June 2, 2019
Insurance companies have been directed to cover treatments for mental
illness on the same basis as is available for treatment of physical illness,
a move in line with provisions of the Mental Health Care Act.
A year after the Mental Health Care Act came into effect in
India, one of its key provisions looks set to be implemented. This is
Section 21(4) of the Act that says every medical insurer must
provide coverage for treatment of mental illness on the same basis as is
available for treatment of physical illness.
The Insurance Regulatory and Development Authority of India
(IRDAI) has taken steps in this regard directing insurers to provide
medical insurance to cover treatments for mental illness.
The IRDAI has come out with a set of draft guidelines where,
along with mental illness, 11 other illnesses related to hazardous
activities, stress/ psychological disorders, puberty and menopause-related
disorders, behavioural and neuro-developmental disorders and genetic
disorders will be removed from the exclusion list. In essence the IRDAI calls
for more coverage and fewer exclusions.
However, 17 diseases such as a condition of epilepsy, Hepatitis B,
Alzheimer’s disease, Parkinson’s disease, HIV-AIDS and loss of hearing
may be permanently excluded.
Welcoming the announcement,Amrit Bakshy, founder of the
Schizophrenia Awareness Association in Pune, says the IRDAI
has taken the lead where many state governments have failed.
The IRDAI is more active in implementing the provisions of MHCA 2017, than
our state governments, which have hardly done anything in this regard.
States have still to form Mental Health Recovery Boards, have no mechanism
in place for registration of mental health establishments, are yet to set
minimum standards or outlets for sale of generic medicines, and have made
no arrangements for supply of free essential drugs. – Amrit Bakshy,
President, Schizophrenia Awareness Association
The IRDAI, on the other hand, as he points out, issued a notification
removing mental illness from the list of exclusion category last year itself
and has now issued guidelines to draw health insurance covers which include
inter alia mental illnesses. It has also reduced the exclusion period for
existing illnesses from four years to two years which will help people living
with mental illnesses.
It would be unfair to expect more from insurance companies given that they
are commercial entities as Bakshy points out. “As insurance companies draw
health insurance policies covering mental illnesses at par with other
illnesses, with no discriminatory clauses, stakeholders should be happy. The
Act provides for parity only and it is wrong to expect insurance companies to
extend benefits which do not flow from the Act”.
According to the National Mental Health Survey done by the
National Institute of Mental Health and Neurosciences
(NIMHANS) in 2016, there are nearly 150 million people
in India needing mental healthcare services.
Legally, insurance companies were required to provide covers to people with
mental illnesses, however they were selective in offering such covers. Now,
the IRDAI has said the treatment of mental illness, stress or psychological
disorders and neurodegenerative disorders will have to be covered. Use of
drugs/anti-depressants prescribed by a medical practitioner would also be
part of the coverage. Failure to seek or follow medical advice or failure to
follow treatment cannot be used as grounds to deny medical insurance.
With the IRDAI move, chances are that insurance companies will launch
specialised products to cover mental health, which is a good move. However,
there are some concerns about premiums going up, which experts say are
misguided.
“If insurance premiums go up, they will do so for everyone”, says
Dr Soumitra Pathare, Director, Centre for Mental
Health Law and Policy, who helped draft India’s new mental health
law and was a member of the Policy Group appointed by the government of India
to draft a new national mental health policy.
“There is a lot of misinformation and people are reading it to understand
that premium will go up for mental health patients alone. It will go up for
everyone, that’s the idea of inclusion, that it will cover everyone”,
adds Dr Pathare.
The question is implementation although history has shown that when the IRDA
has come out with guidelines, companies tend to implement them. In this case,
the IRDAI has said that all existing health insurance products that are not
in compliance with these rules have to be withdrawn by 1 April 2020.
Source: https://newzhook.com/story/22418
