These factors act as barriers to getting proper health treatment.

3. How do you break mental health barriers?

The stigma around mental health may lead to self-doubt and shame. This in turn will intensify the condition. It's safe to seek an online health consultation to get a picture. More people are making mental health their priority which comes by opening up.

4. Does insurance cover treatment for depression?

Most insurance plan conditions like depression, however, they may exclude some services like consultation or medication costs. It's better to consult the insurance agents to compile a comprehensive plan that focuses on depression alone.

5. Is mental health treatment covered by insurance in India?

Yes, The Mental Healthcare Act 2017, mandates health insurance to cover mental health services. All insurance providers are required to oblige to the provision.   *Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.