In recent years, mental health has come to the forefront of health conversations in India. With more people acknowledging the importance of emotional well-being, the demand for insurance that supports mental health treatment has grown. However, despite regulatory efforts, mental health insurance coverage still presents several practical challenges. If you are planning to invest in a policy, it is essential to go beyond just the premiums and understand what you are really signing up for.

This blog highlights five things you must check before purchasing a mental health insurance plan.

1. Scope of Coverage

Before signing up, be clear about what mental health conditions are covered. While the  Insurance Regulatory and Development Authority of India (IRDAI) has mandated that all health insurers cover mental illnesses, the actual scope of what’s covered can vary widely across insurers.

Look for:

  • Types of mental disorders covered (e.g., depression, anxiety, schizophrenia)
  • Inpatient vs outpatient care
  • Emergency hospitalisation due to mental health issues

Common exclusions include:

  • OPD consultations
  • Therapy or counselling sessions
  • Drug and alcohol rehabilitation

When comparing policies through health insurance online platforms, carefully read through the policy documents to understand the scope of coverage.

2. Hospital Network and Accessibility

Many health insurance policies list limited mental health facilities under their network hospitals. This can restrict your access to the right treatment at the right time.

Check:

  • Whether the insurance has tie-ups with mental health hospitals
  • Availability of specialists like psychiatrists and psychologists within the network
  • If treatment centres are located near you

A wide network ensures smoother claim processing and reduces out-of-pocket costs.

3. Waiting Periods and Pre-existing Conditions

Mental health-related claims often come with waiting periods. If you have a pre-existing mental health condition, the waiting time could be longer.

Points to verify:

  • General waiting period (typically 2-3 years for mental illnesses)
  • Specific waiting periods for pre-existing conditions
  • Documentation required to prove mental health conditions or past treatments

Remember, some insurers may reject claims based on undisclosed mental health history.

4. Claim Process and Support Services

Even with the best policy, a complicated claim process can leave you frustrated and financially strained. Mental health claims may require different documentation compared to physical health claims. The lack of standardised procedures across insurers adds to the confusion.

Ask the insurer:

  • What documents are needed for a mental health claim?
  • Is there a dedicated claim support team?
  • How long does claim settlement typically take?

Also, check whether the insurer offers additional support like

  • Counselling helplines
  • Digital health assessments
  • Cashless claim options

If you are also considering policies for your family, explore health insurance plans for parents that include mental health benefits.

5. Cost vs Benefits: Is It Worth It?

The last thing to assess is whether the policy offers value for money. Mental health treatments can be expensive, especially if they involve long-term care.

Check:

  • Annual premium vs expected cost of treatment
  • Co-payments or sub-limits for mental health
  • Add-on riders that enhance mental health coverage

Red flags:

  • Low premium but limited coverage
  • High deductibles for mental health claims
  • No mention of mental health in policy brochure

Conclusion

Choosing a mental health insurance plan requires more scrutiny than a regular policy. It is not just about hospitalisation or emergency care but about continuous support, fair claim settlements, and accessible mental health services.

Comparing health insurance online can provide clarity and access to the latest policy features. Additionally, if your focus is on family, particularly elderly care, consider health insurance plans for parents that include relevant mental health support.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.