The Debate Around Insurance for Alternative Treatments (Ayurveda, Homoeopathy)

A Tug of War for Renu and Veena

Renu and Veena then researched coverage for alternative treatments and became familiar with the coverage of AYUSH treatments. To their surprise, AYUSH, which stands for Ayurveda, Yoga, Unani, Siddha and Homoeopathy treatments, can be covered under health insurance. The key lies in checking the details before buying a plan. Consider choosing options that cover what you want. Dig more into the coverage extent, sum insured, inclusions, exclusions, etc.

IRDAI Brings AYUSH Treatments into the Mainstream

In January 2024, the Insurance Regulatory and Development Authority of India (IRDAI) issued directions on the mandatory coverage of alternative treatments. Insurers were asked to cover AYUSH treatments in the same manner as other treatments. The move was led by the dependence and preference for these alternative treatments by many. By 1st April, 2024, these guidelines came into effect.

The IRDAI mentioned how insurers will have a board-approved policy to offer AYUSH coverage. This will include their approach towards keeping these alternative treatments on par with other treatments. This ensures that you, as a policyholder, can choose a treatment of your preference without any restrictions.

This included quality measures and procedures to add AYUSH hospitals or day care centres as their network hospitals to offer cashless benefits.

Further, IRDAI’s circular states that insurance companies will have control over standard operating procedures in these activities:

• Enrollment of network hospitals
• Adding necessary classes to their healthcare agreements
• Dealing with potential fraud and system abuses.
• Protocols for standard treatment.

On Paper vs Reality

IRDAI circulars and reforms have been aimed at helping individuals. However, people like Renu and Veena are often hesitant about whether these treatments are covered under their health insurance or not. This is commonly because of unawareness. However, insurers today are trying to bridge such gaps as much as possible.

Take a look at the things you should know about AYUSH treatment coverage when buying health insurance.

The Extent of Coverage

One of the prominent concerns for individuals is the extent of coverage for these alternative treatments in their health insurance plan. For instance, typically, for the majority of policies, inpatient treatment expenses are covered. But outpatient therapies and consultations are generally excluded. However, the extent of coverage may vary from one insurer to another. Therefore, it's best to check the coverage limit before buying a policy for yourself or your loved ones.

Tip: Consider consulting your insurer about the policy benefits, its limits, sub-limits, etc.

Policy Inclusions and Exclusions

Next comes the dilemma around policy inclusions and exclusions. See if herbal medicines are included or excluded. Consider reading the fine print of your policy to avoid any confusion or last-minute rejections.

Tip: Get in touch with the customer care/ an insurance expert for clarity on inclusions, exclusions and other terms and conditions.

Hospital Eligibility

Remember, AYUSH coverage is valid only in cases where treatments are taken at:

• Government-recognised AYUSH hospitals.
• Hospitals accredited by NABH (National Accreditation Board for Hospitals)

Tip: Avoid using non-registered or local clinics for treatments to reduce your chances of claim rejections.

Cashless Facilities

Some insurers offer cashless facilities, while others help you with reimbursement benefits mostly. So, make sure to check and compare the same.

Tip: Consider consulting the insurer to understand the claim process before buying a health plan.

Claim Process for AYUSH Treatments Being Covered

Here is what you need to know about the claim process of these AYUSH treatments.

1. Make sure you document the hospitalisation with proper summaries for discharge and bills through a recognised AYUSH hospital.
2. Typically, you can initiate claims any way you prefer: through cashless networks if the hospital is in the insurer's network or via reimbursement.
3. Also, there might be certain rules or conditions around the waiting period for pre-existing concerns or chronic diseases. This may vary from insurer to insurer.

How AYUSH Coverage Affects Premiums?

Another common concern for individuals opting for AYUSH coverage is whether it may increase their policy premiums. Well, there might not be a significant increase since it is typically viewed as an integrated advantage. However, the cost of your policy or premiums may vary depending on the extent of AYUSH coverage, along with other significant factors such as your age, medical history, occupation, lifestyle habits, etc.

AYUSH Coverage Mandate: The Relevance

The debate around alternative treatments, AYUSH, and its coverage holds significant importance. For many individuals, including elderly and rural people, AYUSH treatments have been a traditional way of healing. It is more preferred, cost-effective, and better accessible.

This means that with the mandate of AYUSH treatments, along with quality care, it can be a gentle approach to connect to the elderly and several other individuals who see these treatments as something traditional and rewarding.

Final Word

IRDAI’s mandate for AYUSH treatments has been a relief for people like Renu, Veena and many more who believe in the healing power of AYUSH. However, to make a more significant difference, there needs to be more awareness for individuals. Insurers, individuals, and AYUSH practitioners need to collaborate to make it a success.

Before buying a health insurance policy, it is better to check the coverage limit, its inclusions, exclusions, premium costs, and much more. Jio Insurance Broking allows you to do just that, seamlessly. Here, you may view different health plans, compare their benefits, coverage, and cost, and see what makes them the best health insurance option for you.