Under this health scheme, the beneficiaries need to pay only Rs 30 as registration fee for a year while central and state government pays the premium as per their sharing ratio to the insurer.
The government-promoted Rashtriya Swasthya Bima Yojana (RSBY) will now also cover treatments will respect to mental health. But, will this be enough?
“While the RSBY scheme will cover procedures/treatments related to mental health, hospitals are not equipped to deal with them,” said a senior official of a private general insurance company.
The insurance companies will provide coverage for day care treatments/procedures for psychiatric and psychosomatic illnesses, said the tenders released by the Ministry of Health and Family Welfare.
According to the tender document reviewed by Moneycontrol, the insurance coverage includes screening and follow-up care including medical costs. In individual health insurance plans offered by general insurers, only New India Assurance offers coverage for mental health ailments.
The beneficiaries under the scheme are entitled to hospitalisation coverage of up to Rs 30,000 per annum on family floater basis, for most of the diseases that require hospitalisation. The benefit will be available under the defined diseases in the package list.
In March, the Mental Healthcare Bill that was passed by the Parliament that decriminalises suicide and encourages coverage for mental health-related ailments. With this, Indian insurers are looking to bring out products or add in clauses in their health policies to cover hospitalisation that will cover any expenses incurred if an individual is admitted to the hospital due to a suicide attempt.
Insurers also fear that the current limits under RSBY are restrictive. “Pills for depression and related issues are very expensive and so is therapy. The current limits under the scheme could be prohibitive from a coverage perspective,” said the chief executive of a mid-size non-life insurer.
He added that smaller hospitals that fall under RSBY, will have limited beds and will not be in a position to allocate beds for these ailments.
Under New India’s Premier Mediclaim Policy, all the psychiatric and psychosomatic disorders diagnosed for the first time during the continuous coverage plan will be covered by up to 5 percent of sum insured. The insured needs to be admitted as in-patient and treatment will not be covered under a day-care procedure.
The government has framed indicative package rates for the hospitals for a large number of interventions. Pre-existing conditions are covered from day one and there is no age limit. The coverage extends to maximum five members of the family, which includes the head of household, spouse and up to three dependents. Additionally, transport expenses of Rs. 100 per hospitalisation will also be paid to the beneficiary subject to a maximum of Rs. 1000 per year per family.Under RSBY, the beneficiaries need to pay only Rs 30 as registration fee for a year while central and state government pays the premium as per their sharing ratio to the insurer selected by the state government on the basis of a competitive bidding.