Progressive, compassionate and just. These are the words that would come to your mind when you read the Mental Health Care Act that was passed by the Parliament of India in 2017. The intent of the law was to ensure a life of dignity to those who have mental health issues. It held a lot of promise and relief for people.
But how much of it is more than just words on paper? As far as health insurance is concerned, the sector still seems to be in an eyes-shut-tight sleep when it comes to being woken up by the Mental Health Care Act.
According to the Mental Health Care Act 2017, “Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.”
But when TNM contacted top health insurance companies in the country, it is clear that none of them have any such plans at the moment.
When this reporter tried to get details of health plans that covered mental health, a customer care executive for ICICI Lombard said that they have no such plans plans available. The answer was the same from Max Bupa Health Insurance and Star Health Insurance. The customer care executive for HDFC ERGO meanwhile was unclear on what we were asking about.
When pressed for more information, we were told that if a client is to disclose her mental illness when applying for the insurance, there are high chances that her application will be rejected. Were she to not disclose her mental health illness, she still does not stand a good chance of availing an insurance, even for covering her physical health.
A search on policy marketplaces online shows that there are no questions asked about pre-existing mental illnesses of the prospective buyers, while a list of physical ailments are provided for cover.
The customer helpline numbers of Life Insurance Corporation (LIC) India, on the other hand, were busy or unavailable across different cities. An LIC agent we contacted said, “If the client has physical illness and mental illness, she will not be covered even for her physical illness. Her application for insurance will be rejected because she is having mental health problems.”
Further, the policy document of LIC’s health plan, Jeevan Arogya, says that “mental sickness, disease or illness” will not be considered an accidental bodily injury. Clause ii of the definitions says, “Accidental Bodily Injury means physical bodily harm or injury (but does not include any mental sickness, disease or illness) which is caused by an Accident which first occurs during the Cover Period of the policy and requires inpatient treatment or surgery in a Hospital by a Physician or surgeon, as the case may be.”
However, activists tell TNM that BPL health insurance schemes provided by the government, like Rashtriya Swasthya Bima Yojana (RSBY) do cover mental illnesses. But in states like Tamil Nadu, which has its own health insurance schemes, such schemes are not applicable.
‘The market hasn’t evolved’
TNM tried to contact the executives and spokespersons of several health insurance providers to understand why mental health is not covered by them.
Sanjay Dutta, Chief Underwriting Reinsurance & Claims at ICICI Lombard, claimed that one of the reasons for this is that the market for health insurance is still focussed on inpatient care. “It basically means the market focuses on inpatients and reimbursements, wherein the companies reimburse the cost of hospitalisation,” he said.
“Most mental health treatments currently are done on an outpatient basis and the market is yet to evolve to accommodate this. However, if there are inpatient treatments for mental health problems, not too many places of expertise are currently available for treatment. When there are more such places, market too will grow to accommodate the needs. In the future companies are sure to cover mental health illnesses,” he added.
What next?
Activists however say that for insurance companies to take the law seriously, the act must specify stringent action against those who don’t comply.
“For instance, if the company does not cover mental health, that should be considered as contempt of court. The Act must have specific instructions like these when the companies fail to comply with the Act,” said Vaishnavi Jayakumar, co-founder of The Banyan in Chennai.
Further, she explained that the attitude of the system towards mental health needs to change. “There needs to be mainstreaming of mental well being. It must encompass several aspects of mental well being like emotional health, and not just mental illnesses alone. Such a change can make people take mental health problems seriously enough that mental well being is as much of a priority as sound physical health,” she said.
Vaishnavi added that it is up to the public sector to take the lead in the issue. “Only then will the private sector take the cue and take the necessary steps,” she said.