Hey there policyholder. Assuming you are here because either you or a loved one is
struggling, we are sorry you are going through harsh times. Thus, this blog is dedicated
to providing all you need to know about mental health coverage in insurance policies.
The Insurance Regulatory and Development Authority of India (IRDAI) Acknowledged
the importance of mental health coverage and instructed Indian insurance firms to cover
mental diseases per the Mental Health Act of 2017 in the year 2018.
1. Significance of Mental Health Coverage
Mental health coverage breaks down financial barriers to ensure everyone gets access
to the support and care they deserve. Beyond finances, mental health coverage plays a
pivotal role in dismantling the stigma surrounding mental health.
Mental health coverage in insurance comes with a waiting period, typically of 2 years.
Waiting periods vary between insurers, so we recommend reviewing the terms and
conditions of your health insurance policy for the specifics.
2. Defining mental illnesses
The Mental Healthcare Act of 2017 defines ‘mental illness' as "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."
Commonly included illnesses are-
● Depression
● Obsessive-Compulsive Disorder (OCD)
● Post-Traumatic Stress Disorder (PTSD)
● Attention-Deficit/Hyperactivity Disorder (ADHD)
● Bipolar disorder
● Mood disorders
● Schizophrenia
● Eating Disorders (anorexia nervosa and bulimia nervosa)
● Panic disorder
● Anxiety disorders
● Social anxiety disorder
● Certain phobias
● Psychological disorders
Common exclusions include-
● Mental retardation
● Mental illness stemming from drug/alcohol abuse
● Self-inflicted injury/suicide attempts
You are not alone in this fight. Let's look at the case of Shikha Nischal v. National
Insurance Company Limited And Another
● The case: The petitioner, who had a health insurance policy with National
Insurance Company Limited (NICL), developed a mental illness and sought
reimbursement for the treatment expenses and faced claim rejection.
● The Argument: NICL denied the claim, citing a policy exclusion clause for
psychiatric conditions. The petitioner contended that such discrimination violates
Section 21(4) of the Mental Healthcare Act of 2017, which requires equal
treatment for mental and physical ailments in medical insurance.
● The Verdict: The court observed that the exclusion violated the Mental Healthcare
Act, 2017. It also highlighted the IRDAI's duty to ensure compliance with the law
by insurance companies. Eventually, the IRDAI directed NICL to settle the claim.
The case gives us an insight into how supported you are in this journey and how the
legal system is standing with you.
3. Tips for Filing Mental Health Insurance Claims
● Understanding policies: Confirm if the specific mental health conditions and
services (therapy, treatments etc.) are covered under your policy. Understand
your policy thoroughly, including inclusions, exclusions, co-pays, deductibles etc.
● In-Network Providers: Opt for in-network mental health providers to minimise
out-of-pocket expenses.
● Accurate Documentation: Maintain detailed records of diagnoses, treatment
plans, and receipts for mental health services to facilitate the claims process.
● Pre-Authorization: Check if pre-authorization is required for mental health
treatments and obtain approval from your insurance company before starting
therapy or other services.
● Submit Claims Promptly: File mental health insurance claims promptly to avoid
delays and insurance claim-related issues.
● Appeal if Necessary: in case of unjust claim rejection, stand up for yourself and
appeal by providing additional documentation and clarifying the necessity of
mental health treatment.
● Communicate with Providers: Maintain open communication with your mental
health providers and ensure coordination between healthcare professionals and
your insurance company.
4. Seek Compassionate Guidance from Subject Matter Experts
Recognise that asking for help is a strength, not a weakness. Reach out to subject
matter experts who help you with compassion and understanding. They can provide
expertise and a caring hand to guide you towards swift claim settlement.
Conclusion
Mental health coverages help make the journey of healing more financially bearable.
They become allies in ensuring that you receive the support you need when you need it
the most. Your well-being is worth the wait.
