Insurance cover for mental illness is still a grey area

“We will not hospitalise her for her illness, even if she kills us,” says 76-year-old Amrit Bakhshy, caregiver to his daughter Richa (46) for the last 27 years, after she was diagnosed with Schizophrenia.

Schizophrenia alters a person’s ability to think, feel and behave clearly and Pune-based Bakhshy has spent lakhs of rupees and many a sleepless night for Richa’s treatment.

“Her monthly treatment expenses mount to ₹8,000. Leading private hospitals charge up to a lakh rupees a month for hospitalisation, in extreme cases where a patient refuses to have medication or gets extremely violent,” says Bakhshy, who has played a key role in the inclusion of the health insurance provision in the Mental Healthcare Act (2017).

“If you are covered under medical insurance for physical illness, then that cover has to be expanded to include mental illnesses too,” says Bakhshy. “If you are covered for Inpatient care, it should be for both — mental and physical ailments, and the same applies for Outpatient care too.”

Implications of IRDA circular

If insurance companies include mental health in their policies, then Bakhshy can seek its benefit for Richa’s treatment only after a cool-off period of four years, as she has a “pre-existing,” illness, says a senior official from a leading insurance agency, unwilling to be named.

Insurance companies are still grappling with the Act and the subsequent circular by the Insurance Regulatory Development Authority (IRDA) which says that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.”

Companies like ICICI Lombard are not sure if they will include mental health in all their products, even though the law makes it clear that psychiatric and psychosomatic disorders cannot be excluded from insurance policies.

The regulator has not made it mandatory, believes Sanjay Datta, Chief – Underwriting and Claims, ICICI Lombard, but when questioned about the Act, he says the company is mulling including mental health in product design and that may lead to an increase of premium rates. “If mental health insurance is not included in the cover, it will be contravention of law. We have to abide by the law of the land,” states S Prakash, Chief Operations Officer, Star Health and Allied Insurance Company.

A taboo subject

But mental health is not something many are willing to be open about. Smita Gupta (36), a media professional juggling her job and treatment for infertility while grappling with depression, says, “I will never opt for a company insurance policy for seeking reimbursement for my treatment related to depression. It is too personal.”

Thirty-one year-old Kritika Kamthan, a development sector professional, got her entire thyroid cancer treatment cost reimbursed. But she needed extensive therapy to bounce back from depression. Each counselling session that lasted for less than an hour cost her ₹2,000. She stopped treatment after three sessions as it was too expensive. The hospital declared her free from cancer, but was unwilling to take responsibility for her clinical depression. The insurance did not cover the rehabilitation counselling costs.

“I was emitting heavy radioactivity after my radiation therapy. I was isolated for days, and I later became irritable. That’s when I slipped into clinical depression,” she says. Without a job and regular income, she realised that her outpatient counselling sessions would not be covered by her cancer policy. (Health insurance largely reimburses cost only if the individual is admitted in hospital.)

“There is no parity,” says Kritika. And worse, there is a “lack of sensitivity towards holistic care which should be made easily available to any patient,” she says, outlining the grey areas that remain in fixing insurance for mental health.

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