World Mental Health Day, an annual global event, is observed on October 10 to spotlight the significance of mental health worldwide and to galvanise efforts in supporting individuals grappling with mental health challenges. Mental health, as proclaimed by the World Health Organization (WHO), is an innate human right for all individuals. It is in this context that the discourse on mental health insurance in India assumes paramount importance.
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The rising tide of mental health issues
In India, the surge in mental health issues has been palpable. Plum, an insurtech platform in India, specialising in group health insurance and business insurance solutions, has witnessed a substantial increase in mental health tele-consultations, particularly among the 21-30 age group. There has been a fourfold surge in tele-consultations in this age bracket compared to those aged 31-40. Approximately 73% of telehealth consultations now originate from this demographic.
Women have emerged as frontrunners in seeking mental health support, with 55% of consultations being sought by females and 45% by males. This disparity indicates that women are more inclined to seek assistance for mental health issues, highlighting a need for increased awareness among men.
The reasons prompting individuals to seek mental health consultations vary. Anxiety, stress, coping mechanisms, relationship issues, self-growth, grief and loss, and clinical diagnoses are among the driving factors compelling individuals to seek professional help.
Importance of insurance
Mental health insurance plays an instrumental role in ensuring the well-being of individuals. It provides individuals with financial support for treatment expenditures.
As work schedules become increasingly demanding and the time spent in workplaces surges, the responsibility for the mental and physical health of employees largely rests on the shoulders of employers. Sanchit Malik, Co-Founder and CEO of Pazcare, asserts that employers must proactively foster an environment that supports employee well-being.
The scope of mental health insurance in India
The Mental Healthcare Act of 2017 represents a significant milestone in India's journey towards addressing mental health issues. The insurance regulator had directed all insurance companies to adhere to the provisions of the act, forbidding discrimination between physical and mental ailments.
As of today, most health insurance plans available in India provide coverage for mental illnesses in accordance with the Mental Healthcare Act of 2017. This legal framework has catalysed a shift in the coverage of psychological disorders under health insurance.
In 2020, the Insurance Regulatory and Development Authority of India (IRDAI) further promoted mental health coverage by mandating all health insurance providers to cover mental illnesses, including psychological disorders. This was a significant step towards ensuring comprehensive coverage for mental health issues in the country.
Coverage challenges
Despite these developments, there are challenges. Bhabatosh Mishra, Director of Underwritings, Products & Claims at Niva Bupa, points out that many health insurance products in India are primarily in-patient centric.
"Most mental health conditions require out-patient treatment, which is often inadequately covered in these plans," he told CNBC-TV18.com.
Mental health coverage limitations must be taken into account. While insurers typically do not impose specific waiting periods for mental illnesses, any mental condition declared at the time of policy purchase is considered a pre-existing condition. Its waiting period will be applicable as per the terms and conditions of the product.
Additionally, individuals with a recent history of acute mental illness may face challenges in obtaining insurance coverage. Some insurers may deny proposals based on their risk appetite, while others may accept proposals with certain premium loadings to manage potential risks.
Furthermore, many health insurance policies may impose sub-limits on coverage for specific mental illnesses, such as schizophrenia, bipolar disorder, psychosis, and depression. Individuals seeking mental health coverage should opt for plans without any sub-limits to ensure comprehensive access to treatment.
Key considerations
According to Mishra, people should not look to buy a health insurance plan solely for the purpose of getting coverage for mental health issue. They should instead opt for a comprehensive plan which provides coverage for both physical and mental health.
”It is imperative today to comprehend the terms and conditions which are associated with mental health coverage," he said.
Some health insurance plans that cover mental illnesses
Activ Health Enhanced by Aditya Birla Health Insurance
| Features | Details |
| Sum Insured | Rs 2 lakh – 2 Crore |
| In-Patient Hospitalization | On the basis of the sum insured |
| Pre-Hospitalization Expenses | Up to 60 days |
| Post-Hospitalization Expenses | Up to 180 days |
| Day Care Facility | Available |
| Ambulance facility | Available |
| Domiciliary facility | Available |
| Expenses of organ donor | Available |
| Sum insured reload facility | Offered up to 100% Sum Insured |
| Ayush treatment hospitalization expenses | As per the sum insured |
| Mental illness hospitalization expenses | Up to the sum insured |
(Source: Paybima)
Max Bupa GoActive Plan
| Mental disorder | Treatment details |
| Consultancy for Behavioural Assistance | 3 consultations available per person per policy year |
| Second medical opinion coverage | Available, (one opinion per insured per mental illness (specific) |
| AdvantAGE | Can avail of a 10% discount on base premium for the first policy and subsequent renewals, if the policyholder enters the plan before the age of 35 |
(Source: Paybima)
First Published:Oct 10, 2023 8:21 AM IST
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