Compulsory mental health cover in medical policy likely to make it more expensive


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Health insurers will have to compulsorily include mental health under the list of ailments covered by medical insurance policies. Only those policies which provide disease-specific cover, such as for diabetes, cancer among others, are exempt from this rule.

Industry officials said that the inclusion of mental health cover would make policies at least 20 percent more expensive than disease-specific policies.

“Therapy sessions are expensive in India with average cost of Rs 1,500 per sitting with a psychologist. If this is a default inclusion across health insurance policies, costs will go up,” said the head of underwriting of a private general insurance companies.

The Insurance Regulatory and Development Authority of India (IRDAI) on May 16 issued an exposure draft on the standardisation of health insurance exclusions and said that mental illnesses could not be excluded from health insurance coverage.

All existing health insurance products that are not in compliance with these rules have to be withdrawn by April 1, 2020.

With the Mental Healthcare Act being passed, offering insurance for mental ailments has been made mandatory by law. Under the Act, every insurer has to offer medical insurance for treatment of mental illness on the same lines as insurance for physical illness treatment.

However, insurers are still very selective in offering such covers. Only three insurance policies cover mental illnesses treatment and selectively offer the coverage for only cases of hospitalisation.

Now, IRDAI has said the treatment of mental illness, stress or psychological disorders and neurodegenerative disorders will have to be covered.

Among other things, the use of drugs/anti-depressants prescribed by a medical practitioner would also be a part of health insurance coverage. Similarly, failure to seek or follow medical advice or failure to follow treatment cannot be used as a clause to deny medical insurance.

Anti-depressants like Xanax and Prozac are only sold on the advice of a doctor. Extreme cases that require medical supervision also require multiple therapy sessions complemented by pills. These cases are outside the purview of the health insurance gamut.

Health insurance officials say that mental illness is a subjective matter and, hence, a limit on the amount of coverage cannot be decided. Therapists usually study the symptoms of each individual patient to diagnose if he/she has clinical depression.

IRDAI has not clarified what mental illness means. Insurers will seek clarity on this aspect and what are the exact cases of anxiety/depression that will have to be mandatorily covered under health policies.