Does health insurance cover therapy in India?

The Mental Healthcare Act, 2017 established that insurers must provide for medical insurance for treatment of mental illness on the same basis as physical illness. The insurance regulator subsequently directed insurers to comply. That was a genuine advance, and it is regularly overstated.

What is generally covered

• —Inpatient psychiatric treatment, where hospital admission is medically required.
• —Associated costs during admission — room, medication, diagnostics, doctor charges.
• —Pre- and post-hospitalisation within the window your policy specifies, typically 30 and 60 days.

What is usually not covered

This is the part that affects almost everyone reading this.

• —Outpatient therapy sessions. Most indemnity health policies in India do not reimburse OPD at all, for any condition. Therapy falls into that gap, not into a mental-health exclusion.
• —Counselling without a diagnosis. Much valuable therapeutic work is not treatment of a diagnosed illness, and insurance is built around diagnosis.
• —Sessions with a psychologist rather than a psychiatrist, in many policies, since coverage is often written around registered medical practitioners.

So the common situation — weekly sessions with a psychologist for anxiety, burnout or relationship difficulty — is usually paid out of pocket, despite the legal position on parity.

Where you might find cover

1. 01Policies with a genuine OPD benefit. Increasingly available, usually at a higher premium, sometimes with a defined annual mental-health allowance.
2. 02Corporate group policies. Often broader than retail ones. Check what your employer’s plan includes rather than assuming.
3. 03Employee Assistance Programmes. Not insurance, but many large employers fund a number of free confidential sessions, and your employer is not told that you used it.
4. 04Newer mental-health riders. Some insurers now offer add-ons covering a set number of consultations.

What to ask your insurer

Ask in writing, and keep the reply. Vague verbal assurances from a call centre are worth very little at claim time.

• —Does this policy reimburse outpatient mental health consultations, and up to what annual limit?
• —Are consultations with a clinical or counselling psychologist covered, or only with a psychiatrist?
• —Is a formal diagnosis required, and does a referral have to come from a psychiatrist?
• —Is there a waiting period specific to mental illness before this benefit applies?

A word on disclosure

People sometimes ask whether claiming for mental health treatment will affect future premiums or their ability to get cover. It is a reasonable worry and I am not qualified to give you insurance advice, so I will say only this: ask the insurer directly and get the answer in writing before you claim, not after.

If cost rather than cover is the obstacle, what to do if you cannot afford therapy in India lists the free and subsidised routes.