Representative image of an insurance policy document.
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According to the recent RiseUP for a Better Tomorrow: Mental Health Report 2025, India has poor insurance coverage for mental health. Claims towards treatment of mental health forms less than 1 per cent of the total health insurance claims.
Many insurance companies do not offer mental healthcare benefits in their group insurance plans. The Mental Healthcare Act 2017 makes it mandatory for mental health coverage to be part of insurance plans on par with physical health.
The Insurance Regulatory and Development Authority of India’s (IRDA) 2019 guidelines have also directed insurance service providers to include mental illnesses in their plans but compliance remains patchy. Mental health is a crucial part of the overall health profile but in India, it has not received the attention it needs in terms of treatment or insurance cover.
According to the National Mental Health Survey (NMHS) 2015-16, 10.6 per cent of adults in India suffer from mental disorders, and the lifetime prevalence is about 13.7 per cent. This is considered an underestimate because mental health issues are not fully reported. The Mental Healthcare Act makes access to mental health a statutory right, but there is a large treatment gap. The survey found that 70-90 per cent of patients do not receive any treatment and that 60-70 per cent of mental healthcare costs are paid out-of-pocket. Coverage under the Ayushman Bharat Yojana is limited. Poor insurance coverage should be seen as part of the overall problems that affect mental healthcare in the country.
Some issues highlighted in the report need to be acted upon. Apart from the abysmally low volume of claims, the report shows that as many as 83 per cent of organisations report minimal claims utilisation and 42 per cent of individuals are either unaware of mental health coverage or don’t have access to it. It also notes that only 17 per cent of insured individuals have access to outpatient therapy and counselling. Outpatient treatment is a critical component of mental healthcare but most policies cover only hospitalisation, and outpatient expenses for medication and therapy are out of their scope.
Policies need to be redesigned to expand their coverage. Nearly 50 per cent of the respondents noted that the treatment costs are high. This should have prompted patients to go in for insurance plans – many are not aware of the option. There are also complaints about long waiting periods for payouts. Another constraint is the social stigma around mental illness which prevents many from seeking insurance cover. The government, the IRDA, and the insurance companies should make targeted interventions to resolve these issues.