Taking Cover. Is mental illness cover worth the money?

Given the increasing psychological stress since beginning of the pandemic, and treatment for mental ailments being expensive and long-term in nature, it is necessary that each of you have a plan to handle expenses related to mental illnesses.

While all health insurance companies were mandatorily required to cover mental ailments from 1 October 2020, the experience of those suffering from mental conditions and having an insurance cover, is different. Recently, a reader wrote to us saying that public sector health insurers still have mental illnesses under exclusion list and are not offering coverage.

When we checked, we found he was right. Websites of insurers – United India Insurance Company and the New India Assurance Company, had psychiatric and psychosomatic disorders in the exclusion list.

The IRDAI’s mandate to treat mental illnesses at par with physical ailments and remove it from exclusions, has not been implemented by all insurers.

If you are concerned about mental ailments (including depression, bipolar disorder, schizophrenia, anxiety disorders, psychotic disorder and others) and related expenses, do your homework before you sign up for a health insurance policy - go through the policy document and ensure that it covers hospitalisation due to psychological disorders and mental illnesses.

One thing to note is that treatment for mental ailments in most cases is offered as OPD (Out-Patient Department) consultation. Given that most health insurance plans do not cover OPD expenses, and require minimum 24 hours hospitalisation, claims on consultation in OPD, gets rejected.

Cover for mental ailments

To see if at least the private insurers have incorporated coverage for mental ailments in their health policies, we checked a few big players. The policy document for HDFC ERGO’s my:health Suraksha specifically mentions coverage for hospitalisation expenses (it is silent on cover for OPD consultations) to treat mental ailments.

In ICICI Lombard’s Complete Health Insurance plan, mental illness in not in the exclusion list; the policy covers OPD expenses, for additional premium. In Star Health’s Medi Classic Insurance Policy, if the insured person is diagnosed with psychiatric or psychosomatic disorder for the first time and hospitalized for a minimum period of five consecutive days, then the company will pay hospitalization expenses up to the sum insured.

In Manipal Cigna Health Insurance’s ProHealth plan, there is cover for expenses on mental ailments; the policy brochure, though, does not delve into details.

If you are looking for insurance policies that give OPD covers, so that you can claim for OPD treatments and consultation for mental illness, then ICICI Lombard’s Complete Health Insurance plan and Max Bupa’s GoActive plan/Health Premia plan can be considered.

While GoActive covers OPD consultations (with cap on number of consultations), HealthPremia covers OPD treatment (with cap on claim at ₹50,000). Digit’s health insurance plans provides cover for mental illnesses. If the OPD add-on is opted for, then consultations and therapies under OPD are covered too. However, note that this cover comes with co-pay (for first two years) requirement and the maximum benefit one can avail is ₹ 5,000.

Are OPD covers worth it?

OPD covers, when offered either as in-built in the policy or sold as separate riders, are expensive as insurers are certain that the person who buys the cover is going to make claims on it, and there are limited means to cross-check the medical bills they would provide.

So, for the amount of sum insured (SI) they offer, the premium would almost be 70-75%; with section 80D benefit under the Income Tax Act, the asking price will be 50% of the benefit given.

With OPD covers, you also need to note that many a times, the claim will be settled by reimbursement and cashless benefit will not be given. You would also have to note that OPD policies mostly do not cover cosmetic treatments and expenses on vitamins and tonics unless forming part of treatment for injury or disease and expenses on inoculation or vaccination (except for post–bite treatment and for medical treatment for therapeutic reasons).

Keep some free cash with you always for medical emergencies. Even if you have health insurance with OPD cover for mental ailments, the sum insured under the OPD cover may not suffice.