Do health insurance plans cover the cost of mental health counselling & therapy in India?

Mental health is an essential aspect of our well-being, yet it remains one of the most neglected areas in healthcare. With nearly 150 million Indians in need of mental health services, the existing treatment gap is as high as 84%, and less than 30 million individuals actively seek treatment. These alarming statistics highlight the need for accessible mental health services, including the crucial role of mental health insurance.

Do health insurance plans cover mental health treatment costs?

While the Mental Healthcare Act of 2017 mandates that mental illnesses be treated on par with physical conditions, insurance coverage for mental health remains limited. Typically, this coverage includes in-patient hospitalization costs and, in some cases, outpatient (OPD) consultations with psychiatrists and therapy sessions. Unfortunately, OPD coverage is rare and often comes with significant limitations.

Health insurance policies provide coverage for mental illnesses like depression, anxiety, OCD, PTSD, schizophrenia, etc.Below are some conditions commonly covered under health insurance:

• Bipolar disorder
• Acute depression
• Schizophrenia
• Obsessive-compulsive disorder
• Anxiety disorders
• Hyperactivity/attention deficit disorder
• Mood disorders
• Post-traumatic stress disorder
• Psychological disorders

What mental health expenses are covered by health insurance?

Health insurance plans usually cover the following expenses for mental health treatments: 

• In-Patient hospitalisation: All health insurance plans cover hospitalization expenses for mental health treatments, including room rent, medical procedures, and associated costs.
• Pre and Post-hospitalisation expenses: Costs incurred before and after hospitalisation for mental health conditions are typically covered.
• OPD consultations, medications, and diagnostics: Some plans offer coverage for outpatient psychiatric consultations, prescribed psychiatric medications, and diagnostics under the OPD benefit or rider.
• Counselling and therapy: A few insurers cover counselling sessions with psychologists under the OPD benefit, though this is not common.

Common exclusions in mental health insurance coverage

Like all insurance policies, mental health insurance has certain exclusions. It's crucial to understand these exclusions to avoid unexpected claim denials. Common exclusions include:

• Any form of mental retardation
• Mental illness arising from drug or alcohol abuse
• Self-inflicted injury or suicide attempts
• History of recurring mental illness
• OPD treatments are often excluded unless specifically specified

OPD coverage in mental health insurance

While health insurance plans now cover in-patient hospitalisation for mental illnesses, a significant gap remains—OPD coverage. Most insurance policies do not include OPD coverage, and even when they do, it is usually minimal. This means costs for therapy sessions with counselors or medical professionals outside of a hospital setting are often not covered.

OPD cover is more crucial for treatment of mental illness as patients do not require hospitalisation in the initial stage but need consultations and counselling sessions over a period of time. Outpatient consultations with psychiatrists and counselling sessions are often the first line of treatment, especially for conditions like anxiety and depression. However, most insurance policies in India offer limited or no OPD coverage for mental health. Gradually, some insurance policies have started including the OPD components, but of a small amount - negligible to what a couple of counselling sessions may cost a patient

Health insurance plans offering mental health OPD benefits

While coverage is limited, some plans do offer OPD benefits for mental health, albeit with limitations. Here are a few examples:

• ICICI Lombard BeFit: ICICI Lombard offers an add-on called BeFit Cover, which extends coverage to various OPD-related expenses. This rider can only be availed with a base standalone health insurance policy from ICICI Lombard (HealthAdvantage/Elevate) by paying an additional premium. All benefits under the BeFit Rider can be availed only on a cashless basis through their empaneled health service provider.
  • Out-patient consultation from specialist medical practitioner (including psychiatrist)  
  • Prescribed psychiatric medicine under the pharmacy cover
  • E-counselling sessions with a psychologist to help with issues such as personal and lifestyle imbalances, stress, anxiety, pre-marital counselling, parenting, speech impairment, psychological/mental illness/psychiatric and psychosomatic disorders, etc. 

• HDFC ERGO Optima Wellbeing:  Optima Wellbeing (Add-on) is an insurance product which covers expenses for various outpatient benefits.This add-on can only be opted along with an active HDFC ERGO retail base product (e.g, HDFC ERGO optima secure). The services are provided only on a cashless basis through their network/service provider.
  • Unlimited e-consultations with specialists (including psychiatrists)
  • Unlimited e-counselling sessions with a psychologist for issues related to psychological/mental illnesses, psychiatric and psychosomatic disorders, stress, anxiety, etc.
  • Up to 20% discount on home delivery of prescription medicines
• Bajaj Allianz my health care plan: This policy covers the cost of outpatient department consultation and diagnostics, with a limit of up to 2x the policy premium. 
  • E-consultations with specialist practitioners (including psychiatrists) within the insurer’s network (maximum 15 online consultations per month)
  • In-clinic consultations with specialist practitioners on both cashless and reimbursement basis
  • E-counselling sessions with an emotional health coach/psychologist, available only on a cashless basis through the prescribed network service provider with a paid add-on

To learn more about these plans or explore other options that offer counselling/therapy coverage, talk to our IRDAI certified insurance advisors: Book a free call

How to choose a health insurance plan with mental health benefits:

When selecting a health insurance policy with mental health coverage, keep these key points in mind:

• Waiting period: Be aware of any waiting periods associated with mental health coverage and opt for policies with shorter waiting periods. Most policies have a waiting period of 24 to 48 months before you can claim expenses related to mental health.
• IPD coverage limits: Coverage limits vary by insurer, with some offering full coverage up to the sum insured, while others have sub-limits specifically for mental health treatments.
• OPD benefits: Look for policies that include OPD benefits, covering both psychiatrist and psychologist consultations.
• Provider network: Ensure that the policy includes access to qualified psychiatrists and psychologists within the insurance provider’s network.

Policies that offer broader coverage, including both OPD and IPD services, covering medication, psychotherapy, investigations, and hospitalisation expenses with shorter waiting periods and up to the sum insured, are recommended for families of persons with mental illnesses or if there is a known family history of such diseases.

Who should consider a health insurance policy with mental health cover?

Given the current stressful lifestyle and the increasing vulnerability to mental health issues, mental health insurance is relevant for everyone. However, it is particularly crucial for individuals with a family history of mental illness, those who have experienced traumatic events, or anyone prone to conditions such as depression or anxiety.

While mental health coverage is improving, it’s essential to review specific policy details, especially regarding OPD benefits and exclusions, to ensure adequate support for mental health needs.

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