Does Your Health Insurance Policy Provide Coverage For Depression As Well As Other Medical Conditions

In this fast-paced era, everyone is running fast and changing their lifestyles to fit their busy schedules. With the increasing work pressure coupled with the change in lifestyle and unpredictable day-to-day schedule, one needs to pay more attention to the symptoms that their body and mind throw. As a result, many end up facing a serious health condition or another.

In its recent report, the World Health Organization (WHO) said that one in every eight individuals has a mental disorder worldwide, and mental illness constitutes about 15% of the global disease burden. Pointing out that India has the world’s largest population with mental issues, the report urged immediate action for the upgradation of mental healthcare.

People suffering from mental health illness has multiplied following the COVID-19 pandemic, and people have started seeking professional assistance to overcome the so-called stigma attached to it. This, in turn, has led to an increase in expense towards the treatment, and as a result, many have started opting for individual health insurance policies that cover treatment for mental illness.

Understanding mental illness:

Mental illnesses are health conditions or behavioural patterns involving unsettling changes in feelings, thoughts, emotions or behaviours. According to WHO, a mental disorder is defined as a clinically notable disturbance in a person’s cognition, emotion or behaviour, and they are usually associated with impairment or distress in important areas of functioning.

They are also referred to as psychological disorders or mental health conditions. Some of the commonly prevailing mental illnesses are depression, anxiety disorder, bipolar disorder, schizophrenia, personality disorder and obsessive-compulsive disorder.

It is not always apparent whether a problem with mood or thinking has gotten bad enough to need attention from mental health professionals. For instance, it is normal to feel low or depressed when one loses their loved one. But when the depressed mood continues to cause distress or disrupt normal functioning, it is better to seek professional help.

Mental health diagnosis involves a thorough health evaluation, including a physical examination, because symptoms of certain mental illnesses and medical conditions are similar. In most cases, mental health conditions are treatable, and improvement becomes evident with treatment. There are several instances when people with such conditions have returned to full functioning.

Does health insurance policy cover mental illness:

Until recently, not all individual health insurance policies cover expenses for mental illness treatment. Many insurance companies deny policy at the underwriting stage or refuse to pay for mental illness treatment even though it was a pre-existing disease. As per the Mental Health Care Act 2017, mental illness should not be differentiated from physical illness, and all insurance companies should provide coverage for mental illness under health insurance policies.

In October 2022, the Insurance Regulatory Development Authority of India (IRDAI) revised its guidelines and made it mandatory for all the health insurance companies to cover mental health illnesses.

IRDAI directed all insurance companies to comply with the Mental Health Care Act, 2017, provisions with effect from November 1, 2022. All the insurance products that are in force on or after the Mental Health Care Act 2017 came into force should be deemed to provide cover for mental illnesses.

In India, there are several health insurance products that cover mental illness treatment. Some of them are

1. Individual health insurance policy: Under this policy, the insurer will cover an individual’s hospitalization, out-patient and medical bills. It can be for oneself, their spouse, children or parents. Since the individual does not have to share their insured amount with anyone, exhaustion of the insured amount will not impact others.

2. Family health insurance policy: It is a type of health insurance policy that covers different family members under a single coverage, and the insured sum is shared among the insured family members. If one of the insured members claims a certain amount from the policy, only the remaining amount will be available for the rest of the family members. It will be appropriate to purchase if more than one person has a mental illness in the family.

3. Group health insurance policy: It is a plan that organizations and companies offer their employees collectively. The Insurance Regulatory and Development Authority of India (IRDAI) in its guidelines said, an employer should have at least 20 employees working in their company to become eligible for a group insurance policy.

4. Critical illness insurance policy: Under this type of health insurance policy, insurance companies will provide coverage for specific critical illnesses, including mental health conditions.

5. Personal accident insurance policy: This policy provides coverage for mental illnesses including post-traumatic stress disorder (PTSD) and depression that are the result of accidents.

However, health insurance policies do not offer coverage for mental disorders or complications that are connected with alcohol and drug abuse, self-inflicted injuries and suicide attempts.

Conclusion:

Talks regarding mental illness had been considered taboo, and people with mental illness had been considered a stigma to society for several decades. It is only recently that people have started to overcome the stigmatization and seek professional assistance. Due to the prevalence of mental illness, the treatment cost has increased. To ease the financial burden, purchasing a health insurance policy that covers medical expenses for mental illness treatment is necessary. One needs to be careful and read the terms and conditions before purchasing the policy because not all policies provide coverage for mental illness.

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