There has been a huge development in terms of Insurance for Persons with Mental Illness (PMI) since my last editorial titled, “Insurance for mental illness: Government schemes must show the way.”
Following a landmark judgment by Honorable Delhi High Court in Sikha NIschal vs National Insurance Company Limited case where the exclusion of Mental Illness was found untenable as per provisions of Mental Healthcare Act, 2017 and the company was directed to pay the full insured amount, most of the policies have now removed the mental illness exclusion clause. Furthermore, the capping has been removed but there remain inconsistencies in coverage and definition of Mental Illness across the policies and exclusion clauses. In a welcome development, most of the policies now cover prehospitalization and posthospitalization outpatient treatment of various durations. When we compare our health insurance with the available public and private health insurance schemes of the USA and UK in terms of coverage of mental illness and its treatment, we have a long way to go.
There are areas which should be clarified and gaps should be filled up so that the benefits for insurance for mental illness are at par with physical illness and reach maximum beneficiaries across the country.
Some of the areas which need further action are-
- Ayushman Bharat – While it provides comprehensive coverage it is still limited to Government Institutes
- Suicide attempts and conditions resulting out of such attempts are in exclusion clause as pointed in the letter to editor in this issue by Sarkhel
- Mental and Behavioral Disorders due to Substance Abuse are excluded in all policies except Arogya Karnataka
- Mental Retardation and Autistic Spectrum Disorders are excluded from most of the policies
- Definition of Mental Illness -While most of the policies now provide treatment cover for Depression, Anxiety and other psychiatric disorders, some go by a strict definition of Mental Illness as per MHCA, 2017 which may lead to exclusion of so called minor mental disorders
- Daycare treatment should include Repetitive Transcranial Magnetic Stimulation, Electroconvulsive Therapy, and other neuromodulatory procedures. Except Arogya Karnataka, no other policy covers the cost of these procedures
- Outpatient care and domiciliary treatment are provided in some policies like ICICI Lombard Shield and Digit Health Plus Policy.
While there is now a range of benefits available for PMI, there is still a lack of awareness in the psychiatric community as well as patients and general population. It is imperative that this information be disseminated effectively through seminars and various awareness programs.
Professional bodies should interact with the Insurance Regulatory Development Authority of India and major insurers to plug the loopholes and take legal route as Courts are highly supportive of such initiatives in backdrop of MHCA, 2017.
1. Singh OP. Insurance for mental illness: Government schemes must show the way Indian J Psychiatry. 2019;61:113–4
2. Shikha Nischal V. National Insurance Company Limited and ANRLast accessed on 2021 Oct 30 Available from: https://www.legitquest.com/case/shikha-nischal-v-national-insurance-company-limited
3. Singhai K, Sivakumar T, Angothu H, Jayarajan D. Review of individual health insurance policies for mental health conditions Ind J Priv Psychiatry. 2021;15:3–9
4. Ghosh M. Mental health insurance scenario in India: Where does India stand? Indian J Psychiatry. 2021;63:603–5
5. Sarkhel S. Mental health insurance and attempted suicide: Need for a reappraisal Indian J Psychiatry. 2021;63:624–5