Does Critical Illness Cover Mental Health Issues?

Posted on: Nov 13, 2024 | 3 mins | Written by: HDFC ERGO Team

Does Critical Illness Cover Mental Health Issues?

When you're thinking of buying critical illness insurance, it's very important to understand what it covers and what it doesn't. You might wonder if a mental health condition constitutes a critical illness when people are increasingly aware of the problems relating to mental health in India. Let us discuss this in some detail so that you have a clear picture of how your health insurance and critical illness insurance work in this case.

What is Critical illness insurance?

Critical illness policy gives you a financial head start upon diagnosis of a very serious medical condition. In most instances, such policies will come in handy for illnesses that may potentially have life-threatening consequences or may lead to a significant change in the way you lead your life. It may include conditions like cancer, heart attacks, strokes, or major organ transplants. These are diseases that attract high medical costs and inconvenience you from working and earning a living.

But the story is slightly different in the case of mental health. Generally, the exclusion of mental illnesses under critical illness insurance in India can be easily pointed out. This could primarily be because most critical illness insurance policies are primarily targeted to keep one safe from serious physical ailments; therefore, in most cases, mental health conditions do not fall under that category.

Why is Mental Illness Excluded?

You may wonder what is excluded from critical illness insurance policy, particularly about your mental health, since your mental well-being forms a big part of your health. How the insurance company defines "critical illness" provides the answer. These policies are concerned with conditions that can be medically defined, have significant mortality risk, or have treatments that can affect financial status.

And in many ways, it is faced with criteria; these critical and debilitating mental health conditions are met less often than cancer or heart disease. This wide range in severity and approach to treatment that these types of problems can have makes them less able to be grouped as a classical 'critical illness' by insurers. The slim chances you would ever be able to claim against your critical illness cover in the event your diagnosis was an illness about your mental well-being.

What if mental health matters to you?

Even if mental health and critical illness cover do not go hand in hand, the following becomes an option for those with specific concerns about their mental health and who would feel better knowing they're covered somehow.

1. Mental Illness Health insurance

General health insurance in India has recently started to cover mental illnesses because of prevailing regulations at par with the Mental Healthcare Act of 2017. These policies contribute a little to covering the costs involved with treatments such as therapy or medication related to mental conditions.

2. Additional Riders or Add-ons

Most health insurance policies offer additional riders or add-ons to enhance your insurance coverage, and this includes issues to do with mental well-being. It will not hurt to talk this over with your insurance provider with a view to what is available.

3. Separate mental health insurance

Several insurance companies have special plans targeting mental health care. These can include psychiatric consultations, counselling sessions, or any other related service in the stream of mental health. All these would fall under separate and unrelated critical illness insurance, not including it or giving the lump-sum payout for the matter.

What does critical illness insurance cover?

Critical illness insurance comes in to cover any economic jolt in case one is diagnosed with a serious medical condition. These are sicknesses that may negatively affect your lifestyle and need elaborate treatment, hence biting on your finances. Here are some of the illnesses which are included in the HDFC ERGO Critical illness policy:

1. Heart Attack (Myocardial Infarction)

The policy pays an amount of money when one is diagnosed with a heart attack of the specified severity to go on and help meet the many costs associated with treatment and recovery.

2. Cancer

Generally, the policy would outline the kinds and, to some extent, the severity of cancer. This cover can be most crucial as the cost of the treatment of cancer is pretty astronomical.

3. Stroke

Most forms of stroke which will result in permanent symptoms would typically be covered; however this may also have other wider implications in terms of your ability to work and/or live independently; thus protection is particularly important in such circumstances.

4. Kidney Failure

It normally requires regular dialysis, which can help in keeping up with the ongoing costs of dialysis, which are very expensive.

5. Paralysis/Multiple Sclerosis

Other conditions that can also fall under the category include multiple sclerosis and complete paralysis of your limbs. These diseases could turn one's lifestyle completely around, so some financial backing with your critical illness insurance is priceless.

6. Major Organ Transplant

Major organ transplants, which include the heart, lungs, liver, etc, are generally covered under insurance for critical illness. This is particularly important in India, where such procedures can cost a lot and are beyond the reach of most people without proper insurance.

Here are a few others covered in HDFC ERGO critical illness insurance

1. Aorta Graft Surgery (available in Gold and Platinum plans)

2. Primary (idiopathic) Pulmonary Arterial Hypertension (available in Gold and Platinum plans)

3. Benign Brain Tumor (available in Platinum plan)

4. Open Heart Replacement or Repair of Heart Valves (available in Gold and Platinum plans)

5. Alzheimer’s Disease (available in Platinum plan)

6. Parkinson’s Disease (available in Platinum plan)

7. End Stage Liver Disease (available in Platinum plan)

Conclusion

In India, if you're diagnosed with a mental illness, your critical illness insurance won't typically provide coverage. Though mental health and critical illness covers do not go hand in hand, knowing the range of physical illnesses that get covered can always help you make more informed decisions about your health insurance. So, you are fully covered and can focus on healing without worrying about adding anxiety from financial burden. Always try to go through your policies, and if unsure, take the liberty of asking your insurer to explain in detail so you are well-equipped for life.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

List of Critical Illnesses Covered in Health Insurance

Mental illness coverage by Health Insurance – All you should know

Health Insurance Will Now Cover Mental Illnesses

Can a Critical Illness Claim Get Rejected?

Which Metal Health Conditions Are Covered Under Health Insurance Policies For Senior Citizens?