JULY 9 — After many years of mental health issues being swept under the carpet by insurers in Malaysia, AIA Bhd.’s recent launching of insurance coverage for six mental health conditions has been praised by many, including the Deputy Health Minister, as a pioneering move towards the inclusion of mental illness as an insurable condition in the country.
Amidst this acclaim, praise should be tempered with a careful look at the details of what is on offer. Beyond surface level, how much do AIA’s mental health benefits provide better access to care and recovery from illness for mental health service users, and to what extent are these benefits easily utilised?
Structural differences in AIA’s mental health coverage in Malaysia and Singapore
The first thing that people should be aware of is that the structure of AIA’s mental health coverage in Malaysia is very different from what it provides in Singapore.
Across the causeway, AIA’s offered mental health benefits are part of a full-fledged critical illness insurance plan called ‘Beyond Critical Care‘.
In this plan, mental illnesses appear to be considered on par with critical illness, and once a policyholder is diagnosed, he or she is entitled to receive a lump sum pay-out, which may then be utilised either to cover medical costs or supplement loss of income while seeking treatment.
By contrast, AIA’s newly introduced mental health benefits in Malaysia do not come in the form of a standalone medical plan. Instead, they are an expansion of an existing medical “rider” plan known as “A-Plus Health“, which acts as an optional “add-on” for AIA customers looking to supplement their regular life insurance plans with medical protection.
Within the A-Plus Health rider, mental health claims are parked under a market feature called a “Health Wallet”.
The way that the “Health Wallet” works is as follows: for every insurance year that a policyholder does not make any claims from A-Plus Health for medical protection (see note 1) and additional care benefits (see note 2), a sum of money will be credited into the “Health Wallet” at year-end, with ranging amounts depending on the type of rider plan that is purchased.
According to the product brochure, there are three plans that qualify for mental health benefits, with capped “Health Wallet” amounts of RM 1,500, RM 1,700 and RM 2,000 each year, and top-ups to a total of 10 times.
This money accumulated in the “Health Wallet” can only be used to claim additional medical expenses that are not typically covered by most medical plans, such as preventive care services, health screening and vaccinations, coverage for congenital conditions, external prosthetics, recovery care for cancer, stroke and heart attacks, and death coverage.
As of last week, AIA had expanded its list of “Health Wallet” benefits to include coverage for mental health claims.
A prolonged and obstacle-ridden pathway to making mental health claims
Breaking it down, there appear to be several inherent problems with AIA’s conditions of mental health coverage in Malaysia.
First and foremost, the pathway for an A-Plus Health policyholder to make a mental illness claim is prolonged and, to all appearances, not designed to be easily utilised. Unlike Singapore’s Critical Care plan, where mental illness are counted on par with critical or dread diseases, and policyholders are entitled to a “lump sum” payout upon diagnosis, there is no such direct medical protection for mental illness under the A-Plus Health rider, which lumps mental health benefits together with other additional, “non-typical” medical expenses under its Health Wallet feature.
In Malaysia, policyholders seeking professional help for mental health problems must wait for at least one insurance year to accumulate money in their “Wallet”, which may then be “withdrawn” to pay for treatment. But again, remember that Health Wallet credits are only issuable if the policyholder succeeds in abstaining from any medical claims from A-Plus Health for the duration of the year.
In effect, this means that a policyholder would have to completely abstain from making any claims for health issues that might befall him or her during the course of a year (and be subject to a waiting period of the same duration) before he or she qualifies for these mental health benefits.
Strict capping of coverage amounts
Secondly, there is the issue of the strict capping of coverage amounts. According to the details of the A-Plus Health plan, customers are allowed to use to a limit of RM 1,500 yearly towards mental health treatment, in either private or government hospitals. Compared to Singapore, where pay-out is capped at SGD 50,000, or 20per cent of the plan’s coverage amount, for a single mental health claim, RM 1,500 seems a rather paltry figure. This is especially so, given the expensive costs of mental health treatment in private healthcare.
Notwithstanding the relatively affordable public mental health services in Malaysia, if a customer decides to seek treatment in private settings, initial consultation fees can range from RM 80-RM 235, and follow-up consultations, from RM 40-RM 105. Taking the highest figures as a proxy, the maximum number of “covered” visits would theoretically be equal to one initial consultation and 12 follow-up visits.
Although the question of how “much” therapy is enough remains elusive, there is a general consensus among mental health experts that severe and persistent mental illnesses require longer professional treatment and support. In order to see reliable and sustained improvement, especially if they are receiving treatment in outpatient settings, patients would typically require more than one therapy session per month.
Exclusion of medication costs and restricted types of mental healthcare services
Finally, there is the matter of exclusionary costs. According to A-Plus Health’s schedule of benefits, mental health claims are specifically defined as “psychiatrist consultation fees”.
This specific wording suggests that a policyholder’s entitlements to mental health benefits are limited to seeking treatment from a particular mental health professional, leaving him or her to shoulder the burden of paying for other treatment costs such as medication, or services from other mental health professionals like psychologists and counsellors.
It goes without saying that these are extremely limiting conditions. Out of the six mental health disorders covered, at least four (Obsessive Compulsive Disorder, Schizophrenia, Major Depressive Disorders, Bipolar Disorder) rank among the top 20 leading causes of disability worldwide, and are widely acknowledged to be long-term mental health conditions.
Treatment plans for these illnesses typically require long-term supervised care and management by a team of professionals, and usually involve some form of drug therapy.
Depending on severity of the illness, number and type of medications prescribed (oral or monthly injectable), the cost of purchasing these drugs can range from anywhere between RM 150— RM 450 per month. This is a heavy burden indeed. In the long run, a patient may end up spending more on his or her medication than consultation.
Last but not least, related to the issue of treatment plans and best practice standards, perhaps the most glaring restriction of all in AIA’s current framework is the limitation of mental health claims to psychiatric consultations, while excluding services provided by other mental health professionals such as psychologists and counsellors.
Almost all of the mental illnesses covered under AIA’s policy could be said to have links to underlying emotional or behavioural issues that result in harmful or maladaptive thoughts and behaviours.
In such cases, it makes a great difference to a patient’s recovery outcomes if treatment involves not only medication, but also psychotherapy or counselling, to help correct harmful thinking patterns, and replace them with healthy coping mechanisms.
Although psychiatrists can also perform psychotherapy, as medical doctors, their treatment may be focused more on medication and symptom management, compared to psychologists and counsellors, who are largely oriented towards using psychological methods and behavioural therapy to treat mental and emotional disorders.
Important for consumers to be aware and informed
In summary, before signing up for the A-Plus Health rider, consumers would do well to thoroughly scrutinise the details of mental health coverage on offer, and be thoroughly informed as to what they are signing up for.
Based on the analysis offered above, AIA’s provision of mental health benefits seems, at best, to be a token measure of goodwill by the company that will surely open up the market to competition from other insurers to provide better, more effective solutions for mental health coverage.
At worst, it seems to be a somewhat specious set of benefits that outwardly embodies AIA Bhd.’s message of championing parity for mental health conditions, and to “enable more Malaysians to take that first step to seek professional help”. Yet upon closer examination, a less attractive reality is revealed, one that circumvents effective protection, and does not quite do enough to “move the needle forward” and help Malaysians living with mental health conditions have equitable access to mental healthcare.
Still, all things said and done, it is true that everything needs to start from somewhere. To that end, AIA Bhd’s offer of mental health benefits, while limited, is still a pioneer move. It is no doubt a first step, and one that will hopefully catalyse other insurance companies in Malaysia to begin implementing more wide-ranging and comprehensive forms of protection for mental health conditions.
1. The A-Plus Health policy defines these categories of medical protection as being in-patient and out-patient treatment, out-patient kidney dialysis and cancer treatment, day care procedure and surgery.
2. The A-Plus Health policy defines these additional care benefits as optical support, specified maternity complications, out-patient dengue fever treatment, home nursing care, and emergency medical evacuation and repatriation.
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.