If OPD is covered and a customer goes to a psychiatrist as an outpatient, it is treated like any other disease and the claim is paid like any other OPD.

Mental illness, also known as mental health disorders, has been ignored and avoided for long in India. However, there are significant changes coming in today, with more people being open about it than they were in the past. This shift has also reflected in the health insurance industry too.

Until recently, health insurance policies covered only physical ailments, which have now taken into consideration mental issues or ailments as well. In 2017, the Mental Healthcare Act stated that every insurer will have to make a provision for medical insurance to cover the treatment of mental illness, similar to the available treatment of physical illness. In 2018, the Insurance Regulatory and Development Authority of India (IRDAI) made it mandatory for insurance companies to include the treatment of mental illness in their offerings.

Dr. S. Prakash, Managing Director, Star Health and Allied Insurance, says, “It is unfair to discriminate and not provide coverage for mental illness, while people can get a cover for physical ailments. Falling prey to mental illness is like meeting with an accident. It can happen to anyone at any time.” In an exclusive interview with Priyadarshini Maji, he shares his views on how providing cover for mental illness is a necessity going forward. Excerpts:

Q: Mental illness has been a rising problem for the past few years, and many have been falling prey to this problem, so according to you isn’t it necessary for mental illness to be covered under an insurance policy?

As a doctor in the insurance sector, I believe that it is a necessity. It is unfair to discriminate and not provide coverage for mental illness, while people can get a cover for physical ailments.

Falling prey to mental illness is like meeting with an accident. It can happen to anyone at any time to a careful driver on the road or even while one is sitting at home watching TV. Providing cover for mental illness is a necessity going forward, and it’s heartening to see the industry (health insurers) coming forward to provide support to people without discriminating against patients having a mental illness.

Q: Mental illness first and foremost includes depression – essentially does it need hospitalization? If not, is that covered?

Most policies now cover out-patient treatment (OPDs) and we at Star Health do not distinguish between a person seeking an OPD treatment from an endocrinologist, or an orthopaedist or a psychiatrist. Discrimination should not be there for covering treatment provided for physical ailment versus mental ailment. So, if OPD is covered and a customer goes to a psychiatrist as an outpatient, it is treated like any other disease and the claim is paid like any other OPD.

Q: Additionally what are the challenges that are being faced for extending this part in the policy?

One of the main challenges lies with customers themselves. As I mentioned earlier, it is difficult for people in this country to understand and accept that they are suffering from any kind of mental ailment. Hence, only a section of those who are aware of their mental illness or have had history come forward seeking a cover. It is high time that people use health insurance to not just seek medical respite from physical ailments, but also with their mental disorders.

Q: How will the inclusion of mental ailment benefit policyholders?

The inclusion of mental ailments in health insurance policies will certainly provide a sense of relief to people. For example, earlier if a family of four sought a floater plan and one of the members was found to suffer from a small mental ailment, then the entire family was denied cover. This was a big disadvantage.

However, today, with the inclusion of mental health cover there would be no discrimination in providing coverage to that family. When insurance companies start to respect their customers, there will be a natural affinity for more people to understand, believe and trust in the concept of health insurance, and by health, I mean overall mental and physical. So, I have this strong belief that insurers must come forward and cover common diseases that are prevalent in the country, and only then will we see health insurance penetration increase across the population.

Q: So what has been Star Health’s steps in providing cover for mental illness?

Mental illness is a broad topic, and mental disorders range from anxiety or depression to schizophrenia or bipolar issues. Another factor to note about mental ailment is that while some can seek treatment through counseling, others may require medical support or even hospitalization.

A minimum of 10-15 per cent of the population may be suffering from some form of mental illness, and a majority of those require out-patient (OPDs) treatment. With this in mind, Star Health accepts proposals wherein people are declaring mental ailments, and claims are also approved to those policyholders who seek treatment for it.

If you notice in August-September of 2018, IRDAI had proposed to make it mandatory for insurers to cover mental health. However, there wasn’t much pick up from the industry then. Star Health started providing coverage since April 2019 providing need-based cover, covering the ill. In FY 2019-20, we had given the approval to close to 1060 proposals of people suffering from mental illness, and we have paid out 575 claims.