Denied coverage due to mental health condition? Preserve

Underwriting standards vary, so another insurer may well accept your proposal

Even as the Insurance Regulatory and Development Authority of India (Irdal) has been issuing directives to insurers urging them to improve the coverage of mental ailments, much needs to be done in this regard.Recently, the regulator took another step by constituting a committee that will come up with recommendations regarding how the coverage of mental aliments can be enhanced.

Inclusions and exclusions

The Mental Health Care Act of 2017 defines mental illness as a disorder in an individual mood, cognition, memory, or perception that hampers judgment behavior or decision making.

According to IRDAI regulations, insurers must treat mental aliments on a per with physical ailments and cover them similarly.

In the case of patients who don’t have any pre-existing mental ailment, most common conditions are usually covered by their health insurance policies. ”Conditions such as anxiety, depression and psychosomatic disorders are covered by insurance based on underwriting evaluation.

A few conditions are excluded, “Mental retardation and conditions arising from the abuse of drugs or alcohol are not covered. Earlier, many insurers would straightaway reject patient’s sufferings from conditions such as depression or anxiety, “Now, many insurers offer their health insurance policies to people who already suffer from a mental health condition. However they have to serve a waiting period for that condition.  However, they have to serve a waiting period for that condition. During those two-four years when they are servings the waiting period, they are at least covered for any other aliment they may suffer.

Patients who have a serve condition may, however, find it difficult to get coverage. “Similar to other major illness, health insurance coverage for major psychoses, which tend to require recurrent hospitalizations, are evaluated on a case to case basis. Corporate plans usually cover pre-existing disease , both physical and mental, from day One.”

Lacuna in Coverage

Most health insurance policies today only cover the cost of hospitalization, and that too for more than 24 hours. “ In the case of mental ailments, however, most of the expense is incurred on the recurring therapy sessions that happen on an outpatient department (OPD) basis, and on purchasing the medicines prescribed by the doctor. Since most policies only cover inpatients costs, mental health treatment may njot get covered by most health insurance policies today.

What should you do?

Whether you are trying to cover physical oe mental ailments, the first step is buy adequate health insurance.” People living in a metro should have to 10 lakh worth of health insurance per family member. Those living in tier II or III cities may manage with 5 lakh cover

If you can afford the cost, then avoid policies with co-payments and sub-limit. Those who already have mental ailments must choose a policy with a shorter-waiting period.

Check the policy conditions carefully at the time of purchase o avoid unpleasant surprises later. “Be sure to choose a product which provides cover for mental illness.’

Singhal suggest buying a health insurance plan with an adequate OPD component. In this, the cost of therapy sessions, doctor’s consultation fee, and medication are taken care of. Underwriting standards vary from one insurer to another. Some insurers have more stringent standards that may lead to the exclusion of more people having mental aliments.

Those having pre-existing conditions should not get disheartened if they get turned down by one insurer.  Another insurer may well offer them coverage.

Finally, while purchasing the policy, disclose any health condition that you have with complete honesty, to avoid claim rejection later.

TIPS FOR GETTING MENTAL HEALTH COVERAGE

Buy policy with adequate OPD coverage so that you don’t have to apy for outpatient treatment of mental ailments from your own pocket.

If you already have a mental ailment, go for a policy with a shorter waiting period.

If you have a pre-existing condition and one insurer turns you down, try another.

Check policy wordings: avoid a policy that doesn’t cover mental ailments.

For More Details: Pooja Manoj Gupta, visit www.giia26.com
Email: pmgiia26.com Mobile 8882286639