As world mental health day On the morning of October 10, mental health professionals are still lamenting the inadequate health insurance coverage for people living with mental illnesses. The regulator, the Insurance Regulatory and Development Authority, has had more than a year (IRDA), as per the directions of the Supreme Court in June 2020, made it mandatory for health insurers to include mental health treatment within the ambit of coverage.
“No mental illness is covered under health insurance policies,” said Manish Jain, a psychiatrist based in Indore. “Poor patients have to be taken to bad government hospitals,” he said.
Center’s health insurance scheme, Ayushman Bharat, does not even cover mental health treatment in private hospitals.
According to psychiatrists, 50-75% of hospitalization claims filed for insurance coverage are rejected.
Ashutosh Singh, Psychiatrist, Apollo Hospitals said, “Lack of awareness among patients, their family members and insurance agents if claims are not filed that they will be rejected.” “Medical problems related to alcohol are not included in the order that mandates insurance coverage for mental illnesses,” he said.
“The chronicity of mental health illnesses warrants insurance coverage,” said psychiatrist Samir Parikh, director of Fortis Healthcare’s Department of Mental Health and Behavioral Sciences.
“About 30% of insurance companies in India, including ICICI Lombard, Digit and Care Health, have these covers in their health insurance policies,” said Abhishek Poddar, cofounder of Bengaluru-based health insurance startup Plum Health Insurance.
Limited cover for mental health issues
Poddar of Plum Health Insurance said, “That said, the challenge still exists that these covers come with their own sub-limits. For example, a cover of Rs 5 lakh will go up to Rs 50,000 only for mental illness.”
In addition, there are many diseases that are excluded from coverage because of their association with mental health. “If a psychiatrist visits a patient in corporate hospitals, the insurance claim for medical treatment is rejected,” said Pune-based psychiatrist Amar Shinde. “So, many patients are not referred to a psychiatrist.”
“While insurers can no longer deny hospitalization reimbursement arising from treatments related to mental health, as specified by IRDA, they may impose limits or force waiting periods where the policy The clauses specify that the client cannot claim mental health hospitalization for, for example, “the first four years of the coverage period,” said an executive working with an insurance brokerage.
Insurance companies that ET contacted did not want to comment on the record. An insurance official said that at present no insurance company offers standalone health insurance cover. All comprehensive cover should cover mental health related illnesses as well by design.
However, insurers in India rarely offer policies that cover non-hospitalized treatment or OPD reimbursement. This means that unless mentally ill patients are hospitalized, they will not be eligible for coverage. Insurance cover, thus, naturally excludes medical and psychiatric consultation coverage.
work in progress
“mental health insurance It is in very early stage in India. Till a few years back no insurer was providing any support, because everyone was trying to understand the ground reality.” Treatment protocols are not yet fully standardized in India, but it is heartening to see that we are slowly -Slowly starting talks on this.”
Experts also said that in line with strict IRDA regulations, health insurers have tightened their underwriting rules for anyone who has declared pre-existing mental health illnesses. For example, people with conditions such as depression, anxiety, or even epilepsy are less likely to have health insurance applications approved.
According to an industry expert, the reason for such discrimination is also that insurers believe that patients with mental illnesses are also more likely to be hospitalised. “For example, insurers have models that show that people with epilepsy are at higher risk of road accidents, and those who suffer from depression or hyper-anxiety are more likely to self-harm. There is,” said the expert.
According to Mahaveer Chopra, founder of Beshak.org, a community forum for insurance awareness in India, IRDA has published its board-approved underwriting philosophy for insurers to provide insurance coverage to people with disabilities and mentally challenged people on their website. has also been made mandatory. disease and HIV/AIDS.
“Clients find the language and communication used by some insurers ambiguous,” he explained. “Insurers are complying with the rules, but transparency remains an issue. At the end of the day, insurance companies are making few choices to protect themselves from known unknown risks, ensuring that they effectively protect shareholders. Can give permanent returns.