World Mental Health Day 2022 is October 10th. The World Health Organization (WHO) says it’s an opportunity to “reignite our efforts to protect and improve mental health.” The COVID-19 pandemic has exacerbated mental health problems with a 25% increase in anxiety and depression, which are prevalent worldwide. Despite the prevalence of mental health problems, funding for this global problem remains inadequate in supply and middle-income countries, according to WHO. This blog is an attempt to analyze the Indian scenario of flawed discrimination between physical and mental well-being.
In India, the laws relating to regulation of the insurance industry fall under the Federal List and are enacted by the Parliament, so they are uniform across India. ever since Insurance Act 1938, (Amended) does not expressly recognize or prohibit coverage of psychiatric or psychological disorders or illnesses from its definition of health insurance, nevertheless insurance service providers in India do not allow hospitalization for physical illness and It continued to customize health insurance products that only covered medical expenses. From nationalizing the insurance industry to allowing private companies and foreign investors to enter the industry, laws related to insurance have evolved gradually in India. and has undergone several stages of change at each level.
Post-COVID-19 scenarios:
When the world went into lockdown due to the COVID-19 pandemic, mental health issues increased significantly. Globally, cases of anxiety and depression are on the rise.pass by Data provided by Indian Psychiatric Association, more than 40% of Indians are confirmed to be suffering from mental health problems. While some rushed to buy health insurance to meet the sudden rise in medical costs, it was equally important to make sure their insurance covered mental health issues as well.
For a long time, Indian health insurance covered only physical illness. Contrary to previous trends, some insurers now also offer mental illness coverage. This change is in line with the direction of the Insurance Regulatory and Development Authority of India. Regulators are asking providers to add mental illness to their regular health insurance coverage and to offer health insurance to purchasers who have previously taken antidepressants or opioids.
Mental Health Care Law: Law for the People
after the enactment of mental health care law, people will now have access to some services and will be eligible to seek compensation from the state if services are not available. These rights include the right to confidentiality, the right to access to medical records, the right to live in the community, protection from inhumane treatment, and rights to equality and non-discrimination as provided by law. increase. Under Article 21 of the Mental Health Act 2017, persons with mental illnesses are provided with several other protections to ensure that they receive the same treatment as those with physical illnesses. . Section 21(4) of the Act confirms that there is no discrimination in insurance coverage for patients with mental and physical illnesses.in the case of Shikha Nischal Vs National Insurance Company Limited and Anr (WP(C) 3190/2021) dated 19 April 2021, The Delhi High Court dealt with issues related to mental illness and its insurance coverage. The court held that section 212 of the Mental Health Care Act 2017 recognizes equal rights and prohibits discrimination of any kind in relation to mental illness, so insurers should treat medical illnesses on the same basis as physical illnesses. I said it should be defined.
However, the definition of mental illness has two explicit exclusions. The first excludes mental retardation and the second is the result of alcohol or drug abuse. The Mental Health Act 1987 does not provide a specific definition of mental illness and defines a mentally ill person as a person in need of treatment for mental illness other than mental retardation. Even Substance Use Disorders (SUDs) were not mentioned in previous legislation, except in Chapter III. However, the definition of mental illness in current legislation includes SUD. Following IRDAI guidelines, some insurers have begun offering mental health coverage with existing services. Insurance offered by these companies typically covers hospitalization costs due to mental illness, but outpatient services such as counseling and treatment are only reimbursed if covered by insurance. The cost of inpatient treatment for mental illness is covered by mental health insurance. If the patient was hospitalized for at least 24 hours, it would include the costs of diagnosis, treatment, medication, hotels, etc. Coverage may vary and sub-limits may apply depending on the insurance company. However, insurance companies do exclude some mental health treatments. There are reservations to cover mental illness related to drug and alcohol abuse, as well as outpatient costs that are rarely covered. Mental retardation or intellectual disability is the primary exclusion from the policy.
Types of treatment covered by insurance
The Mental Health Care Act of 2017 states that “All insurers must provide medical coverage for treatment of mental illness on the same basis as is available for treatment of physical illness.An important factor for insurance companies to consider is determining the types of treatment covered by mental health insurance. Literal interpretation of insurance for ‘s’candy baseBecause physical illness leads to hospitalization and coverage of cases requiring immediate care. The psychotherapy sessions required to treat mental health issues require several therapy sessions. Healing takes a long time. This anomaly therefore presents a challenge for medical care. One patient cannot be expected to be cured with the same treatment.The Mental Health Care Act does not directly address this in law.This allows insurance companies to profit from this legal gap. They are free to decide whether their cases should be covered They should receive treatment that is generally accepted in the field. A large number of insured persons do not receive adequate care and treatment.
Pre-existing conditions and underwriting involvement
For physical illnesses, insurance companies have estimates of premiums for a particular set of illnesses. We accept insurance premiums based on this contract. Mental illness cannot be precisely associated with any particular common illness or lifestyle. This makes underwriting difficult as it must determine the basis for charging higher premiums where necessary. The Mental Health Care Act does not provide adequate safeguards to protect those who are exposed to potential mental illness due to stress or other factors. higher risk of being exposed to Insurance companies can use this void to justify higher premiums.
attempted suicide
The Mental Health Care Act of 2017 stipulates that care and treatment must be provided to people who have attempted suicide under severe stress. The law does not stipulate whether all attempted suicide treatment should be covered by insurance companies, or whether only those diagnosed with a specific mental illness before attempting suicide should be covered.
Giving insurance companies access to medical history
All insurance companies require access to medical records to determine claims and premiums. They may require a history of procedures performed, treatments applied, diagnostic methodology, etc. for persons with mental illness. It does not prescribe what should be shared to. Section 23 of the Law provides for the right to confidentiality. However, it does not specify how much information must be shared and what information can be kept.
Implementation of the MHCA and IRDAI mandates will make mental health services more affordable and accessible and will go a long way in de-stigmatizing mental health conditions in India. With the increasing acceptance of mental health problems among young people in India, coordinated coverage of mental health problems and related disorders is enormous.OPD, counseling, treatment, cost of treatment, etc. There are certain aspects that need further guidance, but we have seen a growing awareness of this topic and it will be interesting to see how governments are addressing it. address these issues.
Views are personal.
