Does Health Insurance cover Psychological disorders?

The overall well-being of a person is defined not just by his/her physical health but also mental health to a significant extent. Mental health defines a lot of our activities, our thought processes, and our decision making ability. Life becomes incredibly complicated for a person who is mentally ill as it would adversely affect his physical health as well. Previously, the topic of mental health was stigmatized, thanks to awareness campaigns on mental health, now the society is starting to take mental health seriously. 

In the bygone eras, the insurance providers did not provide coverage for mental health. After the implementation of Mental Health Act, of 2017, IRDAI has directed the inclusion of mental health in a health insurance plan and asked them to treat psychological illness similar to other physical ailments.

What are Psychological disorders?

Psychological disorders refer to mental conditions that alter our thinking and functioning. It may cause significant impacts to our daily activities like the way we talk, act, or take decisions. These psychological disorders when untreated become a serious threat to the person suffering from it and their families too. It is why treating mental conditions on time is very important.

Some of the common psychological disorders include,

• Bipolar Disorder
• Depression
• Stress/Anxiety
• Schizophrenia
• Sleep Disorders
• Dissociative Disorders
• Dementia
• Psychosis

Understanding the Coverage

• Scope: While health insurance covers psychological disorders, the specific extent of coverage may vary depending on the type of plan you have. It’s crucial to carefully review your policy documents to understand the specific inclusions and exclusions.
• Types of disorders covered: Generally, most plans cover common mental health conditions like anxiety, depression, bipolar disorder, phobias, and obsessive-compulsive disorder (OCD). However, some specific disorders or treatments might be excluded, so it’s important to check.
• Benefits covered: Coverage may include various aspects of treatment, such as:
  • Consultation fees: Inpatient and outpatient consultations with psychiatrists, psychologists, and therapists.
  • Hospitalization: Coverage for hospital stays if medically necessary for managing a severe mental health condition.
  • Medications: Coverage for prescribed medications used to treat psychological disorders.
  • Outpatient services: Services such as psychotherapy, cognitive behavioral therapy (CBT), and other evidence-based therapies.

Important Points to Remember

• Waiting period: Similar to pre-existing conditions, some health insurance plans might have a waiting period before coverage kicks in for psychological disorders. This waiting period can typically range from one to two years.
• Sub-limits and co-payments: Some plans might have sub-limits on the amount they cover for mental health treatment or require co-payments for certain services. Be sure to understand these limitations and associated costs.
• Network restrictions: Depending on your plan, you might need to seek treatment from in-network providers to avail maximum coverage benefits. Out-of-network treatment might come with higher costs.

Exploring Your Options

• Contact your insurance provider: If you have health insurance, the best way to understand your specific coverage for psychological disorders is to contact your insurance provider directly or consult your policy documents. They can clarify specific inclusions, exclusions, and any restrictions that might apply.
• Compare different plans: If you’re considering purchasing health insurance, compare different plans and their mental health coverage details before making a decision. Choose a plan that offers adequate coverage for your needs and financial situation.

Additional Considerations

• Seeking professional help: If you’re experiencing symptoms of a psychological disorder, it’s crucial to seek professional help from a qualified mental health professional. Early diagnosis and treatment can significantly improve your well-being and quality of life.
• Mental health resources: In addition to health insurance, various resources are available to support individuals with mental health concerns. These include hotlines, support groups, and online resources.

Remember

Mental health is equally important as physical health. While understanding your health insurance coverage can help you navigate treatment costs, prioritizing seeking professional help and prioritizing your well-being should always be the primary focus.