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Business Standard
27-05-2025
- Health
- Business Standard
Is your health policy Covid-ready? Key features you must look for
Check if your health insurance covers home care, tele-consultations, PPE kits, room rent waiver and has sufficient sum insured to deal with Covid-related hospitalisation costs Sanjeev Sinha Listen to This Article With Covid-19 cases in India crossing 1,000, policyholders must assess whether their health insurance policies offer adequate coverage and possess the features required to deal with this threat. Gaps uncovered The limitations of many retail health policies were exposed during the first and second waves. 'These included sub-limits on room rent, and exclusion of non-payable items like PPE (personal protective equipment) kits,' says Bhaskar Nerurkar, head – health administration team, Bajaj Allianz General Insurance. The rigid definition of hospitalisation was another impediment. 'Domiciliary treatment was not commonly covered across plans at the time,' says Siddharth Singhal, head of health insurance,
Economic Times
19-05-2025
- Health
- Economic Times
Mental health insurance problems continue: 5 things to check before buying a cover
Getty Images All general and standalone health insurers do abide by the Mental Healthcare Act, 2017, and include mental illnesses in their health plans There has been a 30-50% rise in mental health-related claims in the past 2-3 years, claims a recent study by Policybazaar (see graphic). 'We've also seen a 41% year-on-year growth in mental health insurance searches in 2025,' says Siddharth Singhal, Head of Health Insurance, Policybazaar. The surge is corroborated by Bhaskar Nerurkar, Head, Health Administration Team, Bajaj Allianz General Insurance: 'We've seen a steady increase in mental health related claims, with a CAGR of about 33% from 2021-22 to 2024-25. In the last year alone, there was a 23% rise in such claims over the previous year.' These figures seem reassuring in the face of grim societal stigma and the fact that 10.6% of adults in India suffer from mental disorders and the lifetime prevalence of mental disorders is 13.7%, as per the National Mental Health Survey 2015-16 by Anuradha Sriram, Chief Actuarial Officer, Aditya Birla Health Insurance, strikes a discordant note. 'While awareness and conversation around mental health have increased in recent years, we have not observed a significant rise in mental health related hospitalisation claims,' she says. This is because most treatments for mental health continue to be outpatient-based, which are generally not captured in the scope of hospitalisation plans, she explains. The in-patient focus of most plans is only one of the several problems faced by people seeking mental health covers despite the insurance regulator's proactive approach in widening the scope of coverage. Though the Mental Healthcare Act, 2017, was enforced in May 2018, Irdai was forced to issue circulars in August 2018 and then again in October 2022, requesting compliance by insurers and removal of mental illnesses from their list of exclusions. The guidelines stated that mental illnesses had to be treated at par with physical illnesses when it came to providing insurers eventually started offering mental health coverage in their plans by the end of 2022, in February 2023, Irdai was again forced to issue a circular to 'mandatorily launch and immediately offer' an 'appropriate product' and a 'specific cover' for persons with mental illnesses, disabilities and HIV/AIDS, which translated to a standardised, standalone cover.A crucial inclusion was the need to put in place a 'Board-approved underwriting policy that ensures no proposal is denied'. This meant the insurers could not refuse a cover to a person with pre-existing mental all general and standalone health insurers do abide by the Mental Healthcare Act, 2017, and include mental illnesses in their health plans. 'We offer mental health coverage as part of our health insurance plans in alignment with Irdai guidelines. The plans typically cover hospitalisation expenses arising from mental illnesses, including depression, anxiety, bipolar disorder and schizophrenia,' says Priya Deshmukh, Head, Health Product, Operations & Services, ICICI Lombard. Other insurers too cover mental illnesses under their comprehensive not OPD plans: The problem with most such covers is that these are indemnity plans that only cover hospitalisation or in-patient expenses, whereas most mental disorders require periodic doctor consultations, therapies, counselling, medication and psychiatric evaluations, which are out-patient features. Policybazaar data shows that conditions like anxiety (30-35%) and depression (25-30%) are the top reasons for claims, which are usually managed through out-patient care rather than inpatient admission. Without these features and benefits, the insurance policy may not be of much use to you. 1. Does it have a pre-existing disease waiting period? If the applicant already suffers from a mental illness, buying a plan may be a challenge, depending on the severity of the disorder. In all probability, he will have to clear the waiting period for pre-existing diseases, which is 2-3 years for most insurers, before he can be covered for the disorder. 2. Does it offer OPD benefit? Doctor consultations and medication are an integral part of mental health treatments, which can only be covered by a plan with an OPD feature. So, if OPD benefit is missing, either as a part of the base cover or as an optional feature, the plan won't be of much use to you. 3. Does it cover therapy & counselling? Even if the OPD benefit is included in the plan, not all insurers offer all the features that are crucial for mental health treatments, such as therapy, counselling and psychiatric evaluations, which can be very expensive. Make sure these are a part of the cover. 4. Is your therapist or health care centre in the network? Most insurers require the treatment to be conducted by a qualified practitioner in a recognised institute, hospital or clinic that falls in its network. If these don't fulfill the insurer requirements, you will not be able to make a claim. 5. Is your illness covered? You will need to ensure that your particular mental illness is included in the plan. The disorders usually covered by insurers include anxiety, depression, bipolar disorder, schizophrenia, PTSD and dementia. If the illness is not covered, there's no point buying the cover. Agrees Sriram: 'Our flagship products are hospitalisation-focused indemnity plans, covering in-patient treatment for mental health conditions. However, many mental health treatments, like therapy or consultations, are outpatient in nature and are not covered under the base plan.''OPD coverage is crucial even as an addon because a plan that only covers hospitalisation may not suffice for real-world needs,' says Singhal. So, either the policy buyer needs to find a plan that has an in-built OPD feature, or buy an OPD rider along with the base cover, both of which require additional expense due to higher premiums that these entail. Underwriting hurdles: For people with existing mental conditions, especially with a high degree of severity, it can be difficult to buy a plan despite Irdai specifying that insurers cannot refuse it. 'While Irdai has mandated insurers to cover mental health conditions, underwriting still applies. This means that individuals with a known history of mental illness may face medical assessments, loading on premiums, or specific exclusions,' says Deshmukh. This could mean either expensive plans, limits on coverage, or long waiting periods, usually between two and three years, and sometimes even rejection for severe disorders. Network practitioners: Since the treatment for many mental illnesses requires therapy and counselling, many people pick private therapists or clinics, which may not be in the insurer networks or empanelled. Besides, correct diagnosis and effective therapy can often mean sifting through various doctors and counsellors before finding the right one that suits the patient, and not every such practitioner may be a part of the insurer network. Standardised plans: Many general and standalone health insurance companies offer a standardised plan that provides a cover of `4-5 lakh and includes mental illnesses among other disabilities and disorders. This standardised plan is an affordable base plan with similar offerings across insurers, but is available under different names and varying premiums, which is typically low. However, since it is not a comprehensive plan and offers low coverage, it means the policyholders would need to pad it up, besides buying another cover for other illnesses as well. 'Consumers should look for comprehensive plans that include mental health as part of their base coverage and evaluate whether the insurer offers any additional riders/add-ons that support out-patient care or wellness programs,' says Nerurkar. 'It's advisable to consider whether the policy offers OPD benefits for consultations, therapy sessions, and medication. Some plans also provide wellness programs or teleconsultation services, which can be highly valuable for ongoing support. Transparency regarding waiting periods, exclusions (like illnesses related to substance abuse), and pre-existing condition disclosures is critical to ensuring seamless claims later,' he should also check whether the insurer has a strong hospital network with the required facilities. 'Ensure that the insurer's network hospitals include facilities offering psychiatric services and that these are accessible in your area,' says Deshmukh.
Time of India
19-05-2025
- Health
- Time of India
Mental health insurance problems continue: 5 things to check before buying a cover
There has been a 30-50% rise in mental health-related claims in the past 2-3 years, claims a recent study by Policybazaar (see graphic). 'We've also seen a 41% year-on-year growth in mental health insurance searches in 2025,' says Siddharth Singhal, Head of Health Insurance, Policybazaar. The surge is corroborated by Bhaskar Nerurkar, Head, Health Administration Team, Bajaj Allianz General Insurance: 'We've seen a steady increase in mental health related claims, with a CAGR of about 33% from 2021-22 to 2024-25. In the last year alone, there was a 23% rise in such claims over the previous year.' These figures seem reassuring in the face of grim societal stigma and the fact that 10.6% of adults in India suffer from mental disorders and the lifetime prevalence of mental disorders is 13.7%, as per the National Mental Health Survey 2015-16 by NIMHANS. However, Anuradha Sriram, Chief Actuarial Officer, Aditya Birla Health Insurance, strikes a discordant note. 'While awareness and conversation around mental health have increased in recent years, we have not observed a significant rise in mental health related hospitalisation claims,' she says. This is because most treatments for mental health continue to be outpatient-based, which are generally not captured in the scope of hospitalisation plans, she explains. The in-patient focus of most plans is only one of the several problems faced by people seeking mental health covers despite the insurance regulator's proactive approach in widening the scope of coverage. Live Events Irdai guidelines Though the Mental Healthcare Act, 2017, was enforced in May 2018, Irdai was forced to issue circulars in August 2018 and then again in October 2022, requesting compliance by insurers and removal of mental illnesses from their list of exclusions. The guidelines stated that mental illnesses had to be treated at par with physical illnesses when it came to providing coverage. While insurers eventually started offering mental health coverage in their plans by the end of 2022, in February 2023, Irdai was again forced to issue a circular to 'mandatorily launch and immediately offer' an 'appropriate product' and a 'specific cover' for persons with mental illnesses, disabilities and HIV/AIDS, which translated to a standardised, standalone cover. A crucial inclusion was the need to put in place a 'Board-approved underwriting policy that ensures no proposal is denied'. This meant the insurers could not refuse a cover to a person with pre-existing mental disorders. Problems in getting coverage Today, all general and standalone health insurers do abide by the Mental Healthcare Act, 2017, and include mental illnesses in their health plans. 'We offer mental health coverage as part of our health insurance plans in alignment with Irdai guidelines. The plans typically cover hospitalisation expenses arising from mental illnesses, including depression, anxiety, bipolar disorder and schizophrenia,' says Priya Deshmukh, Head, Health Product, Operations & Services, ICICI Lombard. Other insurers too cover mental illnesses under their comprehensive plans. In-patient, not OPD plans: The problem with most such covers is that these are indemnity plans that only cover hospitalisation or in-patient expenses, whereas most mental disorders require periodic doctor consultations, therapies, counselling, medication and psychiatric evaluations, which are out-patient features. Policybazaar data shows that conditions like anxiety (30-35%) and depression (25-30%) are the top reasons for claims, which are usually managed through out-patient care rather than inpatient admission. 5 questions to ask before buying a mental health plan Without these features and benefits, the insurance policy may not be of much use to you. 1. Does it have a pre-existing disease waiting period? If the applicant already suffers from a mental illness, buying a plan may be a challenge, depending on the severity of the disorder. In all probability, he will have to clear the waiting period for pre-existing diseases, which is 2-3 years for most insurers, before he can be covered for the disorder. 2. Does it offer OPD benefit? Doctor consultations and medication are an integral part of mental health treatments, which can only be covered by a plan with an OPD feature. So, if OPD benefit is missing, either as a part of the base cover or as an optional feature, the plan won't be of much use to you. 3. Does it cover therapy & counselling? Even if the OPD benefit is included in the plan, not all insurers offer all the features that are crucial for mental health treatments, such as therapy, counselling and psychiatric evaluations, which can be very expensive. Make sure these are a part of the cover. 4. Is your therapist or health care centre in the network? Most insurers require the treatment to be conducted by a qualified practitioner in a recognised institute, hospital or clinic that falls in its network. If these don't fulfill the insurer requirements, you will not be able to make a claim. 5. Is your illness covered? You will need to ensure that your particular mental illness is included in the plan. The disorders usually covered by insurers include anxiety, depression, bipolar disorder, schizophrenia, PTSD and dementia. If the illness is not covered, there's no point buying the cover. Agrees Sriram: 'Our flagship products are hospitalisation-focused indemnity plans, covering in-patient treatment for mental health conditions. However, many mental health treatments, like therapy or consultations, are outpatient in nature and are not covered under the base plan.' 'OPD coverage is crucial even as an addon because a plan that only covers hospitalisation may not suffice for real-world needs,' says Singhal. So, either the policy buyer needs to find a plan that has an in-built OPD feature, or buy an OPD rider along with the base cover, both of which require additional expense due to higher premiums that these entail. Underwriting hurdles: For people with existing mental conditions, especially with a high degree of severity, it can be difficult to buy a plan despite Irdai specifying that insurers cannot refuse it. 'While Irdai has mandated insurers to cover mental health conditions, underwriting still applies. This means that individuals with a known history of mental illness may face medical assessments, loading on premiums, or specific exclusions,' says Deshmukh. This could mean either expensive plans, limits on coverage, or long waiting periods, usually between two and three years, and sometimes even rejection for severe disorders. Network practitioners: Since the treatment for many mental illnesses requires therapy and counselling, many people pick private therapists or clinics, which may not be in the insurer networks or empanelled. Besides, correct diagnosis and effective therapy can often mean sifting through various doctors and counsellors before finding the right one that suits the patient, and not every such practitioner may be a part of the insurer network. Standardised plans: Many general and standalone health insurance companies offer a standardised plan that provides a cover of `4-5 lakh and includes mental illnesses among other disabilities and disorders. This standardised plan is an affordable base plan with similar offerings across insurers, but is available under different names and varying premiums, which is typically low. However, since it is not a comprehensive plan and offers low coverage, it means the policyholders would need to pad it up, besides buying another cover for other illnesses as well. What to look for in a plan 'Consumers should look for comprehensive plans that include mental health as part of their base coverage and evaluate whether the insurer offers any additional riders/add-ons that support out-patient care or wellness programs,' says Sriram. Agrees Nerurkar. 'It's advisable to consider whether the policy offers OPD benefits for consultations, therapy sessions, and medication. Some plans also provide wellness programs or teleconsultation services, which can be highly valuable for ongoing support. Transparency regarding waiting periods, exclusions (like illnesses related to substance abuse), and pre-existing condition disclosures is critical to ensuring seamless claims later,' he says. One should also check whether the insurer has a strong hospital network with the required facilities. 'Ensure that the insurer's network hospitals include facilities offering psychiatric services and that these are accessible in your area,' says Deshmukh.
Mint
15-05-2025
- Health
- Mint
Can you combine two health plans in a single claim? Yes–here's how
"If you're a salaried employee, chances are you have a corporate health insurance plan from your employer. You may also have a personal health policy. In the event of a high-value hospitalisation, can you combine both to maximise coverage? The answer is yes. All it takes is a few key steps. You must first settle the claim with one insurer. Get a claims settlement letter from the first insurer and submit the same to the second insurer along with bills. The documents include copies of bills already settled by the insurer and original bills of unsettled amount, hospital receipts and KYC documents. If both insurers are involved, you can use the first policy for a cashless claim up to its sum insured. Any amount not covered can be paid out of pocket and later claimed for reimbursement from the second insurer. If the cashless claim is denied by both insurers, you can still go for reimbursement. But the second insurer will only process it after the first one settles the claim. "You may be asked to submit attested copies of bills settled by the first insurer. You can request your first insurer to directly send them to the second insurer," said Bhaskar Nerurkar, head - health administration team, Bajaj Allianz General Insurance. Bengaluru-based Sharad Tulsyan faced no issues with the first insurer in cashless except that the settlement letter came 30 days after the discharge. 'The second insurer asked for too many documents, even the ones which the hospital never submitted to the first insurer," said Tulsyan. They asked for internal case papers which comprised 1,000 pages in my case. The hospital was unwilling to release it and did it only after the treating doctor instructed them to do so." If both your corporate and personal policies are from the same insurer, one can request for cashless treatment from both. "Two scenarios where the entire claim can be settled on a cashless basis are if the insurer is the same for your corporate and retail plans both. The other situation is when you have a super top-up and corporate or retail policy from the same insurer," said Nerurkar. Treatment with sub-limits Sub-limits apply in some treatments, such as maternity coverage. So, if you have exhausted the sub-limit of one policy, can further expenses be claimed up to the sub-limit of the other policy? Yes, this is possible. In some cases, even three policies can be used. For instance, if both spouses have corporate insurance and a family floater plan with maternity coverage, all three policies can be utilised up to their respective sub-limits. However, some corporate insurers may restrict dual claims if one spouse has already claimed under their employer's plan. "Couples should enquire about specific memorandum of understanding that their employers have signed with the insurance company," said Saurabh Arora, director, Sunglare Insurance Marketing. Also, don't overlook pre- and post-hospitalisation expenses.. "In my case, my wife's corporate policy took care of hospitalisation expenses while I used mine to claim for pre-and-post hospitalisation expenses. My policy covered pre-hospitalisation expenses for the entire none months. Our private plan did not have maternity cover," said Tulsyan. Also Read: Why health insurance during and after pregnancy is essential Coverage for modern treatments With medical advancements, modern treatments are increasingly common—but often subject to sub-limits. Having more than one policy can come in handy in such scenarios. Mumbai-based CA Mayank Bhupendra Gosar's relative got diagnosed with tongue cancer stage 3 in January 2025. He had two private insurance policies. One, of ₹5 lakh coverage having 50% cap on modern treatment, and the second one having ₹20 lakh cover with no cap up to the sum insured. "The first chemotherapy was covered through the ₹5 lakh policy, while the rest fell under the second insurer," he said. Notably, the second insurer scrutinised heavily for 2 months where a third-party investigator visited all earlier doctors and the hospital to verify the facts, said Gosar. Also Read: In charts | The health insurance puzzle: 83% Indians aware but only 19% covered When the second insurer rejects claim In some cases, the first insurer may have settled the claim, but the second one might still reject it. Faridabad-based Manju Sharma, 42, applied for maternity coverage from her corporate insurance policy. It had a sub-limit. The next day after delivery, she caught an infection and was put on a ventilator. Her total hospitalisation bill came in at ₹14 lakh. 'My corporate policy covered expenses up to the sum insured of ₹3 lakh cashless after which we paid from our pockets. When we reached out to the second insurer, it only cleared ₹25,000 saying the maternity hospitalisation has this sub-limit," she said. "The first insurer did agree that my case had gone beyond the maternity treatment, but the second insurer did not. We had to furnish additional documents, especially a justification letter from the treating doctor, that the treatment of infection could not be classified under maternity expenses," said Sharma. Mumbai-based Ashish Singodia faced a similar situation. His father got hospitalised for the treatment of prostate enlargement. His corporate policy took care of initial expenses up to ₹5 lakh, excluding the coverage for consumables. The remaining ₹1.9 lakh for reimbursement went to the second insurer. "The second insurer raised too many doubts. We had already submitted the discharge summary, investigation documents, doctor prescription, copies of bills and the settlement letter, but they asked for more documents, such as old reports of when the issue was diagnosed first and prescriptions of previous doctors we visited. They were trying to classify the treatment under pre-existing diseases to reject it. Two months on, the claim is still pending," he said. Also Read: Health insurance for senior citizens: No clarity on implementation of 10% premium hike cap Key things to keep in mind Which policy to choose for the cashless between the two you have? If you have a corporate and a retail policy, better to choose the corporate before retail. This is because corporate policies will have fewer restrictions and little or no waiting period. "The other significant benefit is if the claim is within the sum insured of the corporate plan, it will help you preserve the cumulative bonus of your retail health policy, which you earn for each claim-free year," said Nerurkar. 'It is also advantageous if the private plan is a family floater because this ensures that its sum unsured remains intact and available for future emergencies for other members." A policyholder must intimate the insurance company about hospitalisation within 24 hours of admission. If the second insurer comes into picture, inform it the moment you are sure that the second policy will get used. Do not wait until discharge or directly reach out for reimbursement without informing them beforehand. Make sure to collect the settlement letter from the first insurer. Some insurers give it to you on the discharge day itself but others might take a month long time. When filing with the second insurer, make sure the claim form clearly states that it's a partial claim. "The form should have details of the total hospitalisation bill with a highlight that x amount of it has been cleared by the first insurer," said Arora.
