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Does your insurance policy cover mental health ailments?

Some policies have made some progress in terms of taking mental healthcare in the ambit of insurance by covering up to 25 percent of the sum insured in case of hospitalisation.

June 21, 2021 / 08:58 PM IST
Health insurance (Image: Shutterstock)

Health insurance (Image: Shutterstock)


To say that the pandemic has taken a serious toll on our mental health would be an understatement. In fact, data suggests that ever since Covid-19 gripped our lives, sales for antidepressants have steadily risen to 23 percent, from Rs 189 crore (April 2019) to almost Rs 218 crore this month, as per research reports by All Indian Origin Chemists and Distributors (AIOCD). 

Even NIMHANS (The National Institute of Mental Health and Neuro-Sciences) reported a sharp increase in its helpline and tele-consultancy calls, from 1,085 per day in March to almost 2,000 in the same period in April 2021. 

A 2019 ICMR-PHFI report shows that almost 197.3 million people in the country suffer from various kinds of mental diseases. Adding to this already grim Indian mental health scenario is the bare implementation of the 2018 IRDAI (Insurance Regulatory and Development Authority of India) directive which places mental and physical health on the same pedestal and mandates all insurance providers to make provisions for mental health conditions in the policy as well. 

In fact, in its circular titled “Guidelines on Standardization of Exclusions in Health Insurance Contracts'' dated September 27, 2019, the apex regulatory body has made it clear that the treatment of mental illness, stress, or psychological disorders, and neurodegenerative disorders cannot be excluded. 

In a recent verdict in the case of Shikha Nischal vs National Insurance Company (April 2021), where the appellant was denied hospitalisation expenses for schizoaffective disorder by NIC, stating that no coverage would be provided for ‘psychiatric disorder’, the Delhi High court noted that:

“Mental illnesses cannot be treated differently from physical illnesses. Insurance policies also cannot discriminate between these two types of illnesses. Mental illnesses can also be debilitating and destructive. The recent pandemic also highlights this beyond any doubt. Circumstances leading to patients requiring isolation, healthy persons being subjected to lock-downs, work from home conditions, loss of employment leading to lack of confidence for long durations have led to several mental problems. Availability of insurance for mental disabilities or conditions is, therefore, not only important but is an essential need.”

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Such disparities continue despite Section 21 (4) of the Mental Healthcare Act 2017 mandating all insurance companies to provide medical insurance for mental illness treatments on the same basis as physical treatments. This means that the insurance companies can no longer discriminate between these two. To date, more than 234 mental health products have been approved by the IRDAI in this regard. But in the light of the pandemic, mental health issues have aggravated over the past year, shedding light on the inadequate efforts to revive mental health initiatives in the country. Certified suicidal helpline caller Ahsaas Verma, who has witnessed a surge in the number of distress calls he has received, highlights this gap. 

“There is a large gap in the expectation of how mental health must be addressed and how it is being addressed currently. I have seen a significant rise in the number of calls as people buckled under pressure, guilt, anxiety, and loneliness, due to lack of physical connections with family, friends, and social circle,” he said. 

However, some policies have made some progress in terms of taking mental healthcare in the ambit of insurance by covering up to 25 percent of the sum insured in case of hospitalisation expenses or providing for a 48 month waiting period for treatment for behavioural disorders. 

However, awareness regarding the same is really low, almost non-existent. Nidhi Jindal, an insurance advisor, recalls how she has not received any claims regarding mental health issues from her clientele to date.

“While some companies have accommodated coverage for mental health conditions, the claim rate has been zero till date,” she says. 

Affordable mental healthcare does not have to be a dream. The law empowers people to claim insurance for mental health conditions like schizophrenia, depression, anxiety and personality-related disorders, and more. Make sure you check for your policy exclusions before signing for your insurance and remember, your mental health is liable for health insurance. 
Ira Puranik

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