Mental Health: What all your health insurance covers?

• By Mr. Bhaskar Nerurkar, Head – Health Administration Team, Bajaj Allianz General Insurance

Mental well-being is an integral part of overall well-being, and it has often been neglected due to the taboo around the issue. The fast-paced modern lifestyle, coupled with rising stress levels, is significantly contributing to an increase in mental health issues, which are increasingly getting centre stage and are being recognized for their profound impact on individuals, families, and society at large. The media has played its role in spreading awareness by highlighting some of the celebrities admitting on record about their mental health.

There has been a noticeable shift in the perception of mental health in the country, and the stigma attached to these issues is slowly fading away. Today, more and more people are opening up about their mental health issues and are seeking professional help.

The insurance regulator and industry also understand the importance of the mental health of the citizens and have been working actively to make insurance products more inclusive, covering all important aspects of a person’s overall well-being. So, let’s take a walkthrough of what all your insurance policy covers when it comes to mental health.

Which ailments are covered? A broad range of ailments like Post-Traumatic Stress Disorder (PTSD), Depression, Anxiety, Schizophrenia, Alzheimer’s, Obsessive-Compulsive Disorder (OCD), and Bipolar Disorder are covered.

What is covered? A typical health insurance policy will cover inpatient expenses arising due to mental illness. It includes expenditures like treatment costs, doctor fees, room rent, and ambulance charges, amongst other hospitalization expenses. Pre and post-hospitalization medical expenses are also covered. Some insurers may cover OPD costs like consultation/counselling. OPD riders also cover costs of teleconsultation, emotional well-being, in-clinic consultation, and investigation expenditure, i.e. pathology & radiology expenses, to name a few. Additionally, some insurers offer mental wellness programs to help people manage their mental health better.

Important bit to keep in mind: One of the most crucial things to remember is that illness or disorder arising out of alcohol or drug abuse is not covered. Most of the insurance policies cover the insured only for costs pertaining to hospitalization due to mental conditions. The policies or riders that cover counselling would mostly cover a certain number of sessions per year.

The number of sessions covered will be clearly mentioned in the policy term. When filling out the proposal form, it is important to declare the existing health issues that you suffer, including mental health issues. Though it may seem advantageous to keep certain details under wraps in order to reduce premiums, the potential consequences of non-disclosure can be significant.

If the insurance company determines that a claim is arising due to a pre-existing condition that was not disclosed, they are likely to deny the claim. Even if the condition is minor or under control, failing to disclose it can invalidate both the claim and the entire policy.

Specific products for people suffering from mental illness: Apart from the coverage in standard health insurance policies, there are specific products that cover ailments like Autism Spectrum Disorder, Parkinson’s disease, Intellectual Disability, etc. Such policies also cover AYUSH treatment, which comprises coverage for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. Depending on the insurer, a few pre-existing mental illnesses might also be covered.

Good mental health is just as important as good physical health. Even conditions that seem minor can have serious effects. It is essential to take care of your mental health and get professional help if required. Please note, as per the Mental Healthcare Act, 2017 and the latest insurance directives, all health insurance products cover mental illness. However, be sure to read the policy details carefully to understand what is covered. Remember, your insurer is there to support you. Stay healthy and take care of both your mental and physical well-being.