Summary of this article
Irdai mandates AYUSH coverage, but benefits remain narrower than standard hospitalization.
Insurers cap AYUSH claims, limit sessions, and mostly restrict coverage to inpatient care.
Wellness add-ons expand AYUSH options, but core-policy flexibility remains limited.
Claim disputes persist due to unclear practitioner rules and facility requirements.
The Insurance Regulatory and Development Authority of India (Irdai) has mandated that all health insurance policies cover Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) treatments.
The industry is definitely intended and moving forward in the right direction, but the benefits are still not as flexible as regular hospitalization coverage. Insurers are paying more attention to holistic or alternative treatments, and there are many health plans that now cover AYUSH treatments.
Most insurers cap the claim amount, limit the number of sessions, or allow only specific types of therapies. “Some plans cover only inpatient AYUSH treatments, not Outpatient Department (OPD), or wellness therapies. So, the actual freedom for customers stands limited, and although the insurers are expanding these benefits, the pace still remains slow and cautious to avoid misuse or manage costs,” says Sarita Joshi, head of health and life insurance, Probus.
AYUSH Add-Ons Rise, Core Coverage Still Limited
However, while insurers are expanding the scope of AYUSH and alternative therapies, it is important to note that most additions are still in the trial phase. Companies are selectively introducing these benefits based on early utilization trends. Customer interest and competitive pressure also play a part. Coverage for acupuncture, chiropractic care, or naturopathy is often provided bundled into wellness add-ons or annual health packages and not in the core policy itself.
Industry executives say that the demand among customers is rising fast, but insurers need solid claims data before offering flexible AYUSH benefits.
Most insurers cap the claim amount, limit the number of sessions, or allow only specific types of therapies. Some plans cover only inpatient AYUSH treatments, not OPD or wellness therapies. “So, the actual freedom for customers stands limited, and although the insurers are expanding these benefits, the pace still remains slow and cautious to avoid misuse or manage costs,” says Sarita Joshi, head of health and life insurance, Probus.
Most policyholders are aware that AYUSH claims have specific conditions, but many do not completely understand the exact requirements. The finer details, such as which practitioners qualify or what facility registrations are needed, are often misunderstood. “This usually leads to claim disputes, so better communication and simpler guidelines are still needed by the insurer so customers know exactly what is allowed,” says Joshi.
Insurers Move Slowly On AYUSH
Insurers are trying to keep up with the rising interest of the customers, but it’s a balancing act. There is demand for integrative care, but pricing these benefits requires enough claims data and careful actuarial modelling. At the moment, insurers are being cautious so that premiums don’t suddenly become expensive.
They’re testing these benefits through add-ons, wellness programs, and capped coverage instead of making them full-fledged features. "This helps them maintain affordability while still responding to customer demand. The industry is trying to keep premiums affordable, but sustainable pricing will take some time as utilization patterns become clearer and the industry collects more real-world data,” says Joshi.
