Untangling mental health policy knots

In India, the surge of mental health-related disorders has been alarming. Around 60 to 70 million people in India suffer from common and severe mental disorders such as anxiety, acute depression, dementia, bipolar disorder, grief and traumatic stress to name a few. Given this worrisome trend, IRDAI in October 2022 made it mandatory for insurance companies to include mental health illnesses in their insurance policies. This new diktat has been a beacon of hope for several who were unable to afford therapy, counselling sessions and treatments for mental illnesses. Mental health consultations in metros like Mumbai, Delhi, and Bangalore can range between Rs 1,200 to Rs 3,000 per session for a 45-minute session. The rates usually depend on the experience and popularity of the psychologist or psychiatrist. Many patients and their families have heaved a sigh of relief since the financial burden is borne by the insurance provider for comprehensive treatment, diagnostic expenses, room charges, ambulance fees, pharmacy bills, and more. Yashi Srivastava, a psychologist says, “Insurance coverage ensures families access essential services and support for their children's well-being and development. Often families of autistic children seek insurance as financial expenses including therapy costs, medications, and specialised education are substantially large.”

Scope of Insurance

While some insurance companies are taking one step forward, some are still lagging. Ankur Nijhawan, former CEO of AXA (India Reinsurance Branch) says, “The demand for insurance policies (mental health) is quite low. Maintaining anonymity is an issue which consumers believe insurance companies will fail to follow. The implementation of the policy does not bring confidence in the employees.” Mental health insurance policies differ from company to company. Typically, regular health plans encompass in-patient hospitalisation for mental disorders and illnesses. However, coverage for outpatient counselling or therapy is contingent on the inclusion of OPD benefits in the plan. When dealing with pre-existing mental disorders, insurers have the discretion to classify them as such and determine waiting periods, ranging from 2 to 3 years. Some insurance policies may include exclusions or waiting periods for pre-existing conditions. The eligibility for mental health insurance is also subject to the payment of specified premiums which are costly.

Some commonly covered mental illnesses are depression, anxiety, bipolar disorder, schizophrenia, OCD, PTSD, panic disorder, social anxiety disorder, specific phobias, autism, ADHD, and varied disorders. Certain companies have created plans to suit their customers’ needs. Aditya Birla Health Insurance’s Activ Health policy is Asia's first ever health insurance plan that offers mental illness counselling coverage. GoActive by Niva Bupa includes inpatient and on-the-go access to OPD, diagnostics, personalised health coaching, behavioural counselling and much more. Some insurance plans cover chronic illnesses. HDFC ERGO’s critical illness plan offers coverage for 15 critical ailments including Alzheimer’s and provides a lump sum payout on diagnosis of the illness covered under the policy.

Dr Harish Shetty, a Mumbai-based psychiatrist points out that suicide and substance abuse cases are not covered by most of the insurance companies. “Not giving coverage for suicidal cases is ultimately compromising the safety of the person concerned. The respective person at the time might require medication and inpatient treatment,” Dr Shetty says.

Grim Reality

Patients and their families sometimes face rejection of their applications from insurance companies without reason. Dr Shetty says, “Insurance companies continue to have primitive thoughts about mental health problems. They mostly cover IPD and not OPD and at times, reject applications for imprecise reasons.” Abhiti (33), an independent consultant diagnosed with Attention-deficit/hyperactivity disorder (ADHD) visited a psychiatrist regularly and took medication for ADHD and other mental health concerns. Abhiti wanted to opt for a favourable policy that covers psychiatrist appointments as OPD and medicines as out-of-pocket expenditure. “In 2022, after applying for a policy which included payment, I shared information like current health status, medication and doctor’s prescription. They agreed to cover it after 4 years since it’s an existing mental illness. Later I received a response that my policy application was rejected.” After multiple follow-ups, Abhiti was informed that ADHD was not covered by the company. Currently, Abhiti has coverage from another company that does not cover mental health. Abhiti spends `6,000 per month on medication.

Fear of Risks

Ankur explains that companies don’t have enough supporting data and understanding of mental illness. “They have to assume the probability of the claim at a high cost unlike in a scenario when data allows them to place the price range accurately. Naturally, the company would then refrain from giving insurance,” he explains. r Shetty suggests, “Insurance companies need to be educated and conduct meetings around a holistic approach towards giving coverage for mental illnesses and disorders.”

Grey Matter

Some commonly covered mental illnesses under mental health insurance are depression, anxiety, bipolar disorder, schizophrenia, OCD, PTSD, panic disorder, social anxiety disorder, specific phobias, autism, ADHD, and varied disorders.

Insurance companies need to be educated around a holistic approach towards giving coverage for mental illnesses and disorders.” — Dr Harish Shetty, psychiatrist, Mumbai

The demand for insurance policies (mental health) is quite low. Maintaining anonymity is an issue which consumers believe insurance companies will fail to follow.” — Ankur Nijhawan, former CEO of AXA