Unlike for treatments involving physical illnesses, it has been extremely difficult to get reimbursements for treatments involving mental illnesses from insurance companies in India. This is now set to change. Insurance companies have been directed to cover treatments for both, mental and physical illnesses on the same basis as per the provisions of the Mental Health Care Act section 21 (4).
The Insurance Regulatory and Development Authority of India (IRDAI) has come out with a set of draft guidelines directing insurance companies to provide medical insurance for covering treatments for mental illnesses as well. A list of eleven illnesses related to related to hazardous activities, stress/psychological disorders, puberty and menopause-related disorders, behavioural and neuro-developmental disorders and genetic disorders along with mental illness, are set to be removed from the exclusion list. However, 17 other diseases including epilepsy, Hepatitis B, Alzheimer’s disease, Parkinson’s disease, HIV-AIDS and loss of hearing may be permanently excluded.
Another major step taken by the regulating body involves reducing the exclusion period for existing diseases from the previous four years to two years thereby bringing in more people suffering from mental illnesses, under the insurance coverage. Although it announced the removal of mental illnesses from the exclusion list last year itself, it is only now that it issued guidelines for the health insurance coverage to be extended to patients with suffering from mental health problems.
As per the National Mental Health Survey carried out by the National Institute of Mental Health and Neurosciences (NIMHANS) in 2016, there are nearly 150 million people in India needing mental healthcare services.
According to the new IRDA policy, use of drugs/anti-depressants prescribed by a medical practitioner would also be part of the coverage and failure to seek or follow medical advice or failure to follow treatment cannot be used as grounds to deny medical insurance. The IRDAI has made it clear that all existing health insurance products which are not in compliance with the recently prescribed rules will have to be withdrawn by 1 April 2020. What remains to be seen is how well do IRDA's guidelines get implemented and if the patients do really benefit in substantial ways from it.
Welcoming the announcement, Vidya Shenoy, secretary general, ARDSI (Alzheimer's & Related Disorders Society of India) Mumbai Chapter, says, "There are so many mental health patients who just slip into palliative care because there is no cure as of now for various mental health disorders, including dementia for instance. And often the patients and their families go into near bankruptcy because of huge money required to spend in the treatment of mental health diseases."
