The move by the Insurance Regulatory and Development Authority of India (IRDAI) to bring major mental illnesses under insurance coverage from October 31 has been welcomed by experts like Pune-based Chetan Diwan, chairperson, Centre for Mental Health and Disabilities, Karve Institute of Social Service. Now all health insurance policies will mandatorily cover major mental illnesses, Diwan who recently presented a paper on mental health insurance at a national conference in Chandigarh told indianexpress.com.
Q. What is the provision under the Mental Healthcare Act, 2017, and why was there a delay in providing insurance facilities for mental illness?
Diwan: The Mental Healthcare Act, 2017, has been enacted since May 29, 2018. Section 21 (4) of the Act states ‘every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness’ and now it is the responsibility of the welfare state to make insurance facilities available for all kinds of mental illnesses. The IRDAI in 2018 directed the Indian insurance companies to cover mental disorders as per the Mental Health Act, 2017. Despite this, insurers did not change their policies and did not include the mental illness component to be covered under insurance policies. A Public Interest Litigation filed in the Supreme Court pointed out that the companies were violating the provision of the 2017 Act. The apex court intervened and, finally, the IRDAI had to instruct all insurance companies to introduce policies for mental illness by October 2020. Despite the delay of two years, it will now be implemented.
Q. What kind of illnesses are covered under mental health insurance? Will it cover the costs of therapy?
Diwan: The Mental Healthcare Act, 2017, which lays the foundation for insurance for psychological disorders, defines ‘mental illness’ as ‘means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs.’ Medical insurance will, therefore, cover the treatment of mental diseases that fall under the ambit of the above-mentioned definition.
Q. Which disorders will be covered under insurance?
Diwan: While the extent of the coverage varies with the insurer, some of the disorders whose treatment will be insured are bipolar affective disorder, acute depression, schizophrenia, panic disorders, attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), personality disorder (PD), eating disorders, and dissociative disorders.
Q. Which illnesses will not be covered?
Diwan: The Mental Healthcare Act, 2017, does not include mental retardation in its definition, which it considers as ‘a condition of arrested or incomplete development of mind of a person, specially characterised by sub-normality of intelligence.’ Issues related to mental retardation will, therefore, not be covered under insurance.
Q. Will suicide or attempted suicide be covered by insurance? What about substance abuse, and addiction-related disorders?
Diwan: No. Treatment of intentional self-inflicted Injury or attempted suicide is also not insured. Complications relating to disorders of intoxication, dependence, abuse, and withdrawal caused by alcohol and other substances will also not be considered under mental health insurance.
Q. What benefits will be provided under insurance?
Diwan: Many plans cover medical expenses only when the patient is hospitalized. The benefits are the same as insurance for physical health ailments, such as cashless treatment and pre- and post-hospitalisation coverage depending on the policy. Depending on the insurer, the coverage may include treatment costs, medications, diagnostics procedures, road ambulance charges, and room rent, among others.
Q. Are counselling and consultations covered under mental health insurance?
Diwan: The coverage differs from insurer to insurer. Not all insurers provide health insurance that covers mental illnesses under the outpatient department (OPD) benefit. While many insurers had already extended coverage for mental illnesses as per the guidelines of the Mental Healthcare Act, 2017, more clarity on the changes is expected to emerge after insurers release their revised policy documents.