Updated on - 14 May 2026
Are you wondering, ‘Are mental disorders covered by insurance in India?’ In 2019, a major move that could boost health insurance reliability and penetration in India, the Insurance Regulatory and Development Authority of India (IRDAI) said that mental illness, genetic disorders, and menopause cannot be excluded from insurance coverage. This blog discusses this news in detail.
Key IRDAI Guidelines on Standardisation of Exclusions
As part of an exposure draft on the standardisation of exclusions in a health insurance policy, IRDAI said that any ailment contracted after the policy is taken must be covered.
Also, health insurance plans that don’t comply with these regulations must be withdrawn. It must be noted that by law, it’s mandatory for health insurers to offer coverage to people suffering from mental illness. However, insurers were pretty selective in providing such covers. But now, following IRDAI’s diktat, treatment of mental disorders, stress, neurodegenerative and psychological disorders will have to be covered.
Additionally, the use of prescribed drugs or antidepressants would be covered by health insurance. At the same time, failure to follow medical advice or treatment can’t be used as a clause to deny insurance. The insurance regulator also said that, in the case of artificial life maintenance, expenses incurred up to the date of confirmation by the treating doctor that the patient is in a vegetative state would also be covered. Also, expenses incurred on robotic surgeries and oral chemotherapy will be covered.
The waiting period for lifestyle conditions such as hypertension, diabetes, and cardiac ailments is capped at 90 days under IRDAI’s standardisation guidelines.
What Is the Waiting Period for Mental & Genetic Disorders in Health Insurance?
According to IRDAI criteria, pre-existing diseases, such as lifestyle, mental, and genetic disorders, are subject to a waiting period of up to 36 months. There isn't a distinct set waiting period for mental or genetic issues; however, insurers may offer reduced waiting periods (which could be 12 or 24 months). Subject to the terms of the policy, these ailments are usually covered after the initial waiting period if they appear after the policy is purchased.
What Are the Common Exclusions Still Applicable in Health Insurance?
It must be noted that some of the diseases, including HIV/AIDS, Alzheimer’s disease, Parkinson’s disease, hepatitis B, and chronic liver and kidney disorders, are permanently excluded from coverage. Cosmetic and non-essential treatments, regular dental and vision care, and medical expenses resulting from self-inflicted injuries or substance abuse are other common exclusions. Insurers often also do not include experimental treatments, unless specifically covered.
This is an indicative list. Please read the policy wordings for the complete list of inclusions/exclusions.
Conclusion
The move by the IRDAI strengthens your protection by ensuring mental and genetic disorders are no longer excluded from coverage. If you want the best health insurance, examine the policy wording, including waiting periods and exclusions carefully to understand how much it actually benefits you.
FAQs
1. Are mental health conditions now covered under all health insurance plans?
Yes. These conditions are now covered by IRDAI's mandate.
2. How does waiting period affect coverage for these conditions?
There might be a waiting period of up to 3 years with PED. If you're diagnosed after purchasing the policy, your coverage often begins after the initial waiting period.
3. Does critical illness insurance cover mental or genetic disorders?
Most critical illness insurance plans cover only specified severe conditions, so coverage for mental or genetic disorders is usually limited unless explicitly listed.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the topic featured in the article. It is advised to verify the currency and relevance of the data and information before taking any major steps. Please read the sales brochure/policy wordings carefully for detailed information about on risk factors, terms, conditions and exclusions. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.