What Does Your Health Insurance Policy Cover?

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There has been a long-standing stigma around mental health issues. However, in recent times, mental health has taken the spotlight and many efforts are being made towards ending this stigma. These efforts have led to a change in the way people see mental health and a vast majority have started taking these issues just as seriously as physical illnesses. The same change has also been seen in the health insurance sector. So, does your health insurance cover mental health? If yes, then what does it cover and what should you know about it? Read on to find out more.

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Does Health Insurance Provide Mental Health Coverage?

For the longest time, most of the basic health insurance policies did not cover mental illness regardless of whether it was diagnosed after the policy was purchased or was a pre-existing condition. The National Institute of Mental Health and Neuro Sciences conducted the National Mental Health Survey of India for FY16, which showed that approximately 15% of Indian adults require treatment for one or multiple mental health issues. Seeing this growing need, the Insurance Regulatory and Development Authority of India (IRDAI) has made it mandatory for every health insurance provider to cover mental illnesses as well.

What Does Mental Health Insurance Cover?

When it comes to mental health insurance plans, mental illnesses are considered at par with physical issues. Consequently, these plans cover all medical expenses incurred on the treatment of mental health problems. In addition, conventional benefits like no-claims bonus and cashless treatment apply to mental illnesses, which include psychological disorders.

The coverage of psychological disorders can vary from one insurer to another. For instance, some plans may only cover hospitalisation expenses while other plans may cover the therapy and outpatient consultation cost. Broadly, health insurance plans for mental health may cover hospitalisation charges, diagnostic procedures, OPD consultations, therapies, counselling, medications, rehabilitation, room rent, and road ambulance service, depending on the policy you’ve bought. So, make sure to go through the policy’s documents with a fine tooth comb before buying to fully understand the exact coverage available.

Which Mental Illnesses are Covered by Health Insurance?

Psychological disorders or mental illnesses refer to behavioural patterns or mental conditions that involve atypical or unsettling feelings and thoughts. These disorders can have a considerable impact on the way an individual manages stress, makes decisions, and interacts with others. Some of the most common psychological disorders or mental illnesses usually covered by health insurance include:

  • Bipolar disorders
  • Depressive disorders
  • Anxiety disorders
  • Schizophrenia or other psychosis
  • Stress disorders
  • Eating disorders
  • Sleep disorders
  • Dementia
  • Dissociative disorders
  • Neurodevelopmental disorders

The inclusion or exclusion of these disorders depends on the insurance company. 

Waiting Period for Mental Health Coverage

For most health insurance plans, mental health coverage is not available from the beginning as these policies come with a waiting period just like they do for pre-existing diseases. Typically, a health insurance plan has a waiting period of 2 years for providing mental health coverage. This means that unless you have renewed your health insurance for two subsequent years, you cannot raise a claim for mental illnesses. The waiting period can vary for different insurance providers. So, make sure that you carefully check the terms and conditions of a policy to find out the exact waiting period before purchasing.

What Does Mental Health Cover Exclude?

Just like any health insurance plan, a policy covering mental health issues also has its own set of exclusions. Every policy has certain situations or scenarios that it doesn’t cover. Make sure you clearly know a policy’s exclusions to avoid any claim rejections. Here is a list of common exclusions in most mental health insurance plans.

  • Mental illnesses caused by alcohol or drug abuse
  • Any kind of mental retardation
  • History of recurring mental illness

In recent times, there has been a significant increase in mental health problems, primarily due to stress, reduced physical activity, and unhealthy eating habits. Moreover, the two-year-long pandemic has had a considerable adverse effect on people's mental health. So, it's vital to understand the importance of mental health insurance and receive proper medical care.

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