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Mental Illness to be Included in Health Insurance Coverage

One of the most underestimated illnesses in society is mental illness. Despite the advances we have made in technology and science, as well as the fact that mainstream social media should have raised awareness already, most people still consider it as a theory, more than established disease that has been the root cause of many deaths, especially suicides.

This is reflected in most health insurance plans, as they are usually associated with strictly only physical ailments, like the malfunctioning of any organs in the body, as well as the hospitalization that usually follows for this kind of treatment. However, it seems all the attempts at spreading awareness have not been in vain, as even mental illness is going to be covered under insurance policies, and the costs needed during treatment are going to get reimbursed.

The Mental Healthcare Act of 2017, which was effectuated in May of this year, states that every insurer will make provisions in medical insurance regarding the treatment of mental illness on a similar basis as is available for physical illnesses treatments.

Because of this, the insurance regulator served a circular asking all insurers to follow this provision of the Mental Healthcare Act immediately. This means that the mental health benefits can’t have more restrictive requirements compared to those that apply to physical health.

Definition of Mental Illness in the Act

For the insurers, the definition of mental illness depends on the definition as stated in the Mental Healthcare Act of 2017.

The Mental Healthcare Act states that mental illness is defined as a substantial disorder of thinking, perception, mood, memory or orientation that extremely hinders behavior, judgment, ability to meet the ordinary demands of life or capacity to recognize reality, mental conditions connected to the abuse of drugs and alcohol, but will not include mental retardation which is a condition of incomplete or complete development of a person’s mind, specially noted in the sub normality of intelligence.

Two important things are apparent from the definition. One is that it clearly won’t include mental retardation. However, it does include mental conditions that are associated with drug and alcohol abuse. But insurers are able to exclude the latter, if they wish. According to Vaidyanathan Ramani, the Head of Product and Innovation at Policybazaar.com, the traditional exclusions in physical illness like a full day of hospitalization required, or an outcome caused by alcohol might be excluded from mental illness too.

It is possible that there are certain waiting periods for some of the illnesses. Interestingly, it remains to be seen just how the mental illness will get covered under the pre-existing ailments clause.

For now, most policy documents and brochures will exclude mental illness. According to experts, it will state that treatment of any psychiatric or mental condition including but not limited to mental or nervous breakdown, insanity, dementia, depression, and Alzheimer’s disease.

Mental Illnesses Commonly Known

Ramini also adds that whatever is classified as mental illness according to the World Health Organization’s ICD, also known as the International Classification of Diseases, will be considered covered. The norms here will be according to ICD-10 and 11. For example, schizophrenia and bipolar disorder are considered as mental illnesses.

Just In case of hospitalization due to mental illness, diagnosis and analysis of a person’s mental condition, as well as treatment and care and rehabilitation of the person for his mental illness, suspected or otherwise will be covered. The 24-hour mandatory hospitalization will also be a part of the healthcare process.

According to the Act, mental illness will be determined depending on the internationally or nationally accepted medical standards, which include the updated version of the International Classification of Disease by the World Health Organization.

Will this include existing plans?

The insurer’s pre-existing plans might need to be re-filed with the regulator, and it should be expected that there be a price revision as well. According to Ramani, the insurers are to begin covering mental illness starting on the day the regulation was issued, which was last Aug 16. Also, the mental illness is going to be covered in the existing plans to the extent that is specified by the National Mental Healthcare Act of 2017.

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