COVID-19 and Mental Health: Know inclusions, exclusions in health insurance plans covering mental illness

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Updated: Oct 10, 2020 11:47 AM

Health insurance policies cover treatment for mental illness, stress or psychological and neurodegenerative disorders without any discrimination between mental or physical illness.

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To meet hospitalization cost arising out of COVID-19, the regulator ensured that there are dedicated coronavirus health insurance plans in addition to the regular health covers available in the market. But, COVID-19 is also having an impact on the mental health of the individuals. After the outbreak of coronavirus and the subsequent lockdown across the cities, the focus on the mental health of the individuals has also increased. The good news is the regulator had already asked insurance companies to include the coverage of mental illness as a part of the coverage in the health insurance plans in 2018.

“Heath insurance policies now cover treatment for mental illness, stress or psychological and neurodegenerative disorders without any discrimination between mental or physical illness. In case a patient is hospitalized due to mental illness, the policy will cover expenses for medical examination, treatment procedures and rehabilitation as well,” says Rakesh Jain, ED & CEO, Reliance General Insurance.

Mental illness – definition

However, what exactly is mental illness and how is it defined is also important to know. The claim will finally depend on the manner the illness has impacted the policyholder. Jain informs – The guidelines issued by IRDAI state that treatment of mental illness, stress or psychological disorders will also be provided coverage under standard health insurance policies. The Mental Healthcare Act, 2017, directs every insurer offering health insurance products to cater to policyholders with mental illnesses the same way they cater to physical illnesses or injuries.

According to the 2017 Act, “Mental illness means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognize reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, especially characterized by subnormality of intelligence.”

Mental illness – exclusions

Equally important to understand is what all conditions are not covered under mental illness and hence it is better to read the list of exclusions in a health insurance policy before buying. “Mental illnesses are identified under the World Health Organisation’s International Classification of Diseases. For instance, bipolar disorder & schizophrenia are classified as mental illness and hence will be covered. The coverage will include diagnosis, medications, treatment, care and hospitalisation during the illness but it will clearly exclude mental retardation, as it is a developmental anomaly.  Other factors such as waiting periods for mental illnesses have to be evaluated for mental health insurance coverage. If the plan does not offer OPD treatment, then only in-patient hospitalisation will be covered,” informs Jain.

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