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From being a taboo discussed in hush-hush tones, mental health is now finally being recognised as an ailment just like any other, one that requires treatment and healing.
The COVID-19 pandemic-induced stress and trauma has made many across the world wake up to the reality: mental illness is not something that happens only to ‘others’.
This March, the World Health Organisation (WHO) reported that the pandemic had triggered a 25 percent rise in anxiety and depression worldwide. Its World Mental Health report published in June 2022 showed one billion people were living with a mental disorder in 2019, and that 15 percent of working-age adults had experienced a mental disorder. Not surprisingly, the theme for this year’s World Mental Health Day is, ‘Make mental health for all a global priority.’
Indian insurers are seeing a rise in customers being upfront about mental any illness they may be suffering from. “As we come out of the shadow of Covid-19, we are seeing more customers who have been dealing with mental health issues. They are being transparent about having taken anti-depressants or attended counselling sessions. Insurers do not see this as taboo at all, and there is no discrimination,” says Nikhil Apte, Chief Product Officer, Product Factory (Health), Royal Sundaram General Insurance.
Also read: Does your health insurance policy cover mental illnesses?
In India, regulations have evolved to treat mental and physical illnesses on par. The Mental Healthcare Act, 2017 came into force in May 2018, prompting the Insurance Regulatory and Development Authority of India (IRDAI) to direct insurance companies to comply with the provisions. The Act requires all insurers to provide insurance ‘for treatment of mental illness on the same basis as is available for treatment of physical illness.’
Most people dealing with mental health issues undergo treatment as an out-patient – in the form of counselling or medication – rather than as an in-patient where one is hospitalised (which is what’s required to avail of the medical cover). Hence, not many have been able to claim medical insurance for their mental health treatment.
“Theoretically, you can go to any hospital and get yourself treated, but very few hospitals in India offer in-patient treatment for mental illnesses. Most mental health treatment is on an out-patient basis,” says Sanjay Datta, Chief, Underwriting, Claims and Reinsurance, ICICI Lombard General Insurance.
If your policy covers OPD (out-patient department) expenses – such as doctor’s consultation fees, pharmacy bills, etc., – it will also pay for consultations with psychiatrists and psychologists. “It will be covered up to the OPD sum insured limit (which is lower, and not the overall sum insured),” adds Datta.
Due to prevalent laws and IRDAI regulations, insurers cannot discriminate against an applicant just because she is suffering from a mental illness. However, when taking a new policy the insurer may reject your application depending on the severity of your existing illness and the insurer’s underwriting practices (as is the case with any physical ailment).
Some could charge an additional premium – a loading of 10-20 percent – while issuing the policy. “Our underwriting grid determines how we treat the proposals. If an applicant is suffering from a pre-existing mental ailment, we ascertain if it’s for more than five years, whether she has had to be hospitalised, and whether the applicant is undergoing active treatment,” explains Apte.
So, if you have suffered episodes of anxiety, the insurer could impose a waiting period of 2-3 years for this pre-existing illness at the time of issuing the policy. “If you have been dealing with this issue for over five years, then a loading of 10-20 percent could come into play. If you have had to be hospitalised for the ailment, we might add a co-pay clause. However, we have not rejected any proposal only because the applicant was suffering from a mental ailment,” says Apte.
Also read: Health insurance excludes major costs in treating mental health
Since the industry has seen fewer in-patient claims, insurers have no fear of an increase in claims due to mental ailments.
“Even when hospitalisation is required, it is largely medical management and drugs, particularly in case of younger policyholders. The risk to insurers is only at the end-of-life stage, when policyholders could need treatment for Alzheimer’s or dementia, since these entail long periods of hospitalisation, which is expensive,” says Apte.
On your part, ensure that you are transparent about your health conditions – physical or mental, particularly if you are on medication. “When you file a claim, the insurer will go through the discharge summary. If your doctor has mentioned your (undisclosed) mental health condition in the discharge papers, your claim could be rejected,” says Kapil Mehta, Co-founder and CEO, SecureNow.in, an insurance broking firm.
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Copyright © e-Eighteen.com Ltd All rights resderved. Reproduction of news articles, photos, videos or any other content in whole or in part in any form or medium without express writtern permission of moneycontrol.com is prohibited.