Summary of this article
Health insurers must cover AYUSH treatments on par with allopathy
Coverage applies mainly when treatment requires hospitalisation
Treatment must be at government-recognised AYUSH hospitals
Most policies exclude OPD therapies and may impose claim sub-limits
In India, there are many health policies that now cover the Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy framework (AYUSH). In fact, the Insurance Regulatory Development Authority of India (Irdai) has mandated that insurers treat AYUSH treatments at par with allopathic treatments. However, it still comes with certain conditions. We take a look.
Hospitalisation Is Key
“However, this coverage comes with certain limitations, such as the coverage is applicable only when the treatment demands hospitalisation, and the treatment has to be taken by the policyholder in a government-recognized AYUSH hospital or center. In many cases, the insurer might also set the type and duration of treatment or even the sub-limits. Having said this, all the outpatient/routine consultations or therapies wouldn't be covered,” says Sarita Joshi, head of health and life insurance, Probus.
No Specific Treatments Mandated
So in essence, there are no specific types of AYUSH treatments that are covered under health insurance. Essentially, health insurance is a hospitalisation-based coverage, which means inpatient treatment in a hospital is required. The exception is day care procedures, but again, those are done in a hospital setting and not on an OPD basis. “The AYUSH treatment, to the extent it requires inpatient treatment, is covered under health insurance,” says Hari Radhakrishnan, expert, Insurance Brokers Association of India (IBAI).
Need To Know
Before offering any coverage, insurers generally follow the guidelines issued by Irdai and check whether the treatment centre is recognised by the Ministry of AYUSH. “The coverage is provided based on conditions such as treatment to be taken in recognised hospitals, the need for qualified practitioners, and proper medical records. This ensures that the treatment is being delivered in a regulated manner and all the standard safety/credibility factors are taken care of,” says Joshi.
Essentially, this is based on the evaluation of the case as well as the patient's preference for alternative therapy under AYUSH. “There can be AYUSH treatments that may be more effective than modern medicine. However, there is no condition that AYUSH treatment can be undertaken only if treatment under modern medicine is not available,” says Radhakrishnan.
“For patients who prefer traditional treatments, coverages such as AYUSH can help to reduce out-of-pocket expenses, especially when the treatment requires hospitalisation,” says Joshi.
However, this benefit comes with limitations since many policies exclude outpatient treatments and can impose caps on claims. While the AYUSH cover can provide additional treatment options, the actual support offered by this policy depends on its terms/conditions and the extent of coverage.
