MENTAL HEALTH – A NEW HORIZON FOR THE INDIAN INSURANCE SECTOR


Based in Berlin, Aumio is rethinking children’s entertainment to help boost mental well-being. Founded in 2020, Aumio is “Disney, but with medical backing”. Children have access to a constantly growing selection of child-friendly entertainment in the form of meditations, audio games, yoga exercises, and bedtime stories. The team has already begun to partner with leading German health insurance companies, including Allianz, TK, and KKH, among others. Aumio offers tailored content for schools and more than 900 teachers are already using Aumio in the classroom. As per Jean Ochel, psychologist and founder of Aumio: “The market for digital mental health products for adults has been growing steadily for years. But there are hardly any offerings for young people. With Aumio, we have developed the first app that is specifically tailored to the needs of families. It playfully teaches children how to deal with stress, anxiety or sleep problems in their everyday lives. Aumio is the app I wish I had when I was a kid with ADHD.”1

It is interesting that let alone for children, India does not even have a similar initiative for adults, that is assumed to be prevalent in EU as a precursor to an Aumio-type initiative!

Yes, what I am referring to here is the absence of a Mental Health Security Net in India. There are two aspects to achieving Mental Health Security: accessibility and affordability. This article deals with only the latter in the context of insurance law and policy.


DEFINITIONS & THE LAW


The Mental Healthcare Act, 2017, (the “MHA”) under S. 21(4), requires the inclusion of “mental illnesses”2 for health insurance coverage.3 Further as per the IRDA all Insurers are also directed to comply with the MHA.4

Health insurance is insurance for future medical or surgical expenditure. It is a contract where an individual or group of people purchase, in advance, health coverage by paying a “premium.” Based on the type of insurance plan, the same may be on a reimbursable basis or a cashless basis. The service provider in this context refers to the clinic, hospital, physician, laboratory, or any other establishment where the health care was provided to the insured and to whom the insured is expected to pay for the same. However, at present, in India, health insurance is available only for hospitalization or inpatient care. OPD and Clinical Psychological consultations are not covered at all (with the slim exception of certain corporates that negotiate such coverage for their employees).


THE STATE OF MENTAL HEALTH CARE COVERAGE IN INDIA

Statistically, India spends 1.15% of the gross domestic product (GDP) on health, which remains one of the lowest in the world.5 High out-of-pocket costs make health services inaccessible to a significant proportion of Indian households. Among those who decided not to seek medical care for an ailment, nearly 20% of urban and 28% of rural households cited financial constraints as the limiting factor.6 56% Indians do not have a health insurance policy.7

The Indian government currently provides the: (1) Swavlamban Health Insurance Scheme: a scheme to provide affordable health insurance to persons with blindness, low vision, leprosy cured, hearing impairment, locomotor disability, mental retardation, and mental illness. This scheme is made available for persons with disabilities with an annual family income of Rs. 3 lacs or below, on declaration basis in the proposal form. (2) Pradhan Mantri Jan Arogya Yojana: a scheme provides cashless health insurance cover up to Rs. five lakh per family (no restriction of family size) per year.

Mental disorders resulting from or resulting in alcoholism, and/or drug use are not covered by any of the aforestated provisions or schemes.


CONCLUSIONS: A NEW HORIZON FOR SECTORAL EXPANSION

The IRDA needs to make OPD expenses and clinical psychological consultations part of all health insurance covers. There also needs to be coverage of mental health specifically under the aforestated government health insurance schemes. Mental disorders may involve alcoholism or drug use, may be a result thereof or the former may manifest in the latter. Some mental heath medications may lead to drug dependence and thereby a need for further addiction treatment and consultations. These at present have not been covered, nor have even been conceived either by the MHA or any of the insurance sector offerings. It is essential to provision for the aforementioned by the Indian government since the last person (along with their mental health) being the factory worker, farmer, driver in a logistics company, delivery boy for Zomato / Swiggy / Dunzo, etc. not only make up the very fabric of our economy, but also translate into road accidents, industrial discord, and low agricultural yield, and a weak rural economy.

The recent pandemic has brought out the hard cases in many sectors where the law, and often policy is found wanting, and the insurance sector is one such sector that needs urgent attention. Developments in the EU should be an example and inspiration for the IRDA and the Ministry of Health and Family Welfare to roll out mental health security in India. After all the individual makes up a family, and the family makes up the community for a country to thrive, grow, and survive tough times.


2Defined u/S. 2(1)(s) as: a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence.

3“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.”

4See IRDA Notification No. IRDA/HLT/MISC/CIR/128/08/2018 at https://www.irdai.gov.in/admincms/cms/what
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