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Many Health Insurance Companies Fail to Offer Mental Health Cover Even After Mandate

Published On Oct 07, 2019, Updated On Jan 30, 2020

According to the Mental Healthcare Act passed by the government in the year 2017, the insurance companies have been directed to include mental health coverage under their products. After the act came into effect previous year, cover for mental health was finally promised. It was said that each insurance company will have to provide for health insurance to offer cover for treatments pertaining to mental illness on the same idea as is provided for treatment of physical ailments.    

NIMHANS conducted the National Health Survey of 2015-2016 which estimated that around 150 million Indians required active involvement for mental illnesses. When TNM in April last year verified some top insurance providers for if they offer mental illnesses, the results showed that none of them did. 

But, it has now become mandatory after the IRDAI (Insurance Regulatory and Development Authority of India) made it compulsory in August 2018 for the insurers to add mental illness cover in the list of features offered. 

After one year, TNM again did a check to make sure if the insurance companies were following the mandate. It was found that only HDFC Ergo had this included as a cover feature in one of its plans, which covers hospitalisation expenses in case of mental illness. The Chief Actuary and Chief Underwriting Officer at HDFC Ergo, Anurag Rastogi shares, “If the person has any history of mental illness, in such cases the insurer may offer him/her a health insurance policy with sub-limits on the sum insured or offer a new product which may be specifically designed to cover mental illnesses.” 

Max Bupa claims that it offers cover for mental illness on hospitalisation after 4 years of continuous cover under one of its plans. But there was no policy document found where such offerings were mentioned. 

Similarly, even Star Health did not have any plan that offers mental illness cover. Though it has added psychiatric and psychosomatic disorders, regulatory approval is awaited for the same. 

The Chief Underwriting of Claims and Reinsurance of ICICI Lombard, Sanjay Datta shares, “We inquire from the customer regarding their complete well-being while issuing the policy and if a mental disorder is disclosed, the risk is assessed as per the underwriting guidelines and the decision is taken accordingly.”

Going by the industry sources, all the insurers are under process of revising their policies after the IRDAI’s mandate. It is a new concept for them and they are still trying to form health insurance policies that focus on mental illness. 

Insurers have no example as far as prices for policies that cover mental health or even financial risk that these policies bring along are concerned.

IRDAI issued some fresh guidelines for insurance companies that standardised exclusions for all the insurers. The guidelines stated that treatment of mental illness, psychological and neurodegenerative disorders, stress etc. cannot be excluded. Later, other guidelines were shared too. 

While many companies are ready to bring such guidelines into action, but it may take them a long time before the actual adherence can be witnessed. 

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