Waiting Period for Mental Health Coverage in India

The Mental Healthcare Act, 2017, and (Insurance Regulatory and Development Authority of India) IRDAI’s directives issued in 2018-2019 have made mental health coverage mandatory under health insurance in India.

These policies have made it necessary for the insurer to treat mental illness on par with physical illness. However, waiting periods still apply in most cases. Keep reading to know more.

Typical Waiting Periods for Mental Health Coverage

There is no set waiting period that applies uniformly across the board. It tends to vary based on multiple factors like insurers, policy type, and the mental health condition. Whether the patient is pre-diagnosed or treated before buying the policy plays a major role in deciding the waiting period of the mental health coverage.

Here is a general overview of the typical waiting periods for mental health coverage in India based on common practices:

• The initial waiting period for any hospitalisation claims is 30 days from the start of the policy. This includes any mental health disorder, if not pre-existing. Note that no claims except for accidents are allowed during this period.

• There is a specific waiting period for mental illnesses that are not declared as pre-existing at the time of buying the policy. In such cases, most private health insurance plans impose a 1 to 3-year waiting period.

• When a pre-existing mental illness is declared at the time of buying insurance, it is treated as any other pre-existing disease. Coverage, in such a case, starts after 2-4 years of continuous renewal.

While IRDAI has capped the waiting period at 36 months for pre-existing diseases, many older policies still have specific terms that refer to longer waiting periods, with shorter waiting period options available with higher premiums.

Please note that the exact waiting periods depend on the insurer and the policy wording. Some plans allow reducing the waiting period by paying an extra premium or through add-ons.

These waiting periods and coverage details can also change with policy renewals or IRDAI updates, so it is essential to stay informed and updated.

The Mental Healthcare Act of 2017 and the subsequent IRDAI guidelines have made mental health coverage mandatory for Indian health insurance policies. However, waiting periods still apply for most cases.

The waiting periods vary based on multiple factors, such as the type of policy, the insurer, and the time of disclosure of the mental illness. Apart from that, the waiting period can also change with any new IRDAI update.