Are Mental Disorders a Part of Pre-Existing Diseases in Health Insurance?

Health insurance plans didn't cover medical expenses related to mental disorders for a long time in India, focusing only on physical health issues. However, there has been a significant shift in this approach in recent years, while increasing openness and awareness about mental health concerns.

This shift generally led to the introduction of the Mental Healthcare Act in 2017. Therefore, the Insurance Regulatory and Development Authority of India (IRDAI) directed all insurance companies to provide coverage for mental disorders under their health insurance plans.

However, many insurers may still not cover mental health plans widely available in their policies despite these rules.

Read more to gain better insights about mental disorder health insurance coverage.

What are the Benefits of Including Mental Disorder Coverage in Health Insurance?

Many health insurance plans now cover all the expenses related to mental disorders in such a way as it covers hospitalisation expenses for physical injuries or illnesses. Several health plans are usually structured to offer comprehensive coverage for both inpatient and outpatient treatments, usually with a substantial sum insured.

In addition, the pre and post-hospitalisation, diagnostic tests, and treatments are often included expenses under these plans.

Certain health insurance policies also extend coverage to treatments addressing issues such as memory problems, perceptual disorders, impaired decision-making, and mood disorders.

What are the Key Factors to Consider While Including Mental Health Coverage as a Pre-Existing Disease in Health Insurance?

Here are some key pointers to understand that you should keep in mind while including mental health cover as a pre-existing disease in a health insurance plan:

First Hospitalisation and Diagnosis

Some insurers generally require that the first hospitalisation and diagnosis for a mental disorder occur during the policy period for coverage to apply.

However, if a person has already been diagnosed with a mental health condition before purchasing the insurance policy, the insurer may classify it as a pre-existing condition.

In such cases, health insurance coverage for mental disorder treatment may only start after the waiting period mentioned in the policy documents is completed, or may not even be covered in specific health plans.

Coverage Limited to Hospitalisation

Health insurance plans mainly cover mental disorder expenses when you generally require hospitalization as an inpatient. This usually includes medical treatments, room rents, and other related expenses incurred during your hospital stays.

Exclusion of OPD Treatments

Outpatient department (OPD) treatments, which generally involve day-to-day consultations and also minor treatments not requiring hospitalisation, are usually not covered unless explicitly stated otherwise in the insurance documents.

Waiting Periods

Numerous health insurance plans may impose waiting periods for mental disorder coverage, usually ranging from 24 to 48 months.

In addition, the expenses related to mental disorders as a part of pre-existing diseases may not be covered, and you would be required to pay for these out-of-pocket expenses by yourself.

Mental health cover in India has improved rapidly in recent years due to the Mental Healthcare Act, 2017, and IRDAI guidelines. Health insurers are now required to include coverage for various mental disorders alongside physical conditions.

Many policies usually cover hospitalisation and some outpatient treatments, although certain exclusions and waiting periods may apply.

Therefore, it is important for you to carefully check the policy terms, coverage limits, and treatment conditions before purchasing a specific plan.