Mental health insurance in India: Costs, coverage, and key providers
Source: Business Standard
Bollywood stars like Deepika Padukone, Shah Rukh Khan, and Manisha Koirala have shown courage by openly sharing their battles with mental health issues and their journey to seek help. Hollywood celebrities such as Justin Bieber and Selena Gomez have also joined the conversation, breaking the stigma by publicly acknowledging their need for therapy and support. Their willingness to speak up has sparked discussions on the importance of mental well-being. Yet, for many, accessing professional help from therapists, counsellors, or psychiatrists remains a costly affair.
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Mental health insurance: A financial lifeline
Mental health insurance can play a vital role in alleviating these expenses. “The Insurance Regulatory and Development Authority of India (IRDAI) guidelines from 2019 mandate mental health coverage,” said Jasmine Damkewala, Senior Partner at Circle of Counsels and Advocate-on-Record, Supreme Court of India.
According to Siddharth Singhal, Head of Health Insurance at Policybazaar.com, “Around 60-70 million Indians suffer from mental illnesses. Fortunately, awareness for mental health is rising, as is the importance of ensuring comprehensive medical coverage to support it. This can be achieved by having a comprehensive health insurance plan because all standard health policies in India offer coverage for conditions like anxiety, depression, and Post-traumatic stress disorder (PTSD).”
How does mental health insurance work?
Standard health insurance plans in India cover inpatient treatments for mental health conditions, while some offer outpatient department (OPD) coverage for therapy sessions, consultations, and prescribed medications. Plans with an in-built OPD feature extend financial support for diagnostics and doctor consultations, either physical or through telehealth services.
Leading insurers like ICICI, Magma HDI, Future Generali India Insurance, Niva Bupa, Aditya Birla, and Star Health provide outpatient mental health services as part of their coverage.
“Our insurance plans are designed to provide comprehensive coverage for a range of mental health conditions. Hospitalisation due to conditions like anxiety, stress, depression, and PTSD is covered under the policy, provided the said hospitalisation is medically necessary and prescribed by the treating medical practitioner,” Dr Santosh Puri, Senior Vice President of Health Product & Process at TATA AIG General Insurance said.
How flexible is the coverage for therapy sessions?
Mental health treatments often require ongoing therapy sessions, which can add up over time. TATA AIG MediCare Premier, for instance, offers coverage for post-hospitalisation expenses, allowing for therapy sessions if prescribed as part of the post-hospitalisation care. “We understand that mental healthcare treatments are often long-term and repetitive,” said Dr Puri, “so we try to provide flexible coverages in our products to meet these needs.”
Star Health Insurance has also addressed this need by providing unlimited teleconsultations with specialists as part of its wellness services benefit. Amitabh Jain, COO of Star Health Insurance, explained, “We offer a wide range of coverage for mental health conditions. There is no cap on the number of admissions covered for mental health treatments, provided each admission is medically necessary and requires in-hospital care.”
Beyond traditional therapy and treatment, insurers are introducing wellness programmes to support mental health. Star Health’s Mind & Body Wellness Program includes resources like psychology programming, mindful movement, breath work, and meditation, all available online to ensure easy access.
“Our wellness programmes aim to enhance mental health by providing tools that can be accessed at no additional cost,” said Jain. “We believe that addressing mental health issues through such holistic measures can have a lasting impact.”
Access to cashless treatment and tele-counselling
Magma HDI and Future Generali India Insurance offer specific mental health coverage for conditions like Severe Depression, Schizophrenia, Psychosis, and more. “Our claims process for mental illness works just like it does for any other illness,” said Amit Bhandari, Chief Technical Officer at Magma HDI. “Customers can opt for cashless treatment at any hospital of their choice, with just 48 hours’ notice. We also provide free tele-counselling services to offer support remotely.”
Future Generali India Insurance further covers mental health in multiple ways: through curative therapy (hospitalisation), outpatient treatment, and preventive therapy (counselling). Ramit Goyal, Chief Distribution Officer at Future Generali, said, “Our policies include coverage for therapy sessions and medications prescribed by a psychiatrist, ensuring a comprehensive approach to mental health treatment.”
Here is a breakdown of comprehensive health insurance plans for a 25-year-old adult located in Delhi, according to Policybazaar:
1. Care (Care Supreme + OPD Care)
Base Premium: Rs 11,546
OPD Premium: Rs 681
Total Premium: Rs 12,227
OPD Coverage: 4 general and 4 specialist consultations
What’s included:
Physical doctor consultations
Tele consultations
Consultations with specialist doctors
What’s not included:
Diagnostic tests
Pharmacy costs
2. Niva Bupa (Reassure 2.0 Bronze + Acute Best Care)
Base Premium: Rs 11,090
OPD Premium: Rs 5,161
Total Premium: Rs 16,251
OPD Coverage: Rs 10,000 (per member) with an option to increase up to Rs 20,000
What’s included:
Tele consultations
Consultations with specialist doctors
Diagnostic tests
Pharmacy costs
What’s not included:
Physical doctor consultations
3. Star Health (Super Star + OPD Care Silver)
Base Premium: Rs 8,928
OPD Premium: Rs 4,802
Total Premium: Rs 13,730
OPD Coverage: Rs 25,000 with an option to increase up to Rs 1 lakh
What’s included:
Physical doctor consultations
Tele consultations
Consultations with specialist doctors
Diagnostic tests
Pharmacy costs
4. Aditya Birla (Active Fit Plus + OPD Expenses)
Base Premium: Rs 8,869
OPD Premium: Rs 1,064
Total Premium: Rs 9,933
OPD Coverage: Unlimited consultations, routine diagnostics, pharmacy cover, physiotherapy, e-counselling, diet consultations
What’s included:
Physical doctor consultations
Tele consultations
Consultations with specialist doctors
5. ICICI (Elevate + Befit C)
Base Premium: Rs 8,641
OPD Premium: Rs 1,384
Total Premium: Rs 10,025
OPD Coverage: 4 OPD consultations, diagnostics, pharmacy cover of Rs 1,000, 6 physiotherapy sessions, e-counselling
What’s included:
Physical doctor consultations
Tele consultations
Consultations with specialist doctors
Diagnostic tests
Pharmacy costs
Demand for mental health insurance is rising
The demand for mental health insurance has surged in recent years, driven by increasing awareness and reduced stigma around seeking help. “The growing awareness around mental health has significantly reduced the stigma associated with seeking help from psychiatric counsellors,” Bhandari said. “Today, younger individuals are more proactive in seeking mental health services and looking for insurance policies that include mental wellness coverage.”
Amitabh Jain of Star Health Insurance echoed this sentiment: “Understanding the often long-term nature of mental health treatments, we have designed our policies to accommodate the ongoing needs of our customers, making mental health treatment more accessible and affordable.”
Common exclusions and limitations
Mental health coverage often comes with certain limitations, which policyholders should be aware of:
* A waiting period of 1-2 years before claims for mental health treatments are eligible.
* Caps on the number of therapy or counselling sessions, typically covering 10-15 sessions per year.
* Pre-existing mental health conditions might be subject to waiting periods of up to 36 months.
“Health insurance policies generally cover a portion of therapy or counselling sessions, though most have an annual limit on the number of sessions. This can provide substantial financial relief for short-term treatment, even if it doesn’t fully offset long-term therapy costs,” Siddharth Singhal from Policybazaar said.
