INCLUSION OF MENTAL ILLNESS IN INSURANCE POLICIES

The hard circumstances after COVID-19 have led to change the world financially and mentally.Due to the pandemic, the lives of the individuals are full of stress and anxiety. There is a rise in the percentage of people suffering from Mental health issues. Nearly 150 million Indians are in need of mental health services, according to a survey by NIMHANS.

IRDA INTERVENTION

● Keeping the tough situation in mind, the Insurance Regulatory and Development Authority of India made it mandatory for all the Health insurance policies to include mental illnesses in abidance with the provisions of Mental Healthcare Act 2017.

● All insurance companies must confirm compliance with covering Mental Health in all products by 31 October 2022.

● All the existing policies have to be evolved for the inclusion of overall Mental wellbeing.

IMPORTANT INCLUSION

● Early this year, Irdai mandated that internal congenital diseases, genetic diseases or disorders could not be excluded in policy contracts as exclusions.

● The motive behind this specific decision was to include the newborns in the policy from day one who have genetic disorders or birth defects.

PRESENT SCENARIO IN INDIA- AYUSHMAN BHARAT

● The Indian government has launched a flagship program named Ayushman Bharat.

● Among the goals of the program were

a. Sustainable development goal

b. Universal Health Coverage

● Ayushman Bharat program comes with a two-fold approach

a. Health and wellness centers

b. Pradhan Mantri Jan Arogya Yogna (PM-JAY)

● The program is regarded as the world’s largest scheme of health insurance providing a coverage of 5 lakhs per year per family.

● Using empanelled hospitals, the program aims to cover the bottom 40% of the population in second and third levels of care for a cashless system.

● PM-JAY initiative also covers mental health disorders with a fixed procedure price of Rs1500 for the following disorders:

? Mental retardation

? Mental disorders-organic: symptomatic, schizophrenia, schizotypal, delusional disorders, neurotic disorders, stress-related disorders, behavioural syndromes and mood disorders.

SPECIAL INCLUSIONS

● A provision for the charges of Electroconvulsive therapy (ECT) and Transcranial Magnetic stimulation (TMS) per session is included which is INR 3000 and INR 1000 respectively per session.

● The tests done before ECT and TMS include the liver & kidney function tests, and thyroid function tests are conducted. Also, the venereal disease research tests, HIV tests, Vitamin tests, folate levels and lipid profile are covered under a package of INR10,000.

PRIVATE AND PUBLIC INSURANCE COMPANIES

● By the end of 2019, there was no step taken by any company to include mental health in the health insurance plans.

● It is only after the lockdown due to COVID-19, public insurance companies took steps for mental health inclusion.

● The policies that included mental health illness stated that the hospitals or the insurer will be reimbursed only in case of hospitalization.

● The permanent inclusions of the policies are parkinson disease, alzheimer disease and dementia in alzheimer disease.

● After the public companies, several private companies too included various mental health illnesses to existing policies.

LIMITATIONS OF INDIAN HEALTH INSURANCE POLICIES

● Most of the policies that include health insurance only work if hospitalization takes place.

● Only few mental health require hospitalization and rest others are visits to out patients' wards.

● The mental illness therapies go on for months and require medicines even after discharge from hospital causing a hefty payment as it is not covered in health insurance policies.

● Some mental disorders can only be diagnosed when you wait and observe the symptoms. All those visits during waiting time are not covered under any plan.

● Some require counselling, rehabilitation and psychotherapy apart from medicines which again becomes a matter of concern for the families.

● Some conditions like bipolar disorder or schizophrenia needs a lifelong treatment requiring a huge sum of money which is not covered in the policies as a capping is there for the mental illness disorders in most of the plans.

● In India, there are several court cases filed against insurance companies where they denied insurance cover for mental disorders despite being included in the plan where the insured paid the premiums on time.

Nonetheless, the Mental Health Act, 2017 was a step towards better addressing mental health disorders openly and it is something that nobody has to be ashamed of. In a country like India where the population is over 1 Billion, addressing and taking care of such issues is not an easy task. But due to COVID-19 various steps are undertaken by the Indian government for a healthy mind of its citizens.