Page 12 - The Insurance Times May 2025

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sured patients, face the most chal-
Mental Health Claims Account for Only 1% of Total lenges. Sources indicated that flimsy
Medical Insurance Payouts reasons are sometimes cited for deny-
ing cashless claims, exacerbating pa-
Despite a regulatory mandate from the Insurance Regulatory and Develop-
ment Authority of India (IRDAI) requiring mental health coverage, less than tient frustration.
1% of total health insurance claims in India are for mental health treat- The Commission aims to resolve these
ments, according to the Mental Health Report 2025 released by Marsh issues and improve service quality for
McLennan India and Mpower of Aditya Birla Education Trust. policyholders.
The report highlighted that 42% of survey participants were either unaware
of their mental health coverage or did not have it. "Addiction treatments Care Health Insurance
and rehabilitation centres are excluded from insurance policies, creating Faces Rs 104.7 Crore In-
further barriers to care," the report said.
come Tax Demand
Psychiatrist Dr Harish Shetty noted, "Most patients are unaware of such
coverage, and many hospitals are not clear about it." He added that insur- Religare Enterprises Ltd (REL) has dis-
closed that its subsidiary, Care Health
ance claims are often rejected for patients on psychiatric medication, cit-
Insurance, received an income tax de-
ing the example of a patient whose heart attack hospital bill was denied
mand notice of Rs 104.77 crore for as-
because he was on psychiatric drugs.
sessment years 2020-21 and 2021-22.
The report underscores a significant gap in mental health insurance aware-
ness and accessibility in India. The demand notice was issued by the
Office of the Assistant Commissioner of
Income-Tax, Central Circle 6(2),
Hospitals Intensify Pres- claim settlements. "For example, Mumbai, according to a regulatory fil-
there is always a gap between billed ing by REL. Care Health Insurance's
sure on Insurers Over amounts and reimbursed sums - with financials are consolidated with REL,
Cashless Claims families routinely receiving only 80%- and any tax liability arising will be pay-

Hospitals are stepping up pressure on 85% of the coverage. It is crucial that able by the insurance subsidiary.
insurance companies ahead of a crucial all stakeholders come together to build "Based on the advice of tax consult-
meeting convened by the West Bengal a system that is transparent, efficient ants, Care Health would be filing an
Clinical Establishment Regulatory Com- and empathetic to the patient," said appeal against the said order before an
mission to address rising complaints Rupak Barua, MD & CEO of Woodlands appropriate forum within the prescribed
over cashless claim refusals and delays. Hospital. timelines," REL said in the filing.
Hospital administrators have voiced Peerless Hospital CEO Sudipta Mitra The development comes amid in-
concerns about the widening gap be- highlighted that individual policyhold- creased scrutiny of corporate tax fil-
tween patient expectations and actual ers, who make up around 20% of in- ings, with companies increasingly con-

12 May 2025 The Insurance Times