Health Insurance: Does it Cover Psychological Disorders?


Health insurance coverage is essential if any member included in the concerned insurance plan is affected by any mental disorder. This is a crucial step that the insurance companies have recently taken for further security of the insurance holders.

As per the Mental Healthcare Act of 2017, all health insurance companies are liable to offer coverage for mental disorders. Since the worldwide outbreak of the pandemic, society has witnessed a steep and steady rise in mental disorders. Such changes have compelled the country’s health insurance companies to offer coverage for mental disorders too.

Since this is a highly competitive market, all standard health insurance companies have to offer this facility to be the best health insurance in India.

 A brief introduction to psychological ailments

Mental or psychological disorders refer to certain typical behavioural patterns or mental conditions involving unsettling habits, feelings, and thoughts. The condition drastically affects the feelings, thoughts, and actions of the affected individual, along with his/her decision-making capability and interpersonal and communication abilities. Some of the most popular forms of mental disorders include depression, anxiety and stress disorders, depression, neurodevelopmental disorders, sleep disorders, eating disorders, psychosis like schizophrenia, etc.

The onset and the effects of psychological disorders vary from one individual to another.

  Health insurance and mental ailments

While discussing mental illnesses, one major exclusion that every insurance company follows is that of mental retardation. Moreover, the health plans will also not cover any mental disorder caused by drug abuse or overconsumption of alcohol.

The IRDAI has prohibited insurance companies not to deny health coverage to clients who possess a history of using opioids and/or antidepressants.

The IRDAI mandate for not denying mental disorder coverage has been implemented from November 1, 2022.

  Applicable for old plans too

Because of this significant development, you should not feel the impulse to reject the existing health plan and purchase a new one that includes this coverage. If any individual is diagnosed with any sort of mental ailment subsequently after purchasing the plan and going through the waiting period, the insurer is not supposed to deny the claim.

However, pre-existing mental conditions do not qualify for this coverage.

  Advantages of health insurance coverage for mental ailments

Some of the major advantages of health insurance coverage for mental health disorders include the following:

  1. Compulsory as per the existing law:

This is one of the major benefits of health insurance with mental ailment coverage. As per the Mental Health Act of 2017, this has become compulsory. Every insurer is liable to offer coverage for mental ailments to people included in health plans.

  1. Covers a wide range of mental ailments:

The health plans designed to cover mental ailments offer financial coverage for a variety of mental ailments, including bipolar disorders, Alzheimer’s disease, dementia, etc. These conditions significantly impact the human brain and have adverse effects on a person’s daily routine life.

3. Wide coverage:

Most of these health plans are carefully designed to offer both outpatient and inpatient coverage along with a satisfactory amount of sum insured. It covers both pre-and-post-hospitalisation costs, costs for treatment and recovery, investigations, diagnosis, etc., are included in the plan. Certain health plans even offer special coverage for ailments in perception, memory, poor decision-making capacities, and disorderly mood.

  Mental diseases covered by health plans

Mental health coverage includes costs incurred for in-patient hospitalisation of the affected individual. All the related investigation costs, diagnostics, medicines, consultation fees, ambulance charges, room rent, etc., are included in the package, provided the patient remains hospitalised for a minimum of 24 hours. The coverage span of the concerned plan may differ from one insurer to another, and so do the sub-limits.

Some of the mental ailments for which hospitalisation is essential include the following:

  1. Neurological disorders and
  2. Psychiatric disorders.

Health insurance with mental disorder coverage includes several ailments like:

  1. Bipolar disorder
  2. Acute depression
  3. Schizophrenia
  4.  Anxiety disorders
  5. Obsessive-compulsive disorder
  6. Mood disorders
  7. Psychological disorders
  8. Attention deficit/hyperactivity disorders
  9. Post-traumatic stress disorder.

Exclusions of the plan

Health plans offering mental health coverage maintain certain basic exclusions. These are as follows:

  1. Any sort of mental retardation, as it is a direct or indirect impact of an underdeveloped brain.
  2. Any mental ailment arising because of overconsumption of alcohol or drug abuse.
  3. Possessing a steady history of recurrent mental ailment.
  4. Most health plans only offer coverage during hospitalisation.
  5. Suicidal attempts or self-inflicted injury are not covered. 

Waiting period for covering mental ailments under a health plan:

Most of the health insurance plans that offer mental ailment coverage do not offer it from the very beginning of the plan. Similar to pre-existing ailments, mental health coverage comes with a waiting period.

Under standard circumstances, the tenure of this waiting period is of two years. However, depending on the concerned insurance company and the terms and conditions of the plan, this time limit may differ. Moreover, the concerned policyholder must renew the health plan for two consecutive years to avail of this benefit of claiming mental health coverage.

While purchasing any health plan, it is best to clarify all the necessary terms and conditions, inclusions, and exclusions before proceeding further to avoid any misunderstanding during claim settlement.

H2:  Who needs mental health coverage?

The present-day lifestyle is perfectly suitable for inducing a stressful life, eventually leading to mental disorders. Any person possessing a family history of mental ailment or anyone who has been through any major traumatic experience should consider purchasing a health plan with mental illness coverage. It is also highly beneficial for individuals who are going through any post-accidental phase or the trauma of coping with the death of someone very close. 

Why do you need mental health coverage?

There is nothing to be ashamed of regarding mental ailments. Similar to any sort of physical ailment, any mental disorder too can affect your lifestyle. You must be careful about yourself and your family members to notice any behavioural changes. It must be addressed at the earliest without any delay so that the situation does not worsen. Any aggravation will lead to more expensive treatments and therapies.

So, considering these facts in mind, it is best to opt for health insurance with mental health coverage. It will effectively take care of your finances, allowing you to get the best medical treatment possible.

  Summing it up

It’s high time to keep mental disorders ostracised in society rather than addressing them. Escaping from the situation never solves the issue; on the contrary, it gets aggravated. It is good to see that the IRDAI has witnessed the necessity for the inclusion of mental health coverage in health insurance plans. To offer the best health insurance in India, including this vital factor has become mandatory.

Disclaimer: The above information is for illustrative purposes only. For further details, please refer to the policy wordings and prospectus before concluding the sales.




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