Hospitalised For A Mental Illness? Your Insurance May Still Not Cover Everything

Currently, most health insurance policies in India provide coverage for mental health, but this is usually for outpatient consultations. "Also, while many plans do cover hospitalisation for mental illnesses, therapeutic intervention (especially psychoanalytic), rehabilitation, or unambiguously long-term psychiatric care are often not covered unless it is labelled as such in policies," says Kunal Varma, founder and CEO, Freo. 

So, while many policies do cover inpatient hospitalisation expenses for mental illnesses, similar to physical illnesses, as mandated by the Mental Healthcare Act, 2017. "This includes serious conditions like schizophrenia, bipolar disorder, or borderline personality disorder. The waiting periods vary by different insurance offerings. In some products, there is a waiting period of 24 months, which is the industry standard; however, in some products, this waiting period has been removed," says Bhaskar Nerurkar, head- health administration team, Bajaj Allianz General Insurance. 

Read The Fine Print 

"Sub-limits and exclusions are common. For example, cover for hospitalisation related to mental health may have a lower limit than ailments related to physical health," says Varma. There may also be exclusions for treatment of substance abuse or personality disorders, even though they are nevertheless considered mental health conditions.

For some policies, sub-limits and exclusions may impact the coverage for mental health. Certain policies limit psychiatric hospitalisation up to 30 days per year and cap room rent at a pre-defined percentage of the sum insured per day. A sub-limit may limit the number of therapy sessions a policyholder can take in a year, or some mental illnesses, pre-existing conditions, or therapies might be excluded or come under a waiting period. 

"Some plans cap mental health inpatient treatment, and exclude outpatient therapy unless specified. However, similar is the case with physical health coverage as well. It is essential for customers to carefully review their policies to understand that they have coverage in proportion to their requirements," says Nerukar. 

Included But Not Equal 

The IRDAI directive requires parity, but it is still not the same between insurers. Often, there is still a disparity between intent and actions taken; mental health may be technically covered, but not always as broadly as physical conditions. "Ultimately, policyholders should read the fine print and query their insurer for any clarity on what's covered and what isn't," says Varma.