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Mental health insurance plans: still inadequate?

The Mental Health Care Act 2017 took the first steps in bridging the way for those suffering from mental illnesses to receive coverage under health insurance schemes. Despite this first step, many are asking whether progress is being made fast enough.

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Depression is becoming an ever more common phenomenon in India, even among the young

The act made it mandatory for health insurance companies to provide insurance to mental illnesses in the same manner they would for physical illnesses. Until recently, most insurance companies failed to comply with this provision of the act. This prompted the Insurance Regulatory and Development Authority of India (IRDAI) to issue a circular directing them to do so with immediate effect.

Mental healthcare will be further monitored with the formation of the Central Mental Health Authority (CMHA). Formed a year following the Mental Health Care Act 2017 the body has been established to monitor and regulate mental healthcare outlets in India.

Currently, mental healthcare is reaching only a minute fraction of those who need it. The infrastructure is simply not in place and personnel trained as psychiatrists are in too short a supply. For those who can access mental health care, it is often an expense they simply cannot afford.

Without insurance coverage, treatment of mental health conditions can become an unmanageable expense. Bloomberg Quint gives the example of seventeen year old Akash. Akash suffers from bipolar disorder, often experiencing violent mood swings that have resulted in him occasionally having depressive episodes in which he considers taking his own life. These episodes would often result in prolonged — and expensive — hospital stays.

Akash’s family has so far spent over Rs 500,000 over the three years since his diagnosis. They say they were denied health insurance because counselling is an outpatient expense.

This example exposes a continuing issue in the provision of health insurance to those with mental illness. The provision of care is often far different from physical illness.

Mental illness is a broad term that covers a number of illnesses. Each of these may involve an entirely different approach, depending both upon the specific disease and the patients themselves. Often individuals with the same condition may require entirely different approaches for their treatment.

This has left insurers unclear about what aspects of treatment will be covered. Jyoti Punja, chief customer officer at Cigna TTK Health Insurance, said that “Insurance companies are looking at the regulator for a clear definition.”

“Insurance companies will initially remain cautious and introduce basic hospitalisation plans with adequate controls like a waiting period,” Ashish Mehrotra, managing director and chief executive officer at Max Bupa Health Insurance, told BloombergQuint.

Lack of data regarding pricing and the risk factors of mental health conditions is a major factor in this. Without this data health insurance companies are being forced to estimate costs rather than establish an average. As a result, they are opting to minimise the amount of mental health treatment they will cover.

This provides little help for sufferers of these conditions, as it is often the counselling sessions that are the most costly. While a hospital visit or stay in a hospital can often be a one off bulk expense, counselling could leave an individual making repeat payments for months, or even years. To not cover such an aspect of the treatment leaves huge sections of the medical process paid for out of pocket. The need is for India’s insurance regulators to clarify what companies should be offering in compliance with the Mental Healthcare Act – thereby giving clarity to providers and some measure of relief for patients.

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