Injuries made on self intentionally or unintentionally are outside the purview of insurance
A private sector general insurer had to reject the hospitalisation claim made by the family of a 17-year Delhi resident when he slit his wrist. The insurer had ‘self-injury’ as a clear exclusion in the health insurance product. Now, with the passage of the Mental Healthcare Act, insurance companies are not allowed to discriminate against individuals with such ailments.
As per the Act, it is mandatory for insurers to offer medical insurance for mental illness treatments similar to the ones offered for treatment of physical illness. However, it has not yet been clarified as to what ailments are covered.
Insurance Regulatory and Development Authority of India (IRDAI) had said insurance companies will have to provide coverage for medications and hospitalisation under this cover.
Once the provisions of the Act are implemented, all procedures pertaining to mental health will need to be covered by health insurance. Therapy sessions, which are currently excluded from the health insurance products will need to be mandatorily covered. Each of these sessions cost about Rs 1,500-2,000 per sitting and account for a large part of the expenses in the initial stages of mental health treatment.
Globally, self-injury or suicide attempts due to a mental health ailment are excluded from insurance coverage. If this is taken as a precedent, policies in India will also exclude it. However, IRDAI has not yet brought out a list of items that will be included and those that will be excluded.
“We are awaiting clarity from IRDAI. Without getting details of what can be included, we will not be able to design products,” said a senior official of a mid-sized private general insurer.
Currently, the market has a dearth of health insurance products for mental health ailments. While hospitalisation for psychiatric treatment is covered, day-care treatments including medication for anxiety/panic attacks as well as therapies are not included in the coverage.
If hospitalisation for instances of self-harm is excluded, only a handful of serious treatments will be included. The regulator is expected to clear this issue in the next few months. This will include details related to the product structure and exclusions.
