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IRDAI: Mental Illness will be Covered by Health Insurance Companies from This Month 

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Mental Health Law Insider

Akansha Upadhyay

Published on: 16 November 2022 at 18:47 IST

Despite a five-year-old law already in place to include mental health illnesses in insurance policies, many health insurers in India had not included the provisions. But a new prompt from India’s insurance regulator, IRDAI, has prompted insurers to ensure compliance this month.

The IRDAI has said that all health insurance policyholders will get coverage for mental illness from this month onward. IRDAI, or the Insurance Regulatory and Development Authority of India, has made it mandatory for insurance companies to cover mental illness in all health insurance policies.

The IRDAI has said that it has taken this decision in order to promote the concept of wellness among policyholders. IRDAI has said that “the health insurance companies have been directed to issue policies with mandatory coverage of mental illness, subject to the terms and conditions specified under the policy and circulars issued in this regard.”

In a much-needed move to promote mental health, especially after its importance cropped up amidst the COVID pandemic, the Insurance Regulatory and Development Authority (IRDAI) has directed insurance companies to cover mental illness and comply with the provisions of the MHC Act, 2017 without any deviation, on or by October 31, 2022, implying that, from November 2022 onwards, all health insurance policies must cover mental illness.

IRDAI has also said that the insurance companies have been directed to provide all policyholders with a list of hospitals that offer treatment for mental illness. The insurance companies have been asked to issue a separate brochure on mental illness.

What will be included under new policy-

IRDAI has mentioned that all health insurance policies should cover mental illness. The new guidelines will ensure that health insurance policies cover patients suffering from mental illness, who were hitherto outside the purview of health insurance coverage.

This mandatory coverage means that insurers will have to treat mental illness in the same way as physical illness in both old and new policies. This means that the insured will also be covered for hospitalisation and treatment expenses for the treatment of mental illnesses.

As far as what kinds of ailments are to be covered, the new rules will seek holistic protection of a person’s well-being through insurance, be it physical or mental. Diseases like depression, dementia, bipolar disorder, and Alzheimer’s will be covered unless some specific exceptions are mentioned in the policy.

WHO’s framework

According to the WHO, promoting mental health involves creating an environment that promotes healthy living and encourages people to adopt healthy lifestyles. It is critical to enable the environment to provide comprehensive guidelines for the effective management of mental health disorders and the promotion of mental health through national mental health policies and legal frameworks.

It also mentions that the determinants of mental health include personal qualities such as the ability to manage one’s thoughts, feelings, behaviors, and interactions with others. In addition, social, cultural, economic, political, and environmental factors play a role, as do specific psychological, personality, and genetic factors.